Hodgkin's disease: The significance of vascular invasion

Eighty-nine lymph nodes removed from 71 patients initially diagnosed as Hodgkin's disease (HD) were reviewed. Autopsy material was available in 19 of these cases. Thirteen patients were excluded as not being HD after the review. The remaining 58 biopsies were classified as lymphocyte predominance (LP) in 5 instances; nodular sclerosis (NS), 27; mixed cellularity (MC), 15; and lymphocytic depletion (LD), 4. There were 7 patients with „unclassified”︁ HD. The most frequent sites of lymphadenopathy were neck, mediastinum, and axilla involving 60%, 29%, and 19% of the patients, respectively. Mediastinal lymphadenopathy was most frequently seen in the NS type. There were three interesting findings in relation to vascular invasion: A) The incidence of vascular invasion in the original lymph node biopsies was highest in LD (75%) and decreased in MC, NS, and LP (33%, 13% and 0% respectively). This difference is statistically significant (p > 0.025); B) The incidence of vascular invasion was higher in the autopsy material when the disease was widespread with extranodal involvement; C) Prognosis was better when vascular invasion was not demonstrated in original lymph node biopsies. The average survival time in this group was 65.8 months, while it was 21.8 in those whose lymph node biopsies showed vascular invasion. This difference is statistically significant (p > 0.05). None of the 16 patients who lived over 5 years showed vascular invasion in original biopsy material, while in 9 of 18 patients (50%) who died less than 2 years after diagnosis, vascular invasion was demonstrated.