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Lymphomas: Hodgkin and non-Hodgkin
Lymphoma is diagnosed by excision biopsy of a node (not fine-needle aspiration), staged by PET-CT, and treated by type — Hodgkin with ABVD (or BV-AVD) and DLBCL with R-CHOP; hepatitis B is checked before rituximab.
Why it matters in the exam
The classic Hodgkin question presents a young adult with painless neck or mediastinal nodes, itch, and sometimes node pain after drinking alcohol, with "B symptoms": fever above 38 degrees, night sweats and loss of more than 10% of weight in 6 months. On biopsy — Reed-Sternberg cells (CD15 and CD30). In non-Hodgkin lymphoma the commonest type is DLBCL — a fast-growing mass in an older adult — followed by indolent follicular lymphoma (t(14;18)). Burkitt lymphoma (t(8;14), "starry sky" picture) grows very fast and risks tumour lysis syndrome. Gastric MALT lymphoma is linked to H. pylori and sometimes regresses after eradication.
Work-up questions test when to biopsy a node: size above 2 cm, a hard or fixed node, a supraclavicular site, or a node that has not settled after 4–6 weeks. A standard distractor is fine-needle aspiration — it is not enough, because the node architecture is needed. Staging is by PET-CT under Lugano. In treatment: Hodgkin with ABVD (or brentuximab with AVD) and sometimes radiotherapy, with high cure rates — but with late effects (breast cancer after mediastinal radiotherapy, heart disease, secondary leukaemia); DLBCL with R-CHOP. Before rituximab, HBsAg and anti-HBc are checked because of the risk of a hepatitis B flare.
Key points
- Diagnosis by excision biopsy; staging by PET-CT.
- Hodgkin: Reed-Sternberg, CD15 and CD30; ABVD or BV-AVD.
- DLBCL: the commonest non-Hodgkin type; R-CHOP.
- B symptoms: fever above 38, night sweats, weight loss above 10% in 6 months.
- Before rituximab — HBV; gastric MALT — H. pylori eradication.
Summary table
| Type | Clue | Finding | Treatment |
|---|---|---|---|
| Hodgkin | Young adult, neck and mediastinum, itch, pain with alcohol | Reed-Sternberg, CD15 and CD30 | ABVD or BV-AVD ± radiotherapy |
| DLBCL | Older adult, fast-growing mass | Commonest non-Hodgkin type | R-CHOP |
| Follicular | Indolent, widespread nodes | t(14;18), BCL2 | Observation or rituximab by burden |
| Burkitt | Very rapid growth, abdomen | t(8;14), "starry sky" | Intensive chemotherapy; prevent tumour lysis |
| Gastric MALT | Dyspepsia | H. pylori positive | H. pylori eradication |
| B symptoms | Fever above 38, night sweats, weight loss above 10% in 6 months | Affect prognosis | Part of staging |
Free exam questions
Rituximab לא יעיל ב?איזו מהמחלות הבאות (the question as examined, in Hebrew)
- א. Diffuse Large B Cell Lymphoma
- ב. Follicular Lymphoma
- ג. Hodgkin’s Lymphoma
- ד. ANCA –associated Vasculitis
מה נכון ?לגבי לימפומה פוליקולרית (the question as examined, in Hebrew)
- א. לימפומה פוליקולרית היא הלימפומה השכיחה ביותר
- ב. ניתן להשיג רמיסיה ברוב החולים וברובם יש ריפוי מלא של המחלה
- ג. למרבית החולים תהיה טרנסלוקציה(14:18) וביטוי מוגבר של bcl2
- ד. קצב ההתמרה ללימפומה DLBCL הוא כ- 10% לשנה
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Sources
- Lugano Classification for initial evaluation, staging and response assessment of Hodgkin and non-Hodgkin lymphoma, 2014 — PET-CT staging and response
- ESMO Clinical Practice Guidelines: Hodgkin lymphoma; Diffuse large B-cell lymphoma, 2018 (HL) and 2015 (DLBCL) — First-line treatment
- Harrison's Principles of Internal Medicine, 21st edition (2022) — Non-Hodgkin's Lymphoma; Hodgkin's Lymphoma
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.