Clinical features

The exact causes are unknown, but several risk factors have been associated with HL. Strong association with Epstein-Barr virus (EBV)

• Immunodeficiency: e.g., organ or cell transplantation, immunosuppressants, HIV infection , chemotherapy

• Autoimmune diseases (e.g., rheumatoid arthritis, sarcoidosis)

• Painless lymphadenopathy

  • Cervical lymph nodes (in ∼ 60–70% of patients) > axillary lymph nodes (in ∼ 25–35% of patients) > inguinal lymph nodes (in ∼ 8–15% of patients) [5]

  • Involvement of a single group of lymph nodes

  • Contiguous pattern of lymph node spread

  • Mediastinal mass → chest pain, dry cough, and shortness of breath

  • Splenomegaly or hepatomegaly may occur if the spleen or liver are involved.

• B symptoms [5]

  • Night sweats, weight loss > 10% in the past 6 months, fever > 38°C (100.4°F)

  • Can occur in a variety of diseases (see “Differential diagnosis of B symptoms” below)

  • In the case of confirmed HL, the presence of a single B symptom suffices for a positive diagnosis of B symptoms.

• Pel-Ebstein fever: Intermittent fever with periods of high temperature for 1–2 weeks, followed by afebrile periods for 1–2 weeks. Relatively rare but very specific for HL.

• Alcohol-induced pain: Pain in involved lymph nodes after ingestion of alcohol. Relatively rare but highly specific for HL.

• Pruritus (focal or generalized)

Staging is based on the number of affected nodes, the presence or absence of B symptoms, and whether or not the disease is present on both sides of the diaphragm.