7.5.2A/B Staging

•A: absence of B symptoms (see below)

•B: presence of the following symptoms:

–Loss of 10% or more body weight in the 6 months preceding diagnosis

–Presence of unexplained fever higher than 38°C for three consecutive days

–Night sweats

7.6Clinical Presentation

•Painless enlargement of lymph nodes, mostly in the cervical and supraclavicular regions (see below)

•Swollen lymph nodes are firm, not inflammatory, and painful to palpation

•Extension occurs most commonly from one lymph node group to another:

–Cervical 75%

–Supraclavicular 25%

–Axillary 9%

–Infradiaphragmatic 6%

•Extranodal involvement:

–Lung 6%

–Bone 5%

–Liver 2%

•In mediastinal involvement: a cough is common, sometimes with dyspnea, dysphagia, and enlargement of the vessels of the neck

•Infection: predisposition to bacterial or viral infection:

–Herpes zoster virus

–Cryptococcus

–Listeria monocytogenes

–Diplococcus pneumoniae

–Toxoplasma gondii

•Children might present with paraneoplastic signs such as immune-mediated cytopenias or nephrotic syndrome

B symptoms occurring in 20–30% of patients

•Fever higher than 38°C

•Night sweats

•Loss of more than 10% body weight

•Sometimes pruritus and/or nausea

7.6.1Involvement of Organs and Organ Systems

7.6.1.1 Spleen

•Commonly enlarged; enlargement not correlated with extension of Hodgkin disease