Hodgkin Lymphoma vs Non-Hodgkin Lymphoma
Hodgkin Lymphoma and Non-Hodgkin Lymphoma are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Hodgkin Lymphoma vs Non-Hodgkin Lymphoma at a glance
- Hodgkin Lymphoma: B-cell lymphoma defined by Reed-Sternberg cells in a reactive inflammatory background — highly curable with combined modality therapy.
- Non-Hodgkin Lymphoma: Heterogeneous group of lymphoid malignancies (mostly B-cell) — DLBCL most common aggressive type, follicular lymphoma most common indolent.
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Side-by-side comparison
| Feature | Hodgkin Lymphoma | Non-Hodgkin Lymphoma |
|---|---|---|
| At a glance | B-cell lymphoma defined by Reed-Sternberg cells in a reactive inflammatory background — highly curable with combined modality therapy. | Heterogeneous group of lymphoid malignancies (mostly B-cell) — DLBCL most common aggressive type, follicular lymphoma most common indolent. |
| Classic presentation | Young adult (15-35) with painless cervical lymphadenopathy, mediastinal mass on CXR, and nodular sclerosing histology with Reed-Sternberg cells.; Painless cervical or supraclavicular lymphadenopathy (most common presentation); Mediastinal mass — dyspnea, cough, chest discomfort, SVC syndrome (typical of nodular sclerosing in young… | Rapidly enlarging supradiaphragmatic node in an older adult with B symptoms — biopsy reveals diffuse large B-cell lymphoma. Burkitt: jaw mass in pediatric African patient (endemic) or abdominal mass in immunodeficient host (sporadic).; Lymphadenopathy — painless, peripheral or central; often progressive over weeks to months; B symptoms… |
| Workup / key labs | Histologic identification of Reed-Sternberg cells (or lymphocyte-predominant variants in NLPHL) with characteristic immunophenotype on excisional biopsy.; Excisional lymph node biopsy is essential for diagnosis (fine-needle aspiration is INSUFFICIENT — Reed-Sternberg cells need architectural context); Immunohistochemistry: classical HL… | Tissue diagnosis with WHO-defined histologic and immunophenotypic criteria specific to subtype. Ann Arbor staging used; International Prognostic Index (IPI) prognosticates DLBCL and other aggressive lymphomas (age, stage, LDH, performance status, extranodal sites).; Excisional lymph node biopsy ESSENTIAL — needle biopsy may miss… |
| Imaging | PET/CT — gold standard for staging and response assessment (Deauville 5-point score); CT chest/abdomen/pelvis if PET unavailable; Bone marrow biopsy NO LONGER routinely required if PET is performed (PET detects marrow involvement); Ann Arbor staging with Cotswolds modification: I (single nodal region), II (≥2 regions same side of… | PET/CT — staging and response assessment (Deauville 5-point score); CT chest/abdomen/pelvis with contrast; MRI brain for primary CNS lymphoma or suspected CNS involvement; Echocardiogram (MUGA) before anthracycline; Endoscopy if GI involvement suspected |
| First-line treatment | Early-stage (I-II) favorable: 2-4 cycles ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) + involved-site radiation (ISRT); response-adapted approach using interim PET to minimize toxicity; Early-stage unfavorable: 4-6 cycles ABVD + ISRT; Advanced-stage (III-IV): 6 cycles ABVD or escalated BEACOPP (more intensive, more toxic);… | DLBCL: R-CHOP × 6 cycles (rituximab + cyclophosphamide + doxorubicin + vincristine + prednisone); polatuzumab vedotin + R-CHP (POLARIX trial) improves PFS in higher-risk patients; cure rate ~60-70%; Follicular lymphoma (low grade, indolent): observation if asymptomatic and low burden; bendamustine + rituximab or R-CHOP if symptomatic;… |
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