Signs and Symptoms of Hodgkin Disease

Your child can have HD and feel perfectly well. You may have noticed that a lymph node under the skin in the neck, under the arm, or in the groin is enlarged. Sometimes this will go away only to come back. Eventually, it doesn’t go away, and although it doesn’t hurt, it will become more noticeable and lead you to take your child to the doctor. There may even be several areas of enlarged lymph nodes.

But HD is not the most common cause of lymph node swelling. Most lymph node enlargement, especially in children, is caused by an infection. The node should return to its normal size within a couple of months after the infection goes away. If your child’s lymph nodes have enlarged to more than an inch, especially if your child hasn’t had a recent infection, it is best to have your child’s doctor examine the lymph nodes so that any disease found can be treated without delay.

When HD affects lymph nodes inside your child’s chest, they cannot be felt directly. But the swelling of these nodes may compress the trachea (windpipe) and make your child cough or even have trouble breathing. Some patients with HD have fever, drenching night sweats, or weight loss. The fever can come and go over several days or weeks. Itching, tiredness, and decreased appetite are other symptoms that may occur. Sometimes, the only symptom is being tired all the time.

Other conditions can produce these symptoms. If your child has any of these symptoms, discuss them with your doctor without delay. The sooner a correct diagnosis is made, the sooner treatment can be started and the more effective the treatment will be.

History and Physical Exam

First, your child’s doctor will take a complete medical history to check for symptoms. Next, the doctor will perform a complete physical examination. This provides information about whether your child has an infection or whether HD or other possible health problems are causing the symptoms. During the physical exam, the doctor will pay special attention to the lymph nodes and will inspect other areas of the body that may be involved. Because infections are the most common cause of enlarged lymph nodes in children, the doctor will look for an infection in the part of the body near the swollen lymph nodes.

The only way to know for sure whether your child has HD is by biopsy (examination of a tissue sample under the microscope) of a lymph node. There are several types of biopsy procedures, and doctors choose one based on the unique aspects of your child’s situation. The goal is to get enough tissue to be sure of the diagnosis. If your child does have HD, the doctor needs to know exactly which type it is. Some types are treated differently.

Biopsy Procedures

Excisional or incisional biopsy:These types of biopsy are commonly used and most often will tell whether HD is present. A surgeon cuts through the skin to remove the entire node (excisional biopsy) or a small part of a large tumor (incisional biopsy). If the node is near the skin surface, this is a simple operation that can be done with local anesthesia (numbing medicine only at the site) if the child is cooperative. But if the node is inside the chest or abdomen, general anesthesia is used (the child is asleep). This method almost always provides enough tissue to make a diagnosis of the exact type of HD.

Fine needle aspiration (FNA) biopsy:FNA uses a thin needle and ordinary syringe to remove a small amount of fluid and tiny bits of tissue from a tumor. This is a simple procedure that avoids the need for removal of an entire lymph node. But it does not remove enough tissue for a reliable diagnosis of HD. If the doctor suspects that the lymph node swelling is caused by an infection, FNA may be the first type of biopsy done. But an excisional or incisional biopsy will be needed to diagnose HD.

Laboratory Tests of Biopsy Specimens to Diagnose and Classify Hodgkin Disease

Biopsy specimens are examined under a microscope by a pathologist (a doctor who specializes in recognizing changes in cells and tissues caused by cancer and other diseases). The pathologist looks at the size and shape of the cells and determines whether any of them are characteristic Reed-Sternberg cells. Sometimes the first biopsy does not provide a definite answer, and another biopsy is needed.

Routine examination under the microscope can often reveal whether HD is a likely diagnosis. But more testing is usually needed. This consists of special stains of the tissue section, looking for the presence of certain molecules in the cells, called CD15 and CD30, which are typically found in HD. Other molecules may be examined to make sure the lymphoma isn’t a non-Hodgkin lymphoma.

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