Mortality in Relation to Histologic Type in Hodgkin’s Disease

Abstract

Abstract 1. A study of the trends of mortality in Hodgkin’s disease of diverse histologic type was undertaken with 437 cases at the AFIP Lymphatic Tumor Registry. These represent the records and pathologic material in the Registry of all white males in whom the disease was diagnosed during service in the Army in the World War II period (1941-1946). 2. Follow-up through June 30, 1953 by means of service, Veterans Administration and other records was carried out by established methods which have been demonstrated to result in virtually complete tracing. 3. On histologic analysis of the cases, 388 were confirmed as Hodgkin’s disease and these were differentiated by histologic type as Hodgkin’s granuloma (308 cases, 79 pet cent), Hodgkin’s paragranuloma (35 cases, 9 per cent) and an unspecified group (40 cases, 10 per cent) in which a decision as to type could not be made and as sarcoma (5 cases, 1 per cent). A further analysis of the 308 cases of Hodgkin’s granuloma showed secondary histologic characteristics of sclerosis in 57 instances (18.5 per cent), and of sarcoid in 13 cases (4.2 per cent). 4. The mortality at seven years after diagnosis was 77.1 per cent for the entire group of cases of confirmed Hodgkin’s disease; 28.6 per cent for Hodgkin’s paragranuloma; and 82.8 per cent for Hodgkin’s granuloma. The difference in mortality between these types is significant. 5. The seven year mortality rate for granuloma without qualifying histologic characteristics was 85.7 per cent; for cases with a sarcoid component, 81.8 per cent. The difference in mortality between nonsclerosing and sclerosing Hodgkin’s granuloma (87.5 per cent as against 74.5 per cent) was significant although the significance is borderline. 6. On re-evaluation of the 15 instances diagnosed as Hodgkin’s paragranuloma and terminating fatally, it appeared from the original biopsy material that the diagnosis probably should have been Hodgkin’s granuloma in five instances, and "malignant lymphoma, type uncertain (Hodgkin’s disease not ruled out)" in one case. In the remaining nine instances the histologic diagnosis of the original biopsy material of paragranuloma was confirmed. Autopsy material was available in three of the fifteen cases; two of these showed widespread Hodgkin’s granuloma and one presented a generalized malignant neoplasm, possibly of the Hodgkin’s sarcoma type. 7. For 95 per cent of the deaths among the histologically confirmed cases of Hodgkin’s disease the reported cause of death as found in hospital records or on death certificates was Hodgkin’s disease. It is not known for many of these whether the stated cause of death was verified by autopsy. 8. From the available evidence the question of transformation from paragranuloma to granuloma, or to sarcoma, or to any other form of lymphoma cannot be answered. 9. The correct diagnosis of the types of Hodgkin’s disease and the differentiation of secondary histologic characteristics are of importance in the evaluation of the prognosis, and for the choice of treatment.