A NEW INTERPRETATION OF THE PATHOLOGIC HISTOLOGY OF HODGKIN'S DISEASE

DOUGLAS SYMMERS
1917 Archives of Internal Medicine  
There are two outstanding theories concerning the nature and origin of Hodgkin's disease: one, that it is primarily an infective granulomatous lesion of the lymph nodes with secondary changes in the spleen, liver and other tissues; the second theory postulates that the disease is neoplasmic from the beginning. Neither offers an acceptable explanation of the process as a whole, and there is considerable evidence in contradiction of both. The histologic changes in Hodgkin's disease were
more » ... ease were originally described by Sternberg1 as the expression of a peculiar type of lymph node tuberculosis. Repeated efforts to detect tubercle bacilli in suitably stained microscopic preparations, and the injection of freshly emulsified lymph nodes into susceptible animals, have failed, however, to confirm this view, and it has since been generally abandoned. More recent efforts to implicate a diphtheroid micro-organism as the cause of Hodgkin's disease have likewise been discredited. Nevertheless, the prevalent opinion seems to be that the process is inflammatory, the neoplasmic theory having failed of popular acceptance largely because the histologic changes in the lymph nodes and elsewhere are more in consonance with the conception of a granuloma. As a matter of fact, Hodgkin's disease appears to me to exemplify the frequently neglected fact that inflammation and neoplasia share several important features in common, and that the distinction between the two is, at best, academic and artificial, and, at times, impossible. Thus, the histologic changes in Hodgkin's disease bear a resemblance to those of tuberculosis on the one hand, and to a malignant connective tissue tumor on the other, while the distribution of the lesions in the liver, kidney, bone marrow, and other tissues not commonly included in the lymphoid system, is strikingly like that of a metastasizing tumor, but is also explicable on the basis of inflammatory hyperplasia of pre-existing lymphomatous foci. There is still another possibility, however, which does not appear to have been previously emphasized, namely, that the histologic changes in the lymph nodes, spleen and other parts of the
doi:10.1001/archinte.1917.00080260033003 fatcat:3erfov2trvgrpblciqlms62fgm