Hodgkin’s Disease
A neoplastic disorder, Hodgkin’s disease is characterized by painless, progressive enlargement of the lymph nodes, spleen, and other lymphoid tissue. This enlargement results from proliferation of lymphocytes, histiocytes, eosinophils, and Reed–Sternberg cells. The latter cells are the special histologic feature of Hodgkin’s disease.
Hodgkin’s disease occurs in all races but is slightly more common in whites. Its incidence peaks in two age–groups—between ages 15 and 38 and after age 50. It occurs most commonly in young adults except in Japan, where it occurs exclusively among people older than age 50. It has a higher incidence in males than in females. A family history of Hodgkin’s disease increases the likelihood of acquiring the disorder.
Untreated, Hodgkin’s disease follows a variable but relentlessly progressive and ultimately fatal course. However, recent advances in therapy make Hodgkin’s disease potentially curable, even in advanced stages. Appropriate treatment yields a 5–year survival rate of about 90%.
Causes
Although the cause of Hodgkin’s disease is unknown, studies have pointed to genetic, viral, or environmental factors.
Complications
Hodgkin’s disease can cause multiple organ failure.
Assessment
Most commonly, the patient’s history will reveal painless swelling of one of the cervical lymph nodes or sometimes the axillary or inguinal lymph nodes. The history may also reveal a persistent fever and night sweats. The patient may complain of weight loss despite an adequate diet, with resulting fatigue and malaise. As the disease advances, the patient may become increasingly susceptible to infection.
Inspection during the advanced stages of the disease may reveal edema of the face and neck, and jaundice.
Palpation may identify enlarged, rubbery lymph nodes in the neck. These nodes enlarge during periods of fever and then revert to normal size.
Diagnostic tests
Tests must first rule out other disorders that enlarge the lymph nodes.
A lymph node biopsy confirms the presence of Reed–Sternberg cells, abnormal histiocyte proliferation, and nodular fibrosis and necrosis. It also helps determine lymph node and organ involvement, as do bone marrow, liver, mediastinal, and spleen biopsies; routine chest X–rays; abdominal computed tomography scan; lung and bone scans; lymphangiography; and laparoscopy.
Hematologic tests show mild to severe normocytic anemia, normochromic anemia (in 50% of patients), and elevated, normal, or reduced white blood cell count and differential, showing any combination of neutrophilia, lymphocytopenia, monocytosis, and eosinophilia. Elevated serum alkaline phosphatase levels indicate liver or bone involvement.
A staging laparotomy may be done for patients younger than age 55 and for those without obvious stage III or stage IV disease, lymphocyte predominance subtype histology, or medical contraindications. (See Stages of Hodgkin’s disease.) Hodgkin’s disease is always treated as advanced, regardless of the findings of a staging laparotomy.
Treatment
Depending on the stage of the disease, the patient may receive chemotherapy, radiation therapy, or both. Correct treatment allows longer survival and may even induce a cure in many patients.
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