[Hodgkin's disease--current problems in etiology and clinical picture]

Abstract

The conception of etiology and pathophysiology of lymphogranulomatosis has essentially changed since the first description made by Hodgkin in 1832. In former communications, this disease was initially regarded as a tuberculosis of the lymphatic system with a pseudoleukemic course, then as an inflammatory disease, then as an intermediate state between cancer and tuberculosis, and finally as a chronic autoimmune process accompanied by interactions between neoplastic and normal lymphoid cells. Today the symptomatology is defined as a malignant disease of the lymphoreticular system beginning in a single lymph node, then expanding to other lymph nodes and spreading out by hematogenic propagation into the parenchymatous organs. The histologic examination of granulomatous tissue shows Hodgkin cells with one nucleus and Sternberg-Reed giant cells with several nuclei. The origin of Hodgkin cells is not yet clear, however, there are some hints resulting from investigations with monoclonal antibodies that the precursor cells possess some characteristics of granulopoietic cells, but also of antigens which are recognized by specific monoclonal antibodies. The immune system shows some modifications, above all with regard to the cellular immunity. The evolution of the disease is probably determined by some correlations with troubles of the cellular immune system. The treatment modalities depend on the stage which is classified according to the Ann Arbor Conference. The diagnosis should be established under rational aspects and with the aid of the most recent image-producing methods.