Case Study – Differential Diagnosis of Suspected Hodgkin Lymphoma in a Young Adult

Case Study – Differential Diagnosis of Suspected Hodgkin Lymphoma in a Young Adult

This case study revolves around a 22-year-old male with a non-painful lump on the neck accompanied by increased fatigue. Consideration of his medical and lifestyle history, together with the findings of physical examination that reveals a fixed rubbery lymph node raises the suspicion of a Hodgkin lymphoma. In addition, more serious adult conditions such as malignancy should be considered due to lymphadenopathy, habits such as occasional cannabis smoking, and alcohol consumption which serve as risk factors for such serious conditions. However, the patient reports no pertinent symptoms such as fever, weight loss, or night sweats. This paper delves into underscoring other clinical manifestations related to Hodgkin lymphoma, elucidating on other diagnoses with similar manifestations, and other diagnostic tests together with their findings if the diagnosis is Hodgkin lymphoma.

Other Clinical Symptoms Consistent with Hodgkin Lymphoma

            Hodgkin lymphoma is a cancer that stems from the lymphatic system and presents with swelling of the lymph nodes. Other symptoms may include B-symptoms such as fever, drastic weight loss, and diaphoresis. One may also experience generalized itching with no apparent cause and increased fatigue. In our client, the mediastinal mass may present together with cough, splenomegaly, and alcohol-induced pain (Kaseb & Babiker, 2020).

Other Possible Diagnoses for the Manifestations

Other than the Hodgkin lymphoma, non-Hodgkin lymphoma may present with lymphadenopathy, fatigue, and systemic symptoms. Due to the patient’s history of mononucleosis, infectious mononucleosis may be a possible diagnosis to have re-occurred, which might present with fatigue and lymphadenopathy. Other potential conditions may include sarcoidosis, metastatic cancer, reactive lymphadenopathy, and tuberculosis which may present with lymphadenopathy and other symptoms like fatigue and fever (Wang et al., 2018).

Diagnostic tests for Hodgkin Lymphoma

If the patient suffers from Hodgkin lymphoma, diagnostic tests such as complete blood count may show decreased hemoglobin levels, leukocytosis, elevated electrolyte sedimentation rate, and the presence of C-reactive protein. An excisional lymph node biopsy might be done, which is expected to reveal Reed-Sternberg cells. Imaging might also be done to explore the extent of lymphadenopathy. As suggested by Wang et al. (2018b), other tests may include liver and kidney tests to determine organ involvement, bone marrow biopsy, and a chest x-ray to reveal mediastinal mass.

References

Kaseb, H., & Babiker, H. M. (2020). Cancer, Hodgkin Lymphoma. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499969/

Wang, H.-W., Balakrishna, J. P., Pittaluga, S., & Jaffe, E. S. (2018a). Diagnosis of Hodgkin lymphoma in the modern era. British Journal of Haematology, 184(1), 45–59. https://doi.org/10.1111/bjh.15614

Wang, H.-W., Balakrishna, J. P., Pittaluga, S., & Jaffe, E. S. (2018b). Diagnosis of Hodgkin lymphoma in the modern era. British Journal of Haematology, 184(1), 45–59. https://doi.org/10.1111/bjh.15614

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Case 2
A 22-year-old man comes in because he was shaving and felt a lump on his neck. He states the lump is not painful and he noticed it about 2 weeks ago. He states he’s been more tired than usual for the past month and attributes this to his hectic schedule with work and school. He has not noticed any other changes in his health and denies other symptoms such as fever, weight loss, and difficulty swallowing.

Case Study – Differential Diagnosis of Suspected Hodgkin Lymphoma in a Young Adult

The remainder of his history is as follows:
Past medical and surgical history: tonsillectomy and adenoidectomy; mononucleosis; Medications: none; Allergies: none; Social history: smokes pot two to three times a week and uses no other drugs: drinks four to five beers on weekends; denies tobacco use; business major in college; not in a relationship for the past 6 months.
A complete physical exam was done and is unremarkable except for the presence of a cervical lymph node that is 2 centimeters, rubbery, and fixed. Hodgkin lymphoma is suspected.
Answer the following questions based on this scenario.
1. What other clinical manifestations are consistent with Hodgkin lymphoma?
2. What are other possible diagnoses to explain these manifestations?
3. What diagnostic tests (e.g., CBC) will be done, and what are the expected findings if the diagnosis is Hodgkin lymphoma?