Usually presents with asymptomatic lymph node enlargement or with adenopathy associated with fever, night sweats, weight loss, and sometimes pruritus. Mediastinal adenopathy (common in nodular sclerosing HD) may produce cough. Spread of disease tends to be to contiguous lymph node groups. Superior vena cava obstruction or spinal cord compression may be presenting manifestation. Involvement of bone marrow and liver is rare.