Diagnosis of Primary Hodgkin's Disease of the Stomach

Primary Hodgkin's disease of the stomach is a rare condition. A search of the literature reveals that approximately 22 cases have been reported up to the time of the present writing. The case to be included in this report will bring the number to 23. Of these cases, only one is claimed to have been diagnosed preoperatively, namely, the second of two reported by Browne and McHardy (1) in 1946. Among these 22 cases, approximately 16 were treated by surgical means, mainly total or subtotal gastric resection and, so far as can be determined, all those that survived the immediate postoperative period have continued to live without definite evidence of recurrence (2), indicating that if this disease can be diagnosed preoperatively it should call for immediate extensive surgery. In other words, the presence of a very extensive lesion of the stomach, in some cases involving almost the entire organ, should not be a deterrent to radical surgery, in spite of the usual hopeless prognosis of extensive gastric carcinoma. The authors made this very mistake in the case being reported in this article. It is believed that cases of Hodgkin's disease primary in the stomach seen from time to time are diagnosed radiologically as extensive infiltrating carcinoma, with a hopeless prognosis, and the patients are sent home to die. As a result, autopsies are not performed, so that the true condition is never ascertained. A few characteristics stand out, both in the authors' case and in the cases reported, that should be pointed out to radiologists in the hope that they may be made more suspicious of the possibility of this lesion and that the number of exploratory laparotomies may perhaps be increased. The principal criterion that we have noted consists in the presence of polypoid-like masses along the course of the involved area of the stomach. Apparently, almost any portion of the organ may be affected, from the fundus to the pylorus. Ulcerations may be present but the most obvious feature in these cases is the rounded masses. They may be multiple, as in our case, or they may be large and solitary, as reported by Browne and McHardy (1). The history and physical findings are of little value for the diagnosis. The ordinary laboratory procedures are of no help. The blood counts may be of any type. The disease is limited entirely to the stomach, with no evidence of chest pathology or of lymphadenopathy elsewhere in the body. Palpable masses are not always found, and the history may be rather acute in onset or it may extend over a period of many years. In the authors' case, the gastric symptoms began some two months before admission, although the patient had had vague complaints for many years, putting him in the classification of a psychoneurotic. Pain may or may not be present. Frequently it is of the ulcer type. Obstructive symptoms may occur if the lesion is near the pylorus or possibly adjacent to the esophageal opening.