# Hodgkin Lymphoma in Children

> Hodgkin lymphoma in children for NEET-PG Paediatrics: Reed-Sternberg cells, Ann Arbor staging, B symptoms and risk-adapted therapy.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/hodgkin-lymphoma-in-children
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Hodgkin Lymphoma in Children", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/hodgkin-lymphoma-in-children

## Direct answer

Hodgkin lymphoma in a child is an indolent, painless, rubbery cervical or supraclavicular mass that announces itself earlier than most childhood cancers and, treated with modern risk-adapted chemo(radio)therapy, is curable in the great majority. The Reed-Sternberg cell — a binucleate CD15- and CD30-positive giant cell — defines it histologically, and the disease spreads predictably to contiguous node groups, which is why the Ann Arbor staging system, not the Murphy system used for non-Hodgkin lymphoma, applies. Fever above 38 degrees for three consecutive days, drenching night sweats and more than 10 per cent weight loss over six months are the B symptoms that upstage every patient.

## What you must remember

- Bimodal age curve with an adolescent-young adult peak (15–34 years) and a second peak after 55; in developing countries younger children with mixed-cellularity histology and EBV association are seen more often.
- Histological subtypes: nodular sclerosis is commonest overall in adolescents; lymphocyte-predominant has the best outlook; lymphocyte-depleted the worst.
- Reed-Sternberg cells mark CD15 and CD30 positive; the cellular background of reactive lymphocytes and eosinophils is what actually determines prognosis.
- Presentation: painless cervical/supraclavicular adenopathy; mediastinal mass; the classic sign of pain at the lymph node site after alcohol intake is famous but rare.
- B symptoms: unexplained fever over 38°C for three or more consecutive days, drenching night sweats, or loss of more than 10 per cent body weight over six months.
- Staging is Ann Arbor I–IV with A/B suffix; the spleen, and contiguous spread, matter — stage II means two node regions on the same side of the diaphragm, stage III both sides, stage IV extranodal dissemination.
- A mediastinal mass more than one-third of the transthoracic diameter on an upright film flags superior mediastinal widening with airway and anaesthetic risk.
- Modern therapy is risk-adapted combination chemotherapy (regimens of the OEPA/COPDAC or ABVD families) with response-adapted, volume-reduced radiotherapy; over 90 per cent of localised and the majority of advanced-stage children survive.
- Late effects shape follow-up: second cancers including breast carcinoma after chest radiotherapy, anthracycline cardiomyopathy, infertility and hypothyroidism after neck irradiation.

## A typical exam case

A fourteen-year-old notices a lump above the left clavicle for six weeks — non-tender, rubbery, 3 cm, freely mobile. There is a month of evening fever and drenching night sweats. Step one is the chest radiograph before anything invasive: a widened mediastinum changes the approach entirely, both for staging and because a supine biopsy under general anaesthesia in a child with a large mediastinal mass can obstruct the airway. Step two is excision biopsy of the accessible peripheral node — the node itself, not a fine-needle aspirate, because architecture is the diagnosis in Hodgkin lymphoma. Step three is staging with contrast CT (PET-CT where available), plus counts, ESR and an echocardiogram ahead of anthracyclines.

Suppose the biopsy shows nodular sclerosis with Reed-Sternberg cells, and imaging shows disease confined to the cervical and mediastinal nodes without B symptoms: Ann Arbor stage IIA. Treatment is a short course of risk-adapted chemotherapy with or without involved-field radiotherapy, and the expected cure rate is well over 90 per cent. The examinable nuance is what happens fifteen years later — breast screening after chest radiotherapy in girls, cardiac surveillance after doxorubicin, thyroid function after neck fields, and fertility counselling before gonadotoxic cycles.

## How the exam frames it

Mostly through contrasts. A painless rubbery node with contiguous spread and B symptoms versus a rapidly enlarging extranodal abdominal mass (non-Hodgkin); Ann Arbor versus Murphy staging as a matching question; CD15/CD30 versus CD20 and lymphoblastic markers; and the staging vignette that turns on the spleen or on nodes crossing the diaphragm. A favourite one-best-answer asks which child needs urgent airway assessment before biopsy — the one with a mediastinal mass and positional stridor. Candidates lose marks by suggesting staging laparotomy (historical, abandoned) or fine-needle aspiration cytology as adequate — the reactive cellular background, visible only on histology, grades the disease.

## Frequently asked questions

### Which staging system is used for Hodgkin lymphoma and why?
The Ann Arbor system (I–IV with A or B suffix), because Hodgkin lymphoma spreads contiguously from one lymph node region to the next, unlike the haematogenous pattern of non-Hodgkin lymphoma staged by the Murphy criteria.

### What are B symptoms and how do they alter staging?
Unexplained fever above 38°C on consecutive days, drenching night sweats and loss of more than 10 per cent body weight over six months; their presence adds the B suffix and worsens prognosis.

### Which immunohistochemical markers define the Reed-Sternberg cell?
CD15 and CD30 positivity; the classic owl-eye binucleate appearance is supported by these markers; CD45 is typically negative.

### Why is excision biopsy preferred over fine-needle aspiration in suspected Hodgkin lymphoma?
Diagnosis depends on nodal architecture — the mixed reactive background of lymphocytes, eosinophils and plasma cells around Reed-Sternberg cells determines subtype and prognosis, and this is lost on cytology.

### What late effects must be monitored after treatment of childhood Hodgkin lymphoma?
Second malignancies (especially breast cancer after chest radiotherapy in girls), anthracycline cardiomyopathy, post-irradiation hypothyroidism and infertility.