Chapter 167
Hodgkin’s Disease
Epidemiology
The incidence of lymphomas has been increasing over the last 4 decades. In the United States, it is now the fifth leading cause of death in men and the seventh in woman. Hodgkin’s disease (HD) has a bimodal distribution, with the first peak in teenagers and young adults and the second peak in middle age (50 to 60 years old). This malignancy is more common in men.
Clinical Findings
HD is principally a disease involving lymph nodes, and the involvement of extranodal sites is uncommon. Patients usually present with painless neck masses. These nodes may be painful if there is rapid growth resulting in nodal necrosis. This phenomenon is present in high-grade lymphomas. Systemic symptoms such as fever and night sweats are uncommon in HD of the head and neck.
Pathology
The diagnosis of HD is based on the presence of Reed-Sternberg cells. There are four main histologic types: nodular sclerosing, mixed cellularity, lymphocytic predominant, and lymphocytic depletion.
Treatment
Treatment of HD depends on staging and grading. The most widely used system is that of the Ann Arbor classification into four stages:
