Hodgkin's disease; a review of two hundred and sixteen cases.

Abstract

This study covers 216 cases of Hodgkin's disease treated at Walter Reed Army Hospital from 1938 through 1948. In every instance the diagnosis was established by histologic study of an excised lymph node. In view of present knowledge regarding Hodgkin's disease, it is believed that its best management is based on the concept that it is a malignant neoplasm. The pros and cons of an infectious granulomatous process versus a malignant neo-plastic process cannot be settled by the practicing physician. Certainly, to date, the handling of Hodgkin's disease as an inflammatory condition has done nothing but delay its treatment as a cancer. Study of any of these cases from the onset of the disease, through its course, to the postmortem findings will convince one that it meets all the criteria of cancer. The high incidence of primary involvement of a single lymph node, or a small group of nodes, lends support to the belief that Hodgkin's disease is unicentric in origin. This is corroborated by the relatively higher survival rate of patients with single lesions (Stage I). All patients in this series were treated primarily with x-ray irradiation. A small percentage, about 10 per cent, were also given nitrogen mustard sometime during the course of their illness. Diagnosis Even though the watchword in handling cancer today is “early diagnosis,” which means histologic confirmation of the clinical diagnosis, the question of performing a biopsy in a given case is often handled with indecision and delay. The high percentage of Stage III cases found in this series bears this out. In 74 per cent of the patients in this series the first sign of the disease was enlargement of a lymph node in the cervical chain. The bulk of these nodes were found in the inferior region of the cervical lymphatics. Indications for a lymph node biopsy are: (a) an enlarged lymph node, chiefly in the lower cervical chain; (b) persistence of the enlargement for three weeks or more; (c) absence of a regional inflammatory lesion as a cause for the adenopathy. Regression of adenopathy spontaneously or during antibiotic therapy is frequently misleading. Periodic examinations will usually reveal the regression to be partial, and enlargement of the same node or adjacent lymphatics will reappear. Another potential pitfall is the histopathological diagnosis of lymphadenitis or reactive hyperplasia. When this occurs, the physician should re-examine the patient for adenopathy every three months. This precaution will more often lead to a definitive diagnosis of Hodgkin's disease in the early phase. Clinical Classification In order to evaluate properly any method of therapy for malignant neoplastic disease, a suitable clinical classification should be used. Each case should be staged at the time of initial examination.