Hodgkin lymphoma and neck enlargement explained practically: This article shows the most important differential diagnoses for a swelling in the neck, including thyroid diseases, infectious lymphadenopathy, tuberculosis and malignant causes. With typical features, clinical clues and B symptoms – ideal for FSP, knowledge exam and M3.
Hodgkin lymphoma
Main complaint
A patient over 50 years presents with a swelling or enlargement in the neck. The swelling may be so pronounced that buttoning the collar is already difficult.
Differential diagnoses
1. Thyroid / thyroid disease
- Diffuse goiter: uniform, symmetrical enlargement of the entire thyroid, common with iodine deficiency or Hashimoto thyroiditis.
- Nodular goiter: nodular thyroid enlargement with single or multiple nodules. These can include thyroid cysts or thyroid adenomas.
2. Lymphadenopathy
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Infectious:
- Epstein-Barr virus (EBV) → infectious mononucleosis
- Streptococcal tonsillitis
- Malignant / Tuberculosis
Characteristics
| Infectious | Malignant / Tuberculosis |
|---|---|
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Further clinical clues
| Infectious / reactive | Malignant | Tuberculosis |
|---|---|---|
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Thyroid dysfunction
Optionally, specifically ask about symptoms of hypothyroidism:
- Cold intolerance
- Constipation
- Dry skin
Note
- An enlargement of the neck can be caused by thyroid disease as well as by enlargement of lymph nodes.
- Painful, soft and mobile lymph nodes are more suggestive of an infectious cause.
- Hard, firm and painless lymph nodes with a chronic course are suspicious for malignancy.
- B symptoms with fever, night sweats and unintentional weight loss should always be actively inquired about.
- Lymph node pain after alcohol consumption is a classic sign of Hodgkin lymphoma.
- Systemic diseases such as SLE, sarcoidosis or rheumatoid arthritis can also cause generalized lymphadenopathy and should be considered in the differential diagnosis.