Differentials
Non-Hodgkin's lymphoma (NHL)
SIGNS / SYMPTOMS
There are no pathognomonic clinical signs or symptoms that can differentiate HL from NHL. However, generalities can be helpful to differentiate the two entities. In contrast to NHL, HL tends to spread from one lymph node chain to another in contiguous fashion. Involvement of Waldeyer ring and extra-nodal sites is more common with NHL. Although HL and NHL can occur at any age, patients with HL tend to be younger.
INVESTIGATIONS
Pathological confirmation, interpreted by a skilled haematopathologist, is the only method to distinguish HL from NHL. The most common NHLs that can be confused with HL are T-cell-rich large B-cell lymphoma and anaplastic CD30+ large-cell lymphoma.
Lymphadenopathy from other malignancies
SIGNS / SYMPTOMS
A variety of different malignancies present with lymphadenopathy. Cancers of the head and neck often spread to cervical lymph nodes. Breast cancer most commonly spreads to axillary lymph nodes. Malignancies of the anus and vulva characteristically spread to inguinal lymph nodes.
INVESTIGATIONS
In addition to the clinical context and supporting imaging studies, performing a biopsy is the best way to differentiate Hodgkin's lymphoma from other malignancies when the aetiology of an enlarged lymph node is in doubt.
Infectious mononucleosis
SIGNS / SYMPTOMS
As opposed to HL, the enlarged lymph nodes are often tender. Sore throat is common with infectious mononucleosis but unusual with HL. Infectious mononucleosis is a risk factor for HL, with an estimated median incubation time from mononucleosis to Epstein-Barr virus (EBV)-positive HL of 4 years.[11] If HL is suspected, lymph node biopsy is necessary.
INVESTIGATIONS
Blood tests can be done to test for EBV, the causative agent of infectious mononucleosis.
Reactive lymph nodes
SIGNS / SYMPTOMS
Lymph nodes, particularly in the neck, can become enlarged from a variety of infectious/inflammatory causes. Benign lymphadenopathy typically resolves within a few weeks.
INVESTIGATIONS
If enlarged lymph nodes persist or if other symptoms are present (e.g., B symptoms, such as fever, drenching night sweats, and weight loss), a lymph node biopsy should be considered.
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