Spleen Involvement at the Onset of Hodgkin's Disease

Abstract

Twenty-five patients with Hodgkin's disease were subjected to laparotomy and splenectomy because the usual clinical evaluation raised doubt as to the stage of the disease. Patients below the age of 50 with fever, sweats or chills, or a palpable spleen, a positive lymphangiogram, or two minor indications (equivocal lymphangiogram, splenomegaly by X ray, palpable liver, elevated sulfobromophthalein or alkaline phosphatase levels, or unfavorable histology) were explored. At laparotomy 13 patients had lymphoma of the spleen, but no patients had extrasplenic abdominal lymphoma without spleen involvement. Nine patients had positive para-aortic nodes; nine had positive celiac nodes, and four had a positive liver biopsy. In 7 individuals laparotomy resulted in reclassification into a more advanced stage; in 5 the clinical stage was reduced, and in 13 the stage was unchanged. These data are consistent with the view that the spleen is among the initial abdominal organs to which Hodgkin's disease spreads and that subsequently the abdominal nodes are involved.