As a relatively uncommon disease in clinical practice, Hodgkin's lymphoma of the nasopharynx is particularly susceptible to misdiagnosis, which might delay treatment. Clinical dilemmas are regularly faced in the attempt to forecast this disease. With the aim of developing a flawless prediction system in the future to raise the rate of early diagnosis and enhance patient prognosis, we primarily highlight several dilemmas about tumor microenvironment, comparison of biopsy and surgery, and the usage of fluoro-2deoxy-D-glucose positron emission tomography in this study. We summarized the predictive biomarkers in the Hodgkin's lymphoma microenvironment, including both routine and specific biomarkers such as mast cells, tumor related macrophages and so on. Fluoro-2-deoxy-D-glucose positron emission tomography is a highly useful method for the early diagnosis of Hodgkin's lymphoma. It can increase the accuracy and sensitivity of diagnosis and is also a valuable tool for therapy evaluation. Additionally, for pathological procedures, surgery is more dangerous but produces more accurate findings, whereas biopsy is less risky but produces less accurate results.