The disease can present at any age but is rare in children and has a peak incidence in young adults. There is an almost 2 : 1 male predominance. The following symptoms are common. 

1. Most patients present with painless, non – tender, asymmetrical, firm, discrete and rubbery enlargement of superficial lymph nodes. The cervical nodes are involved in 60 – 70% of patients, axillary nodes in approximately 10 – 15% and inguinal nodes in 6 – 12%. In some cases the size of the nodes decreases and increases spontaneously. They may become matted. Typically, the disease is localized, initially to a single peripheral lymph node region and its subsequent progression is by contiguity within the lymphatic system. Retroperitoneal nodes are also often involved but usually only diagnosed by computed tomography (CT) scan.
2. Modest splenomegaly occurs during the course of the disease in 50% of patients. Th e liver may also be enlarged because of liver involvement.
3. Mediastinal involvement is found in up to 10% of patients at presentation. Th is is a feature of the nodular sclerosing type, particularly in young women. Th ere may be associated pleural effusions or superior vena cava obstruction.
4. Cutaneous Hodgkin lymphoma occurs as a late complication in approximately 10% of patients.Other organs (e.g. bone marrow, gastrointestinal tract, bone, lung, spinal cord or brain) may also be involved, even at presentation, but this is unusual.
5. Constitutional symptoms are prominent in patients with widespread disease. The following may be seen:
   • Fever occurs in approximately 30% of patients and is continuous or cyclic;
   • Pruritus, which is often severe, occurs in approximately 25% of cases;
   • Alcohol – induced pain in the areas where disease is present occurs in some patients;
   • Other constitutional symptoms include weight loss, profuse sweating (especially at night), weakness, fatigue, anorexia and cachexia. Haematological and infectious
     complications are discussed below.

The diagnosis is made by histological examination of an excised lymph node. Th e distinctive multinucleate polyploid RS cell is central to the diagnosis of the four classic types and mononuclear Hodgkin cells are also part of the malignant clone. Th ese cells stain with CD30 and CD15 but are usually negative for B – cell antigen expression. Inflammatory components consist of lymphocytes, neutrophils, eosinophils, plasma cells and variable fi brosis. CD68 detects infi ltrating macrophages and, if strongly positive, is an unfavourable feature.
Histological classification is into four classic types and nodular lymphocyte predominant disease, each of which implies a different prognosis. Nodular sclerosis and mixed cellularity are most frequent. Patients with lymphocyte rich histology have the most favourable prognosis of classic Hodgkin lymphoma. Nodular lymphocyte predominant does not show RS cells and has many features of non – Hodgkin lymphoma and may be treated as
such.