Case Studies

 Case 6.5 Hodgkin's disease

A 23-year-old man presented with malaise, night sweats, loss of weight and intermittent fever dating from a flu-like illness 3 months previously. On examination, he had bilateral, cervical and axillary lymphadenopathy; the glands were 2-5cm in diameter, firm, rubbery, discrete and fairly mobile. His liver and spleen were not enlarged. Investigation showed that his haemoglobin was low (113g/l) and the white-cell count was normal (4.2 x 10⁹/l) but his erythrocyte sedimentation rate (ESR) was 78mm/h; the blood film did not show any abnormal cells. No enlargement of the hilar glands was seen on chest X-ray, unlike in Figure where enlarged hilar lymph nodes are obvious. A cervical lymph node was removed for histology. The gross architecture of the node was destroyed; the tissue consisted of histiocytes, eosinophils, lymphocytes and giant cells known as Reed-Sternberg cells. These large binucleate cells are characteristic of Hodgkin's disease. A bone marrow examination was normal and computed tomography showed no involvement of other lymph nodes. This patient had stage 2 Hodgkin's disease, because, although only lymphoid tissue above the diaphragm was involved, his ESR was above 40mm/h. In view of his symptoms, the suffix 'B' was added to the stage which suggests a poorer prognosis associated with systemic symptoms, so he was given cytotoxic therapy.