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Hodgkin Lymphoma





Most children and adolescents with Hodgkin lymphoma are reasonably well and only present with minor symptoms. 

The most common presentation is finding a mass due to peripheral lymphadenopathy(most common site is cervical LNs).

Sometimes mediastinal adenopathy can cause a cough or shortness of breath and may potentially lead to SVCO.



Specific systemic symptoms with important prognostic significance.

Occur in roughly one third of cases with:

  • Fever > 38.0 degrees C
  • Anorexia and weight loss (>10% of baseline body weight over past 6 months)
  • Drenching night sweats

Other systemic symptoms that are not B symptoms and have no clear prognostic implications:

  • Tiredness.
  • Generalized pruritus (itching) seen in 15-25%; usually mild
  • Pel-Ebstein Fever (waxing-and-waning course over days to weeks)


HL patients may also have:

  • Cough and shortness of breath may be due to pulmonary disease.
  • Alcohol-induced pain at site of involved LNs
  • Neurological symptoms due to epidural disease tend only to be seen in very advanced cases.
  • Increased risk of infection - Herpes zoster commonly encountered.
  • Bone marrow involvement can cause tiredness due to anemia.
  • Bone involvement can cause significant bone pain.
  • Paraneoplastic syndromes associated with Hodgkin lymphoma are very rare.
  • Skin nodules can occur - very rare - usually in the setting of advanced disease



Summary of Hodgkin lymphoma symptoms:

Region of Involvement


Peripheral lymph nodes

(90% of cases)

  • Painless lymphadenopathy

Mediastinal lymph nodes

(60% of cases)


Can cause mediastinal syndrome with:

  • Dyspnea
  • Chest pain and cough
  • Dysphagia
  • Early morning facial edema
  • Superior vena cava syndrome (only present with massive mediastinal lymphadenopathy)

Systemic symptoms

(30% of cases)

  • Fever (>38oC or Pel-Ebstein)
  • Weight Loss (>10% of baseline weight over past 6 months)
  • Night sweats (drenching)
  • Anorexia and weight loss
  • Tiredness
  • Itching in 15 - 25% of patients (usually mild)


(15 - 20% of cases)

  • Dyspnea
  • Chest pain and cough

Bone Marrow

(5% of all cases)

  • Anemia
  • Pancytopenia


(2% of all cases)

  • Bone pain


(1 - 2% of all cases)

  • Nausea
  • Jaundice associated with advanced disease,

Paraneoplastic syndromes

(less than I% of cases)

  • Limbic encephalitis
  • Subacute cerebellar degeneration
  • Subacute motor neuropathy
  • Subacute necrotic myelopathy
  • Guillain-Barré syndrome


(less than 1% of cases)

  • Skin nodules and involvement rare and only seen in advanced disease.
  • Paraneoplastic skin rashes can occur - urticaria and bullous rashes.









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