Guidelines for pediatric cancer centers and their role in the treatment of pediatric patients with cancer have been outlined by the American Academy of Pediatrics. These Reed-Sternberg cells are considered to be the malignant cell of Hodgkin's disease, but their normal counterparts have not been definitively identified. Most cases of Hodgkin's disease probably arise from germinal center B cells that are unable to synthesize immunoglobulin. 2 Clinically, patients usually present with painless adenopathy, commonly in the supraclavicular or cervical area. The enlarged nodes are typically firmer than inflammatory nodes and have a rubbery texture.
Many patients have some degree of mediastinal involvement at presentation.
Patients may have systemic symptoms such as fever, night sweats, and weight loss that are perhaps secondary to the lymphokines released by the Hodgkin's cells. In the United States, there is a bimodal age distribution of Hodgkin's disease with an early peak in the mid to late 20s and a second peak in late adulthood. Hodgkin's disease is rare before 5 years of age, and in children younger than 10 years of age the incidence is much higher in boys. Although rare, Hodgkin's disease can be familial. While Hodgkin's disease occurs in various age groups, children with the disease should be treated in multidisciplinary pediatric oncology institutions with experience treating children with cancer.