Hodgkin’s disease
A neoplastic disease, Hodgkin’s disease is characterized by painless, progressive enlargement of lymph nodes, spleen, and other lymphoid tissue resulting from proliferation of lymphocytes, histiocytes, eosinophils, and Reed-Sternberg giant cells. The latter cells are its special histologic feature.
Untreated, Hodgkin’s disease follows a variable but relentlessly progressive and ultimately fatal course. Advances in therapy have made Hodgkin’s disease potentially curable, even in advanced stages, and appropriate treatment yields a 5-year survival rate of about 90%.
Causes
The cause of Hodgkin’s disease is unknown. This disease is most common in young adults and occurs more commonly in men than in women. It occurs in all races but is slightly more common in whites. Incidence peaks in two age-groups: ages 15 to 38 and after age 50, except in Japan, where it occurs exclusively among people over age 50.
Signs and symptoms
Symptoms vary, depending on the stage of the disease.
Early signs
The first sign of Hodgkin’s disease is usually a painless swelling of one of the cervical lymph nodes (but sometimes the axillary, mediastinal, or inguinal lymph nodes), occasionally in a patient who has a history of recent upper respiratory tract infection.
In older patients, the first symptoms may be nonspecific, such as persistent fever, night sweats, fatigue, weight loss, and malaise. Rarely, if the mediasti-num is initially involved, Hodgkin’s disease may produce respiratory symptoms.
Another early and characteristic indication of Hodgkin’s disease is pruritus, which, although mild at first, becomes acute as the disease progresses. Other symptoms depend on the degree and location of systemic involvement.
Late signs
Sooner or later, most patients develop systemic manifestations, including enlargement of retroperitoneal nodes and nodular infiltrations of the spleen, liver, and bones. At this late stage, other symptoms include edema of the face and neck, progressive anemia, possibly jaundice, nerve pain, and increased susceptibility to infection.
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