iatroX Rounds #44
The clues
- 1
A 24-year-old man presents with a two-month history of painless, rubbery lumps in his left neck.
- 2
He reports feeling generally unwell with drenching night sweats that require him to change his bedding.
- 3
The patient notes that the lumps occasionally become painful shortly after he consumes alcohol at the pub.
- 4
He has unintentional weight loss of 6kg over the last three months and persistent pruritus without a rash.
- 5
Full blood count shows a normocytic anaemia and lymphopenia: a chest X-ray reveals a wide mediastinum.
- 6
Excisional lymph node biopsy demonstrates large, multinucleated cells with prominent owl-eye nucleoli.
Hodgkin lymphoma is a B-cell malignancy characterized by the presence of Reed-Sternberg cells. It typically presents in young adults with painless, rubbery lymphadenopathy and systemic B symptoms.
- Painless cervical lymphadenopathy
- B symptoms including fever, drenching night sweats, and weight loss
- Alcohol-induced lymph node pain
- Mediastinal mass on chest radiography
for education and entertainment. not medical advice.