Abdominal involvement at the onset of Hodgkin's disease

Abstract

One hundred consecutive staging laparotomies were performed in untreated patients with Hodgkin's disease without an operative death. Abdominal involvement was documented in each of 16 patients with grossly positive lymphangiograms (clinical stage III). In patients with negative lymphangiograms, 12 of 50 (24 per cent) without symptoms (clinical stages I and IIA) and 16 of 34 (47 per cent) with symptoms (clinical stages I and IIB) were found to have abdominal disease. Of the 44 patients with abdominal involvement, in 15 disease was identified only in the spleen and celiac nodes; in 19 the spleen and paraaortic nodes were involved; and in 5 disease was present in the liver, spleen and paraaortic nodes. In only two patients was abdominal Hodgkin's disease restricted to the paraaortic nodes, but in an additional patient involvement was limited to the paraaortic and celiac nodes. One patient had disease in the liver and a common duct node, and another patient had disease in the liver, celiac and paraaortic nodes. Except for a few patients in whom the disease presented in the mediastinum or groin, or with lymphocyte predominance histology, patients with an insignificant risk of abdominal Hodgkin's disease could not be identified preoperatively. Neither site of presentation (neck versus axilla, or the right versus the left side of the neck), spleen size, alkaline phosphatase level nor histologic subtype (nodular sclerosis versus mixed cellularity) accurately predicted abdominal disease. Patients with clinical stage I or II Hodgkin's disease must either be explored, or treated for abdominal involvement; the need for exploration in patients with clinical stage III disease depends on the treatment plan.