Which presentation is typical for Hodgkin lymphoma in a adolescent?

• A. Fever and pain
• B. Anorexia and nausea
• C. Enlarged inguinal lymph nodes that are painful at the touch
• D. Painless, firm, movable adenopathy in the cervical area

Answer: (D)

Painless, firm, movable lymphadenopathy in the cervical region is the classic presentation of Hodgkin lymphoma in adolescents. Hodgkin lymphoma typically shows localized, non-tender enlargement of lymph nodes, with the neck being the most common site. The nodes feel firm or rubbery and can move against surrounding tissue, but they are not painful unless there is a secondary infection or other complication. While systemic symptoms like fever, night sweats, and weight loss can occur (B symptoms), they are not required for the diagnosis and are less specific. In contrast, fever with pain, nonspecific anorexia or nausea, or painful inguinal nodes point away from the typical Hodgkin presentation and toward infection or other conditions. Therefore, the description of a painless, firm, movable cervical adenopathy aligns best with Hodgkin lymphoma in an adolescent.