Hodgkin’s Disease is not a Cancer
Hodgkin’s disease was discovered in the 19th century by Hodgkin. Last century it was regarded as a chronic inflammation which may become a (Hodgkin’s) lymphoma. Clinically and epidemiologically it differs from lymphoma. Currently without any justification it is regarded as a lymphoma. Which is false since Hodgkin’s disease is neither a lymphoma nor a cancer.
Here how I view cancer:
1. All cancers progress along the same trajectory
2. Cancer starts as an inflammation of an organ or field which ultimately may become malignant.
3. Tissues are composed of units, each nourished by a stem cell.
4. Cancer starts with a neoplastic transformation of a stem cell and its progeny.
The question is how does Hodgkin’s disease and its lymphoma fit into this frame work.
Progression of Hodgkin’s disease:
1. Lymphocytic predominance
2. Nodular sclerosis
3. Mixed cellularity
Granulocytosis, eosinophilia, histiocites and plasma cells. Reticular fibrosis.
4. Lymphocytic depletion
Severe reticular fibrosis and maturation arrest (depletion of lymphocytes)
Phases 1-3: Chronic inflammation with dysplastic foci.
Phase 4: Maturation arrest. Manifested clinically by: Lymph node swelling, weight loss, Fever chills, and itching.
Inflammation progresses as a dysplastic field, involving several lymph nodes. Accompanied by proliferation of reticular stroma. Phase 4 is an analog of carcinoma in situ and adenomatous polyp. Neoplasia is always preceded by a chronic inflammation, Hodgkin’s disease is the inflammatory phase of lymphoma. While NHL is generally incurable Hodgkin’s disease may be cured. 1
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