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Hodgkin Lymphoma BHL — RACP Adult Medicine MCQ

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ModerateHaematologyHodgkin Lymphoma BHLRACP Adult Medicine

A 25-year-old man presents with BHL on CXR, night sweats, weight loss, and severe pruritus. CT shows bulky mediastinal lymphadenopathy (15 cm aggregate). PET-CT shows intensely FDG-avid nodes. Lymph node biopsy shows Reed-Sternberg cells in a background of mixed cellularity. What is the most likely diagnosis?

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Correct answer: A — Lymphoma

BHL with B symptoms (night sweats, weight loss) and pruritus with bulky mediastinal disease and Reed-Sternberg cells is Hodgkin lymphoma (mixed cellularity subtype). HL is the most important diagnosis to exclude in BHL with B symptoms. Pruritus is more common in HL than other causes of BHL. Treatment: ABVD × 2 cycles then interim PET → adapted therapy (RATHL/AHL2011 approach). Advanced stage: 6× ABVD or escalated BEACOPP.

Reference: ALLG – 2024 – Hodgkin Lymphoma; NCCN 2025