Diagnostics

Diagnosis of HL is primarily based on medical history and clinical features (B symptoms, localization of lymph node involvement) and is confirmed with lymph node biopsy.

• Complete blood count

  • Elevated or decreased WBC count

  • Anemia

  • Eosinophilia

• Serum chemistry

  • ↑ LDH

  • Hypercalcemia: most commonly due to paraneoplastic production of 1,25-dihydroxyvitamin D

• Obligatory diagnostic step

• Lymph node excision

  • Reed-Sternberg cells (RSCs)

    • Tumor cells that are pathognomonic of HL

    • Originate from B cells

    • Large cells with binuclear/bilobed nuclei with dark centers of chromatin and pale halos, which results in an owl-eye appearance on histopathologic examination.

    • CD15/CD30-positive

  • Hodgkin cells: mononuclear, malignant B lymphocytes

  • Inflammatory background containing the following cell types in varying numbers: lymphocytes, neutrophils, eosinophils, macrophages/histiocytes, plasma cells, and fibroblasts

  • Granuloma formation

• Chest x-ray or CT-scan: detection and measurement of masses and enlarged lymph nodes in chest, abdomen, and pelvis

• Bone scintigraphy or PET-CT: performed before treatment to assess disease spread

• Non-Hodgkin lymphomas, Hodgkin lymphomas

• Other hematopoietic malignancies (e.g. CML, ALL)

• Solid tumors

• Tuberculosis

• HIV

Examining lymph nodes can yield important diagnostic clues. Generalized lymphadenopathy is usually a sign of systemic illness, such as HIV, mycobacterial infection (e.g., tuberculosis), infectious mononucleosis, systemic lupus erythematodes, or serum sickness. Signs of malignancy include rapid growth, painlessness, hardness/coarseness, and being fixed to underlying or surrounding tissue. Most often, though, there is no discernible cause or pathology.