Hodgkin's Disease, with Bone and Skeletal Muscle Involvement

In 1832 (1) Hodgkin called attention to a group of cases characterized by enlargement of lymph nodes and spleen. In 1856 (2) Wilks recognized the condition as a clinical entity, suggested the name “Hodgkin's disease,” and believed it to be allied to tuberculosis. Since that time to the present there has been much investigation and writing in regard to the nature of this disease, the resulting confusion being indicated by the proposed names, viz., pseudoleukemia, lymphoma malignum, lymphadenoma, lymphogranulomatosis, and Hodgkin's disease. From 1885, the literature records many case reports and varying methods of approach, attempting to ascertain the nature of the process. Sternberg (3) studied thirteen cases of Hodgkin's disease and reported that eight of them presented tuberculosis in one or more organs. His paper has profoundly influenced medical thought in this direction ever since. Andrewes (4), in England, and Reed (5) and Longcope (6), in this country, have done much to clarify the histopathology of the disease, and from their studies they have concluded that it is not due to the tubercle bacillus, though tuberculosis may be associated. Etiology At the outset it may be well to state that there is no recognized etiological agent. Sternberg (7), in 1925, still adhered to the tuberculous nature of the disease, but many clinical and laboratory studies have not settled this problem either way. The disease is considered neoplastic by some; others state that malignant changes may occur in the diseased tissues, while still others have searched for an infectious agent. Fraenkel and Much (8) reported finding a diphtheroid organism in Hodgkin's nodes. Bunting and Yates (9) isolated and described similar organisms, which, when injected into monkeys, produced lesions similar to those seen in Hodgkin's disease. Bloomfield (10) isolated similar organisms from both normal nodes and nodes from varying pathological processes. Some believe the infectious agent to be a protozoa, others that it is a fungus. Pathology The disease is one of the lymphoid system and may show the predominant lesion in different tissues of the body. The lymph nodes of the body are the structures most frequently involved, but the superficial nodes are not uniformly affected. Symmers (11) divides the lymph nodes into three divisions: a. Those of neck, axilla, thorax, abdomen, and groin. It is these which are most commonly affected. b. The submucosal group, including the faucial and lingual tonsils, and the lymphoid tissues of the gastro-intestinal, urinary, and respiratory systems.