The Practical Aspects of the Diagnosis, Treatment, and Prognosis of Hodgkin's Disease and Allied Disorders

Publisher Website
Google Scholar
Abstract
To cover all aspects of Hodgkin's disease and allied conditions in twenty minutes is a task of some magnitude. If I seem dogmatic, please believe me when I say that I really do not feel dogmatic at all. It is simply that in the time allotted one cannot-surround all that one says with the ifs, buts, and whereas's that really should be there. The more I see of these conditions-these that kill and maim the young and the old-the more humble I become in their presence, and, indeed, I have an uncomfortable feeling that the more I see of them, the less I really know. For many years at the Mallory Institute of Pathology and in the Thorndike Memorial Laboratory, Dr. Frederic Parker and I have used a classification which differs only in minor respects from that of many competent pathologists elsewhere. We believe that this classification is simple, that it is in accord with the facts, and that it has stood the test of time. We believe that it is wrong to lump (this word is used advisedly) all the various types under the rather vague and actually meaningless term malignant lymphoma, though we ourselves have so erred. The different types of Hodgkin's disease and allied disorders occur at various ages, have different symptoms, and behave quite differently to our therapeutic approaches. The prognosis of each type differs from that of the others. These facts alone may justify the classification. Hodgkin's disease itself we divide into three types: the comparatively benign paragranuloma, the more frequent and more fatal granuloma, and the rare but extremely malignant sarcomatous type, not recognized by all but first described by Ewing, a formidable antagonist and a brilliant pathologist. It has repeatedly been shown (by multiple biopsies) that the paragranulomatous type may progress into the granulomatous and that this latter in turn may on rare occasions change into the sarcomatous form. A reversal of this sequence never occurs. Then we have the universally accepted, though variously named, giant follicle lymphoma originally described by Brill, Baehr and Rosenthal. Like Hodgkin's paragranuloma, it is often a prelude to adventure, for all are agreed that a considerable percentage of these cases eventually change into one of the more malignant tumors such as lymphosarcoma or Hodgkin's disease. This metamorphosis into a more malignant disease may be seen in some small portion of an excised node when the patient first comes under observation, or it may occur months or years later. Of 25 of our cases showing the characteristic picture of giant follicle lymphoma, 15 eventually changed into some more malignant form.

This publication has 0 references indexed in Scilit: