Preferential Sites and Mode of Spread of Hodgkin's Disease and Lymphoreticular Sarcomas on the Basis of Clinical Evaluation of 500 Cases.

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Abstract
The preferential sites and mode of spread in 500 consecutive untreated patients with malignant lymphomas (200 Hodgkin's diseases, 150 lymphosarcomas and 150 reticulum cell sarcomas) have been studied. After a detailed diagnosis all patients with primary involvement of lymph nodes and spleen were staged according to the international four-stage clinical classification proposed at Rye in 1965. The lymphoreticular sarcomas with primary onset in Waldeyer's ring were staged according to the T.N.M. classification as modified in Milano by the National Cancer Institute in 1965. Patients with involvement of viscera or tissues without apparent disease in the lymph nodes, spleen or pharynx were listed separately. Primary involvement in Hodgkin's disease was confined in 99.5 % to lymph nodes and spleen. In lymphosarcoma and in reticulum cell sarcoma there was a high primary involvement of Waldeyer's ring (20 % and 53 % respectively) and in other extranodal sites (11–12%). Besides the cervical regions the distribution of lymph node involvement in Hodgkin's disease was predominantly in the mediastinum (20%) and in the paraaortic area (20%), while in lymphoreticular sarcomas mainly in the axillary (16%), iliac (23%) and inguinal (17%) regions. In the lymphoreticular sarcomas with primary onset in Waldeyer's ring the disease on first admission was limited to the pharynx and to the neek nodes in 73 % of cases. Study of the mode of spread showed that in untreated Hodgkin's disease the number of cases with contiguous involvement was 66 % while in lymphoreticular sarcomas it was only 35 %. Further, after localized radiation therapy Hodgkin's disease has a higher (72%) tendency to recur in adjacent lymphoid regions than lymphoreticular sarcomas with primary involvement in nodes and spleen (45%). The therapeutic implications of this study are discussed. The most important conclusion is that prophylactic irradiation should be given to localized Hodgkin's disease and not to lymphoreticular sarcomas with the exception of those arising in Waldeyer's ring.