Natural history of Hodgkin's disease as related to its pathologic picture

This paper evaluates the significance of the clinical stages and histologic features of Hodgkin's disease in 377 U. S. Army cases from World War II with a 15- to 18-year follow-up. From this study 6 histologic types have emerged: (1) lymphocytic and/or histiocytic (L & H), nodular; (2) lymphocytic and/or histiocytic (L & H), diffuse; (3) nodular sclerosis; (4) mixed; (5) diffuse fibrosis and (6) reticular. There is a definite relationship between histologic types, clinical stages and survival. The L & H types are expressions of lymphocytic proliferation and diffuse fibrosis and reticular types represent lymphocytic depletion while the mixed is intermediate between these extremes. Nodular sclerosis appears to be a regional expression of Hodgkin's disease in the mediastinum and is of major prognostic significance in stage I. The histologic types are regarded as expressions of an attempted host response and possibly evidence of the dramatic interplay between the host and the factors responsible for the development of Reed-Sternberg cells. The authors suggest that the Hodgkin's disease process represents the attempted induction of malignant neoplasia and that the evolution of the histologic process is a manifestation of the natural history of the disease.