Hodgkin's disease

'Medusa head ataxia': the expanding spectrum of Purkinje cell antibodies in autoimmune cerebellar ataxia. Part 3: Anti-Yo/CDR2, anti-Nb/AP3B2, PCA-2, anti-Tr/DNER, other antibodies, diagnostic pitfalls, summary and outlook

Serological testing for anti-neural autoantibodies is important in patients presenting with idiopathic cerebellar ataxia, since these autoantibodies may indicate cancer, determine treatment and predict prognosis. While some of them target nuclear antigens present in all or most CNS neurons (e.g. anti-Hu, anti-Ri), others more specifically target antigens present in the cytoplasm or plasma membrane of Purkinje cells (PC). In this series of articles, we provide a detailed review of the clinical and paraclinical features, oncological, therapeutic and prognostic implications, pathogenetic relevance, and differential laboratory diagnosis of the 12 most common PC autoantibodies (often referred to as 'Medusa head antibodies' due to their characteristic somatodendritic binding pattern when tested by immunohistochemistry). To assist immunologists and neurologists in diagnosing these disorders, typical high-resolution immunohistochemical images of all 12 reactivities are presented, diagnostic pitfalls discussed and all currently available assays reviewed. Of note, most of these antibodies target antigens involved in the mGluR1/calcium pathway essential for PC function and survival. Many of the antigens also play a role in spinocerebellar ataxia. Part 1 focuses on anti-metabotropic glutamate receptor 1-, anti-Homer protein homolog 3-, anti-Sj/inositol 1,4,5-trisphosphate receptor- and anti-carbonic anhydrase-related protein VIII-associated autoimmune cerebellar ataxia (ACA); part 2 covers anti-protein kinase C gamma-, anti-glutamate receptor delta-2-, anti-Ca/RhoGTPase-activating protein 26- and anti-voltage-gated calcium channel-associated ACA; and part 3 reviews the current knowledge on anti-Tr/delta notch-like epidermal growth factor-related receptor-, anti-Nb/AP3B2-, anti-Yo/cerebellar degeneration-related protein 2- and Purkinje cell antibody 2-associated ACA, discusses differential diagnostic aspects and provides a summary and outlook.

Radioimmunotherapy of refractory or relapsed Hodgkin's lymphoma with 90Y-labelled antiferritin antibody

The aim of this study was to evaluate the safety and efficacy of radiolabelled rabbit polyclonal antiferritin antibody in relapsed or refractory Hodgkin's lymphoma. The protocol included a first intravenous injection of In-labelled antiferritin antibody, followed by immunoscintigraphy at 4, 48 and 72 h, and an intravenous injection of Y-labelled antiferritin antibody in the case of tumour targeting. Ten patients were included in the study: median number of chemotherapy regimens: 3; number of autografted patients: 8; number of previously irradiated patients: 9; response to last chemotherapy: six partial response and four progressions. All immunoscintigraphies showed tumour targeting. Nine patients were treated, as the last patient died from progressive Hodgkin's lymphoma before therapeutic injection. Median injected activity was 12 MBq/kg (0.32 mCi/kg). Among the 10 patients who were included in the study, one complete response and six partial responses were observed (overall response rate 70%) with a median duration of response of 8 months (range: 7-12 months). Toxicity was mainly haematological, with grade 1 or 2 neutropenia and anaemia, and grade 2 and 3 thrombocytopenia. The pharmacokinetic study showed that the half-lives of In and Y were almost identical. These results confirm those previously reported and show the therapeutic potential of rabbit polyclonal antiferritin antibody in relapsed or refractory Hodgkin's lymphoma. They therefore justify further multicentre prospective trials.

Hodgkin's disease, work, and the environment. A review

Hodgkin's disease (HD), a lymphoma with an annual incidence in the United States of approximately 7500 cases, primarily affects the lymph nodes, spleen, and liver. The point of this article is to critically review the literature regarding the purported relationships between HD, certain occupations, and exposure to chemical agents. Attention will also be focused on recent advances in molecular genetics in the etiology of this ailment. A MEDLINE search was conducted to assess case-control and mortality evaluations that investigated links between HD and certain occupations and exposure to designated hazards. A review of citations in the Silver Platter Occupational and Environmental Medicine CD-ROM database was also conducted to ensure that all pertinent reports were obtained. Of the industries evaluated, woodworking showed the most consistent link between an increased risk of HD (relative risk, 1.8 to 7.2), but not all studies conducted showed positive associations. Although certain chemicals (ie, chlorophenols, pesticides) were reported as risks, no chemical was consistently and unambiguously linked with HD. Recent investigative work, however, points to a major etiological role for the Epstein-Barr virus (EBV), genetic fragments of which have been noted in Reed-Sternberg cells, the classic malignant cells of HD. The occupation most consistently associated with HD appears to be woodworking, although no specific chemical has been consistently linked with this lymphoma. The most persuasive evidence regarding the cause of HD arises from recent studies, including epidemiological, clinical, and genetic studies, that point to a major role by the EBV.

Immunological characterization of a neuronal antibody (anti-Tr) associated with paraneoplastic cerebellar degeneration and Hodgkin's disease

We studied an autoantibody (called anti-Tr), found in the serum and CSF of five patients with paraneoplastic cerebellar degeneration (PCD) and Hodgkin's disease (HD). Anti-Tr antibodies labelled the cytoplasm of Purkinje cells of human and rat cerebellum. The molecular layer of rat cerebellum showed a characteristic dotted pattern suggestive of immunoreactivity of dendritic spines of Purkinje cells. Patients with cerebellar disorders without HD (159) or HD without PCD (30) did not harbor anti-Tr antibodies. Immunoblots of human Purkinje cells or rat and mouse cerebellum were negative. Anti-Tr antibodies, as defined in this study, appear specific for HD-associated PCD. The immunohistochemical pattern described in the rat cerebellum coupled with the absence of reactivity in the immunoblot may be used to identify anti-Tr antibodies.

Myristylation of Pr60gag of the murine AIDS-defective virus is required to induce disease and notably for the expansion of its target cells

Murine AIDS (MAIDS) is characterized by severe lymphadenopathy and splenomegaly. The proliferation of the infected target B cells is also an important manifestation of the disease (M. Huang, C. Simard, D. G. Kay, and P. Jolicoeur, J. Virol. 65:6562-6571, 1991). The etiologic agent of MAIDS is a defective murine leukemia virus that is deleted of most of its pol and env genes and appears to encode a single protein, the Gag precursor Pr60gag protein. Pr60gag is myristylated and attached to the plasma membrane. To study the role myristylation on the function of Pr60gag, we have generated a myristylation-negative (Myr-) mutant of the MAIDS defective virus. We found that Myr- Pr60gag interacted less tightly with the plasma membrane. In addition, the Myr- MAIDS defective virus mutant was unable to induce expansion of infected cells and was nonpathogenic. These results emphasize the essential role of Pr60gag in the disease process. Our data also suggest that Pr60gag, once recruited to the cell membrane through its myristylation, interacts with other membrane-bound effectors to send signals to induce proliferation of the infected cells and to initiate immune dysfunctions.

Hodgkin disease in Iranian children

The epidemiological pattern of Hodgkin disease (HD) was studied in 139 Iranian children with an age range of 2.5-15 years (mean age 8.3) over a 17-year period (1972-1989). The main features observed were: a high male to female ratio of 3.2:1, a high frequency of HD in toddlers and young school children (73%), the prevalence of mixed cellularity subtype (74.5%) and rare occurrence of lymphocyte depletion subtype (2%) the high occurrence of constitutional symptoms (57%) and the high rate of stage III and IV patients (73.5%). Response to the treatment consisting mainly of chemotherapy and/or radiotherapy was favourable and overall and disease-free survival rates of 91.4% and 74.2% were achieved over a follow up period of 6 months-17 years. According to these findings the epidemiological pattern of Iranian children with HD is similar to that occurring in rural areas of developed countries.

Metaphor as illness: postmodern dilemmas in the representation of body, mind and disorder

The search for a synthesis bridging the gap between materialist and idealist approaches in anthropological theory has been invigorated by recent efforts to develop a critical medical anthropology. Not limited to integrating class analysis and cultural interpretation, the "mindful body" paradigm also aims at empowering the ill, whose experience is denied by biomedical and psychiatric categories that locate disease either in the body or in the mind, and treat them separately from one another and independently of social context. However, missing from the "mindful body" discourse is a reflexive awareness of its contextual grounding in both popular and biomedical discourses of illness, with which it exchanges meanings and from which it borrows dominating power. The case of cancer as a metaphorized illness and a pathologized trope is used to illustrate this process.

The majority of cells infected with the defective murine AIDS virus belong to the B-cell lineage

Murine AIDS (MAIDS) is caused by a defective retrovirus which encodes a gag fusion protein (Pr60gag). We previously reported that this virus induced an oligoclonal proliferation of infected cells and suggested that this cell expansion was an important event in the pathogenesis of MAIDS. To identify these target cells, we constructed novel defective viruses whose genomes could be detected with specific probes. Helper-free stocks of these viruses induced MAIDS. Using in situ hybridization and immunocytochemistry and Southern analysis, we found that most infected cells belong to the B-cell lineage. Transformation of these B cells appears to be the primary event responsible for the development of immunodeficiency. This animal model may be relevant to our understanding of AIDS, of the immunodeficiencies associated with B-cell lymphoproliferative disorders, and of the role of B-cell proliferation and transformation in the effects of superantigens, since Pr60gag appears to be a superantigen.

Stage I and II subdiaphragmatic Hodgkin's disease

From January 1971 to December 1986, 521 patients with Hodgkin's disease were evaluated and treated at the Yale University School of Medicine or one of its close affiliates. A total of 258 patients had pathologic stage (PS) I or II disease, with 239 patients having Hodgkin's disease above the diaphragm (ADHD) and 19 patients having Hodgkin's disease below the diaphragm (BDHD). A comparison of patients with BDHD versus patients with ADHD showed that patients with BDHD were older (mean age, 42 versus 28 years of age, P = 0.005), were initially seen less often with nodular sclerosis subtype (32% versus 77%, P = 0.00001), and had a higher male: female ratio (2.8 versus 1.2, P = 0.12). Ten patients with BDHD (53%) had positive findings at staging laparotomy (0 of 4 clinical stage [CS] IA patients and 10 of 15 (67%) CS II patients). Radiation therapy alone was the initial treatment of choice for 74% of patients with BDHD versus 94% of the patients with ADHD. There was no statistical difference in the overall survival or relapse-free survival rates for patients with BDHD versus ADHD (10-year survival rates, BDHD = 73% and ADHD = 81%). However, patients with BDHD who initially had intra-abdominal disease had a statistically significant increase in death rate (60%) due to Hodgkin's disease compared with patients with BDHD who initially had only peripheral nodal disease (0%). Treatment recommendations for patients with BDHD should be tailored to the specific clinical presentation of each patient. For most PS IA/IIA patients initially seen with peripheral nodal disease, radiation therapy alone is a successful treatment program. However, combined modality therapy should be the treatment of choice for patients with BDHD initially seen with intra-abdominal disease.

Dermatomyositis as presenting symptom of Hodgkin's disease

The association between dermatomyositis and malignancy is well documented. However, the association between dermatomyositis and Hodgkin's disease is very unusual, particularly in children, adolescents, and young adults. A MEDLINE search of the literature revealed only 13 previous cases.

Hodgkin's disease in adults in Saudi Arabia. Clinical features, prognostic factors and an analysis of therapy. Outcome of combination chemotherapy only, for both localized and advanced disease

Fifty evaluable, previously untreated, adult patients with clinically staged (CS) early and advanced Hodgkin's disease were treated with chemotherapy alone, using various regimens. Their mean age was 31.9 years. Fifteen patients (30%) had CS I or II and 35 (70%) had CS III or IV. Eighty-eight per cent of patients had one or more of the B symptoms and 64% had an unfavorable histology. Complete remission (CR) was achieved in 43 out of 50 patients (86% with 95% confidence interval of 76% to 96%), partial remission in 3 (6%) and treatment failure in 4. Adjusted analysis, using all possible subset regression, showed that unfavorable histology, bulky disease and receiving a total dose-intensity (TDI) less than or equal to 0.80 were negatively associated with the likelihood of achieving CR. At a median follow-up of 36 months (range, 6-90), 84% of patients were alive and 82% were disease-free. The overall median survival has not been reached, but the projected 5-year survival probability was 79%. Time-to-relapse was also estimated for those who achieved initial CR. The estimated 5-year relapse-free survival was 87%. The Cox proportional hazards model predicted that unfavorable histology, bulky disease and TDI less than or equal to 0.80 had an independent, adverse influence on survival. We conclude that the results of chemotherapy alone are encouraging and the rationale is practical and acceptable in those countries where the availability of radiotherapy units is limited.

Hodgkin's disease in black Zimbabweans. A study of epidemiologic, histologic, and clinical features

A 3-year prospective study of the histologic and clinical features of patients with Hodgkin's disease presenting to the medical units in Harare, Zimbabwe, was undertaken. The histologic pattern of disease was similar to that of other African countries with mixed cellularity and lymphocyte depleted patterns prevailing (58% and 21%, respectively). Unlike most African countries, however, disease occurred most commonly in teenagers and young adults. Nutritional status was poor in just under 50% of the patients. Clinically, the extent of disease at presentation was striking, with over 90% of patients having advanced stage disease in spite of the stated duration of symptoms being moderate. The histologic and clinical findings resembled those reported from other African countries, but in certain aspects the epidemiologic pattern was intermediate between those of affluent and underprivileged communities.

Lymphocyte predominance Hodgkin's disease. A clinicopathologic reassessment

A clinicopathologic analysis of 35 cases of lymphocyte predominance Hodgkin's disease (LPHD) was performed, and the relationship between various histologic features and stage at presentation was examined. The series comprised 31 male and 4 female patients with a median age of 32 years. Twenty patients had Ann Arbor Stage I disease; 5, Stage II; 8, Stage III; and 2, Stage IV. Eight cases showed a multifocal epithelioid histiocytic reaction; six of these had advanced-stage (III or IV) disease (P = 0.003). Five cases contained relatively frequent atypical mononuclear cells; four of these were Stage III or IV (P = 0.017). A purely diffuse growth pattern was also associated with high stage (P = 0.031). Presence of nodularity correlated with low stage (P = 0.031). During follow-up (median, 4 years; range, 2.5 months-18 years) there was a high incidence of second neoplasms (2 large cell lymphomas, 3 non-hematologic malignancies). LPHD manifests greater diversity of stage at presentation than originally thought. A high content of epithelioid histiocytes, relatively frequent atypical mononuclear cells, and diffuse histology appear to define subsets associated with advanced-stage disease. The correlation of nodular growth pattern with low-stage disease is consistent with the distinctive behavior and derivation of nodular LPHD.

Lymphocyte-depleted Hodgkin's disease. Clinicopathologic review of 25 patients

Clinicopathologic material from 25 patients with lymphocyte-depleted Hodgkin's disease was reviewed. The median age of the patients was 57 years. The patients had no prior diagnosis of Hodgkin's disease and were divided according to pathologic subtype of lymphocyte-depleted Hodgkin's disease: 11 diffuse fibrosis, 10 reticular, and four not otherwise specified. The clinical presentation included B symptoms of fever, weight loss, or night sweats (92 percent), subdiaphragmatic disease (88 percent), frequent marrow involvement (56 percent), and advanced-stage disease (100 percent). Four of 11 patients with diffuse fibrosis had peripheral adenopathy as compared with seven of 10 patients with the reticular subtype (p = 0.3); 10 of 11 patients with diffuse fibrosis had marrow involvement compared with two of nine patients with the reticular subtype (p = 0.006). Among patients who received chemotherapy, median survival was longer in the diffuse fibrosis subtype (nine patients, 39 months) than in the reticular subtype (10 patients, 10 months), p = 0.005. Of the 17 patients who received more than one cycle of combination chemotherapy with mechlorethiamine, vincristine, procarbazine, and prednisone, the median survival was 36 months with 11 (65 percent) complete remissions. In eight patients, disease remains in remission (12 to 127 months) with five patients surviving beyond five years. These results indicate that lymphocyte-depleted Hodgkin's disease has at least two clinicopathologic subtypes and is curable if adequate therapy can be given.

Prediction of splenic involvement in children with Hodgkin's disease. Significance of clinical and intraoperative findings. A retrospective statistical analysis of 154 patients in the German therapy study DAL-HD-78

In 154 splenectomized children and adolescents with histologically proven Hodgkin's disease in the therapy study DAL-HD-78, the incidence of splenic involvement was 39%. In single-parameter analyses 6 of 16 examined pre- and intraoperative findings showed significant correlation to splenic involvement: B-symptoms, palpable splenic enlargement, mediastinal/lung hilus involvement, nodular changes of splenic surface, enlarged lymph nodes at splenic hilus/pancreatic tail, or enlargement of other upper-abdominal lymph nodes. The results of multivariant analyses (Cox regression model) of these six parameters showed that the two most significant intraoperative parameters--changes of splenic surface and enlargement of lymph nodes at splenic hilus/pancreatic tail-gave almost all of the information which can be obtained about splenic involvement. With these two parameters, an intraoperative decisional strategy for selective splenectomy has been developed which allows the omission of splenectomy in about two thirds of children with Hodgkin's disease while still obtaining detailed information about infradiaphragmatic spread of disease. Since minor splenic involvement remains undetected in about 10% of the nonsplenectomized patients (i.e., 6% of all patients), this method should be used only in combination with chemotherapy.

Dermatomyositis and Hodgkin's disease. Case report and review of the literature

The association between dermatomyositis and Hodgkin's disease has been infrequently reported. A patient with advanced Hodgkin's disease and dermatomyositis is presented and an additional 11 cases obtained from the world literature are reviewed. The clinical features, response to treatment, and outcome of these diseases are discussed.

Clinical and laboratory findings in untreated patients with Hodgkin's disease with special reference to age

During a 6-yr period 258 adult patients (greater than or equal to 15 yr) with biopsy verified Hodgkin's disease (HD) were reported to the Stockholm-Gotland Oncologic Center. In 57 elderly patients (mean age 74 yr) the diagnosis was established shortly before death or at autopsy. One hundred and eighty-two of remaining 201 patients (118 men and 64 women, mean age 47 yr) were investigated. They were evenly distributed in stages I-IV and 43% had B symptoms. NS, 38% and MC, 38% were the most common histological subtypes in contrast to LP, 14% and LD, 10%. Stage II disease and NS histopathology dominated among patients below 50 yr. Patients with hilar/mediastinal lymphomas were often young and had NS histopathology with B symptoms. The diagnosis was established within 3 months after the first symptoms in 52% while 15% had symptoms for more than one year. Eleven patients reported a previous malignancy which is similar to the expected number of 13.8. The results support the concept that in unselected patient series HD seems to be at least as common among elderly as in young people. In the investigated series advanced disease and MC and LD histopathology did not dominate among patients above 50 yr which has been reported previously.

Discriminant analysis of Hodgkin's disease and non-Hodgkin's lymphomas by age and serum proteins

Immunonephelometric evaluations of 13 serum proteins were made in 71 patients with two types of lymphoproliferative diseases: Hodgkin's disease (32 patients) and non-Hodgkin's lymphomas (39 patients). The subjects were differentiated by discriminant analysis by means of age and three selected proteins: properdin factor B, IgM and ceruloplasmin. The results obtained permitted classification of 90% of the cases reported.

Management of Hodgkin's disease in western India

The authors report a retrospective analysis of 441 patients with Hodgkin's disease seen at the Tata Memorial Hospital, Bombay, over a 4-year period from 1975 to 1978. Clinicopathologic features seem to vary from those reported in the western literature, but are similar to the patterns observed in Africa and South America. Thirty-three percent of all malignant lymphomas were Hodgkin's disease. Histologically, the mixed cell (MC) type (40%) and the lymphocytic predominant (LP) type (24%) were the most common, with 52% of patients presenting in Stages III and IV. The nodular sclerosis (NS) variant occurred in only 11% of the cases. Systemic symptoms were present in 24% of clinical Stage I patients, and increased steadily to 85% in Stage IV patients. Bone marrow biopsies in 242 patients were found to be of little value in Stages I and II. Thirty of 34 patients with positive bone marrow biopsy were in clinical Stages III B and IV, whereas 24 of 34 patients showed MC and LD patterns. Lymphangiography in 104 patients altered the clinical staging of Stages I and II in 27% of the cases with accuracy of 80%. Staging laparotomy performed in 93 patients altered the stage in 45% of clinical Stage I and 62% of Stage II patients. Splenic involvement was common in the presence of systemic symptoms (67%) and MC/LD histology (82%). The incidence of liver involvement was 16% in 15 patients with all, but one, associated with splenic pathology. The clinical stage and histopathologic variants of the disease bear an excellent correlation with a significant impact on treatment responses and total survival. The survival rates for Stage I were 81%, Stage II 76%, Stage IIIA 71%, and Stage IIIB and IV 46% at 48 months. The LP type had the best prognosis with 85% survival at 48 months, whereas the survival in the depleted variety was only 56%. Surprisingly, the MC type did better with a 64% survival, while the nodular sclerosis group had 59% surviving at 48 months.

Lymphocyte predominant Hodgkin's disease: clinical presentation and results of treatment

The records of 59 patients with lymphocyte predominant Hodgkin's disease (LPHD) evaluated and treated at Stanford University Medical Center between 1963 and 1983 were reviewed. Of these 59 patients, 92% are alive at 10 years following treatment, 78% are relapse-free, and none have died of Hodgkin's disease. Compared with the other histologic subtypes of Hodgkin's disease, LPHD presents more frequently as stage I or II disease (78% vs. 55%) and less frequently with constitutional symptoms (7% vs. 32%). Despite these factors, there is no statistically significant difference in either survival or freedom-from-relapse (FFR) between the histologic subtypes when comparisons are made on a stage-for-stage basis. Analysis of sites of presentation and relapse reveals that LPHD rarely involves intrathoracic structures. Patients with C.S. I disease presenting in inguinofemoral or high cervical lymph nodes do not require staging laparotomy as none of these patients were upstaged by surgery. Patients with stage I disease involving high cervical lymph nodes may be treated with limited field irradiation employing fields no more extensive than a mantle and Waldeyer's ring field, as no relapses have been seen in such patients treated in this fashion. Although limited field irradiation was used successfully for LPHD presenting in other localized sites, inadequate patient numbers preclude assessment of this treatment for those clinical presentations.

Splenectomy and infection in Hodgkin's disease

The incidence of infection in 56 patients with Hodgkin's disease who had undergone staging laparotomy with splenectomy was compared with that of 28 non-splenectomized patients with Hodgkin's disease treated concurrently. The results suggest that splenectomy does not result in a major change in the incidence of infection experienced by such patients with stage II or stage III disease. Aggressive therapy may be of greater importance in increasing the susceptibility to infection in Hodgkin's disease.

Lectin staining of carbohydrates of haemic cells. III. The cells of Hodgkin's disease and other lymphomas

When stained for reactive sialyl groups with fluorescein-labelled Aprotinin (FLA), lymphocytes of three diffuse lymphomas were uniformly faintly fluorescent. The nodules of a nodular lymphocytic lymphoma showed dimly fluorescing lymphocytes surrounded by brightly fluorescing, apparently normal cells. The spleens of eight patients with Hodgkin's disease showed involvement in six cases. With FLA, the two uninvolved spleens contained only brightly fluorescing lymphocytes, whereas the foci of Hodgkin's lesions in the six spleens and in eight involved lymph nodes from a further eight patients contained varying proportions of brightly and dimly fluorescing lymphoid cells. Mononuclear Hodgkin's cells and bi- or multinucleated Reed-Sternberg cells fluoresced faintly. Fluorescein-labelled Ricinus communis agglutinin (FL-RCA) for galactose, and Concanavalin A (FL-Con A) for mannose or glucose, showed eosinophils, reticulin and collagen fibres especially in nodular sclerosing Hodgkin's disease, whereas all lymphocytes, Hodgkin and Reed-Sternberg cells stained faintly with either lectin. The reduction of reactive sialyl groups in malignant lymphocytes of lymphomas and Hodgkin's lesions is similar to that in lymphocytic leukaemias. It is suggested that in Hodgkin's disease these lymphocytes together with the Hodgkin and Reed-Sternberg cells represent the malignant component, whereas the brightly fluorescent normal lymphocytes, together with histiocytes, eosinophils (and neutrophils) represent a reactive component in the lesions. Similarly, the reactive lymphocytes in sarcoid lesions and sinus histiocytosis were brightly fluorescing.

Tumours of the mononuclear phagocyte system: a review of clinical and pathological features

Cells of the mononuclear-phagocyte system (MPS) may give rise to a wide variety of tumours of diverse morphology ranging from acute leukemia to small benign tumours of the skin. This review of tumours of the MPS was prompted by recent advances in understanding of tumour morphology and immunologic features. It is now possible to differentiate tumours of the MPS mor precisely from tumours of lymphoid origin with which they have often been confused; however, controversy still exists as to the origin of the malignant cell of Hodgkin disease. Current evidence is reviewed which favours the view tht the malignant cell of Hodgkin disease is of monocyte origin. A classification of MPS tumours based on organ system of origin and disease extent is presented.

Hodgkin's disease: a clinicopathologic study of 659 cases

A large number of histologic and clinical parameters were assessed, tabulated and intercorrelated in 659 patients with Hodgkin's disease evaluated and treated at Stanford University Medical Center. Nodular sclerosis was the most common pattern (60%) and also had the best total survival, but lymphocyte predominance had the best relapse-free survival. While a number of histologic parameters showed a significant correlation with relapse-free survival, multivariate analysis showed that age, stage, and treatment were relatively more important. Of the histologic parameters, only the number of lymphocytes, fibroblasts, and amount of sclerosis remained significant after multivariate analysis. The positive correlation of sclerosis, negative correlation of the number of fibroblasts and lack of correlation of lacunar cells with relapse free survival in patients with nodular sclerosis suggested that the type of mesenchymal reaction was of prime importance in determining prognosis in that form of Hodgkin's disease. The number of lymphocytes did not independently affect prognosis in patients with nodular sclerosis but did so for the entire group. The cellular phase of nodular sclerosis was found to have an overall survival and some clinical features more akin to mixed cellularity Hodgkin's disease.

Impaired autologous mixed lymphocyte reactivity in Hodgkin's disease

In patients with Hodgkin's disease, the impaired immune reactivity, especially of the thymus dependent system, is well established. This decreased immune response of the lymphocytes from the peripheral blood contrast to an increased lymphocytopoiesis in the the lymphatic organs with a hyperplasia of these tissues. We studied the reactivity of peripheral T lymphocytes from 20 patients with Hodgkin's disease and 26 healthy control persons against autologous and allogeneic non T cells respectively in the mixed lymphocyte culture (MLC). Our experiments show an extremely depressed autologous mixed lymphocyte reactivity (MLR) of T lymphocytes from patients with Hodgkin's disease compared to those from normal donors. In the allogeneic MLC, the proliferation of the patients' T cells was stronger than in the autologous MLC, but significant lower than the proliferation of normal T lymphocytes when stimulated by normal non T cells. Patients' non T cells stimulated T lymphocytes from healthy donors as well as non T lymphocytes from normals did. Finally, the autologous MLR of normal lymphocytes was significantly suppressed by 18 of 23 sera from Hodgkin's patients when these sera were substituted for normal AB serum in the cultures. These results demonstrate an impaired function of T lymphocytes from patients with Hodgkin's disease in the autologous MLC and the presence of one or more factors in their serum which inhibit the proliferation of normal lymphocytes in the autologous MLC. The role of suppressor cells and their factors will be discussed.

Hodgkin's disease and non-Hodgkin's lymphoma in children and young adults: a clinicopathologic study of 127 cases

One hundred twenty-seven cases of non-Hodgkin's lymphoma and Hodgkin's disease in children and young adults at the University of Wisconsin Hospital between 1969 and 1980 have been reviewed. Nodular sclerosing was the most frequent histologic type in patients with Hodgkin's disease. Malignant lymphoblastic lymphoma (MLLB) was the most common type of non-Hodgkin's lymphoma. The relationship of the histological pattern to age and sex as well as clinical behavior and survival are discussed.

Ataxia telangiectasia with evolution of monosomy 14 and emergence of Hodgkin's disease

A young woman, with ataxia telangiectasia (AT) had a chromosomally abnormal T-lymphocyte clone detected at 23 years of age. This clone showed nonrandom loss of chromosome # 14, a karyotypic abnormality not previously described in AT. Eighteen months later, evolution of the monosomic clone was noted; the karyotype of this latter clone was 45,XX,-14,del(6) (q21). The patient died of Hodgkin's disease of mixed cellularity type, Stage IIIB, a few months later. A striking histological features of a lymph node biopsy was the presence of numerous epithelioid histiocytes. The patient's paternal first cousin also suffers from AT.

Abscopal regression in lymphoma: a mechanism in common with total body irradiation?

The hospital records of 895 patients presenting to this centre with a diagnosis of Hodgkin's or non-Hodgkin's lymphoma have been reviewed. In the records of 26 patients there was evidence for or against the occurrence of abscopal regression with radiotherapy. Attention is drawn to inevitable inaccuracy in a retrospective study of this type. Evidence of abscopal regression was seen in the records of 10 patients, four with Hodgkin's and six with non-Hodgkin's lymphoma. It appears to be associated with a more favourable prognosis in patients with non-Hodgkin's lymphoma. It is suggested that this phenomenon is elicitable in more patients than is commonly recognised, and that together with response to low dose total body irradiation, could be explained by radiation damage to normal lymphocytes.

Descriptive Epidemiology of Hodgkin's Disease in the Province of Padova, 1970-1974

The age-standardized incidence rates of Hodgkin's disease in the province of Padova during the period 1970-1974 were 4.33/105 per year for males and 3.70/105 per year for females. These rates are higher (particularly for females) than in other European countries and close to those reported for North America. A bimodal distribution by age is present in the province as a whole. These findings, with the limitations due to the small population and diagnostic difficulties taken into account, are discussed with a view to further investigation.

Severe conduction disturbances and ventricular arrhythmias complicating mediastinal irradiation for Hodgkin's disease: a case report

A 27-year-old male had undergone mediastinal and retroperitoneal irradiation for stage IIIA Hodgkin's disease at age 19. When he was admitted to the hospital, because of lightheadedness and syncope, trifascicular bundle branch block was noted and the patient underwent a clinical electrophysiological investigation. AH and HV intervals were prolonged and ventricular fibrillation was induced during programmed right ventricular stimulation. Serial electrophysiological studies allowed us to prescribe effective antiarrhythmic drug therapy with no recurrence of symptoms during a follow-up period of 12 months.