7.6.1.2 Lungs

•Pulmonary involvement in patients with mediastinal enlargement; in about 20%, also pulmonary involvement as solitary peribronchial or subpleural lesion

•Intraparenchymal:

–Nodular form: similar to lung abscess, tuberculosis, or fungal infection

–Alveolar form: similar to pneumonia

•Pleural manifestation when obstruction of lymphatic channels is present (rarely)

7.6.1.3 Bone Marrow

• Bone marrow involvement in patients with B symptoms and with anemia; low WBC and/or thrombocytopenia

• Multiple bone marrow biopsies necessary, because involvement is mostly focal

• Bone scintigraphy may indicate biopsy location

7.6.1.4 Bone

• Involvement via hematogenous spread

• Vertebral involvement with spinal compression or with vertebral body collapse, as well as involvement of epidural area, is known

• Bone involvement indicates poor prognosis

7.6.1.5 Liver

•Involvement mostly together with concomitant splenic disease

•Histologically diffuse or nodular pattern

•Hodgkin involvement of the liver is prognostically unfavorable

•Nonspecific hepatomegaly with or without abnormal liver-function tests is often described in Hodgkin disease

•Differential diagnosis: hemolysis, hepatitis due to virus toxoplasmosis, cytomegalovirus infection, cholestasis, periportal infiltration of lymph nodes

7.7Laboratory Analyses

7.7.1Blood

•Anemia indicates an advanced stage of disease or an autoimmune phenomena of hemolysis with or without thrombocytopenia and neutropenia

•Neutrophilia and eosinophilia occur in 15–20% of patients

•Occasionally thrombocytosis

•Lymphocytopenia indicates an advanced stage of the disease

•High erythrocyte sedimentation rate in active Hodgkin disease; normal during remission

•Bone marrow involvement (see above)