47 patients with Hodgkin’s disease presenting after age 60 were analyzed retrospectively for clinical presentation, distribution of disease, and histopathology, and compared to a younger control group. The types of clinical presentation included: local or generalized adenopathy, 50%; ‘B’ symptoms, 25%; ‘unusual manifestations’ and intra-abdominal complications, 13%; and incidentally discovered disease, 12%. In contrast, the younger group presented less often for symptoms (p < 0.01) and more often for adenopathy (p < 0.01). Disease distribution was unique in the elderly compared to the young with a higher incidence of inguinal (p < 0.01), splenic (p < 0.01), and gastrointestinal disease (p < 0.01) and a lower indicence of mediastinal disease (p < 0.01). Histopathology in elderly patients revealed more lymphocyte depletion and less nodular sclerosis than the young patients. 38 of 47 elderly patients were classified as stage III or IV compared to 22/47 in the young. 26 elderly and only 9 young patients had ‘B’ symptoms. Survival was compared for pathologically matched stage IV A and B patients, and the median duration was 5 and 40 months for the elderly and young groups, respectively, (p < 0.001). This difference may be a consequence of differences in therapeutic approaches toward the elderly. Hodgkin’s disease has distinctive clinical and pathologic features which characterize the disease in the elderly and are relevant to diagnostic and therapeutic management.