Overview
Definition
A clonal B-cell malignancy originating in the lymphatic system, histologically characterized by the presence of multinucleated Reed-Sternberg cells on a background of reactive inflammatory cells.
Epidemiology
Bimodal age distribution (peaks in young adults 15-35, and older adults >55). Highly curable.
Etiology & Risk Factors
- Association with Epstein-Barr Virus (EBV) infection in some subtypes
- Genetic and environmental factors
Clinical Symptoms
- Painless, rubbery lymphadenopathy (typically cervical or supraclavicular)
- Alcohol-induced lymph node pain (highly specific but uncommon)
- Constitutional B symptoms: Unexplained fever, drenching night sweats, weight loss
- Mediastinal mass (causing cough or dyspnea)
Clinical Approach
Diagnosis
- Excisional lymph node biopsy (essential; core/needle biopsies often inadequate) showing giant, binucleated Reed-Sternberg cells ('owl-eyes' appearance)
- Staging via PET/CT scan
Management
- Chemotherapy (e.g., ABVD regimen: Adriamycin, Bleomycin, Vinblastine, Dacarbazine)
- Involved-site radiation therapy
- Brentuximab vedotin (antibody-drug conjugate) for relapsed/refractory disease
Complications
- Secondary malignancies (Breast cancer, Lung cancer, Leukemia) due to radiation/chemotherapy
- Radiation-induced coronary artery disease and hypothyroidism
- Pulmonary toxicity (from Bleomycin)