EXTRA NODAL SPREAD OF HODGKIN’S DISEASE

The pathogenesis of 45 instances of extra nodal Hodgkin’s disease occurring at 4 selected sites, the skin, epidura, lung, and bone, was studied in 150 patients. The corresponding regional lymph nodes were involved before the appearance of extra nodal disease in 75 per cent of these patients. In 40 per cent of the cases there was no evidence of other extra nodal disease. Retrograde lymphatic embolization of Hodgkin’s tumor cells was postulated as the mechanism of extra nodal spread.

The major significance of these findings is that they emphasize the role of lymphatics in the spread of Hodgkin’s disease. Extension via lymphatics is probably the predominant mechanism of both inter nodal and extra nodal spread.

The clinical data also suggest the importance of retrograde flow in lymphatics, a direction of flow that may occur in both inter nodal and extra nodal spread.

Once the concept that extra nodal spread may occur by retrograde lymphatic embolization is accepted, then the implication of extra nodal disease for a given patient is entirely different and each patient must be evaluated individually with a view toward the optimum treatment.

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