Pitfalls in the diagnosis and classification of Hodgkin’s disease: Surgical pathology and classification for the 1980’s

Is the Lukes-Butler classification still relevant?
  • Thomas V. Colby
Part of the Cancer Treatment and Research book series (CTAR, volume 16)


Compared to the controversies surrounding the pathologic classification of the non-Hodgkin’s lymphomas, the pathologic classification of Hodgkin’s disease (HD) has produced barely a murmur of discontent. Perhaps the dramatically improved prognosis in patients with HD [1–3] has occasioned little need for criticism. HD is classified according to the Rye modification [4] of the histologic classification proposed by Lukes and Butler [5] (Table 1). Early series of patients classified according to this scheme showed significant and reproducible variations in survival among the different histologic subtypes [6]. However, current data show that pathologic stage is the most important prognostic factor and histologic classification per se does not have significant influence on prognosis when other parameters are held constant [7–13]. These findings have led some to question the usefulness of classification in HD.


Chronic Lymphocytic Leukemia Germinal Center Mycosis Fungoides Malignant Histiocytosis Staging Laparotomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Aisenberg AC, Linggood RM, Lew RA: The changing face of Hodgkin’s disease. Am J Med 67: 921–928, 1979.PubMedCrossRefGoogle Scholar
  2. 2.
    Devita VT Jr, Simon RM, Hubbard SM, Young RC, Berard CW, Moxley JH, Frei E, Carbone PP, Canellos GP: Curability of advanced Hodgkin’s disease with chemotherapy. Ann Intern Med 92: 587–595, 1980.PubMedGoogle Scholar
  3. 3.
    Kaplan HS: Hodgkin’s disease: Unfolding concepts concerning its nature, management and prognosis. Cancer 45: 2439–2474, 1980.PubMedCrossRefGoogle Scholar
  4. 4.
    Lukes RJ, Craver LF, Hall TC, Rappaport H, Rubin P: Report of the nomenclature committee. Cancer Res 26: 1311, 1966.Google Scholar
  5. 5.
    Lukes RJ, Butler JJ, Hicks EB: Natural history of Hodgkin’s disease as related to its pathologic picture. Cancer 19: 317–344, 1966.CrossRefGoogle Scholar
  6. 6.
    Butler JJ: Relationship of histologic findings to survival in Hodgkin’s disease. Gann Monograph on Cancer Research 15: 275–286, 1973.Google Scholar
  7. 7.
    Glatstein E: Hodgkin’s disease and non-Hodgkin’s homphomas: How important is histology? Front Radiation Ther Onc 9: 203–216, 1974.Google Scholar
  8. 8.
    Fuller LM, Madoc-Jones H, Gamble JF, Butler JJ, Sullivan MP, Fernandex CH, Gehan EA: New assessment of the prognostic significance of histopathology in Hodgkin’s disease for laparotomy-negative stage I and stage II patients. Cancer 39: 2174–2182, 1977.PubMedCrossRefGoogle Scholar
  9. 9.
    Torti FM, Dorfman RF, Rosenberg SA, Kaplan HS: The changing significance of histology in Hodgkin’s disease (Abstract). Proc Am Assoc Cancer Res 20: 401, 1979.Google Scholar
  10. 10.
    Deforges JF, Rutherford CJ, Prio A: Hodgkin’s disease. N Engl J Med 301: 1212–1221, 1979.CrossRefGoogle Scholar
  11. 11.
    Fuller LM, Gamble JF, Velasquez WS, Rodgers RW, Butler JJ, North LB, Martin RG, Gehan EA, Schultenberger CC: Evaluation of the significance of prognostic factors in stage III Hodgkin’s disease treated with MOPP and radiotherapy. Cancer 45: 1352–1364, 1980.PubMedCrossRefGoogle Scholar
  12. 12.
    Hoppe RT, Rosenberg SA, Kaplan HS, Cox RS: Prognostic factors in pathological stage IIIA Hodgkin’s disease. Cancer 46: 1240–1246, 1980.PubMedCrossRefGoogle Scholar
  13. 13.
    Colby TV, Hoppe RT, Warnke RA: Hodgkin’s disease: A clinicopathologic study of 659 cases. Cancer 49: 1848–1858, 1981.CrossRefGoogle Scholar
  14. 14.
    Neiman RS: Current problems in the histopathologic diagnosis and classification of Hodgkin’s disease. In: Pathology annual 13, part 2. Sommers SC, Rosen PP (eds) New York, Appleton- Century-Crofts, 1978, pp 289–328.Google Scholar
  15. 15.
    Dorfman RF, Colby TV: The pathologist’s role in management of patients with Hodgkin’s disease. Cancer Treat Rep 66: 675–680, 1982.PubMedGoogle Scholar
  16. 16.
    Dorfman RF: Personal observations.Google Scholar
  17. 17.
    Hartsock RJ: Postvaccinial lymphadenitis. Hyperplasia of lymphoid tissue that simulated malignant lymphomas. Cancer 21: 632–649, 1968.PubMedCrossRefGoogle Scholar
  18. 18.
    Tindle BH, Parker JW, Lukes RJ: Reed-Sternberg cells in infectious mononucleosis? Am J Clin Pathol 58: 607–617, 1972.PubMedGoogle Scholar
  19. 19.
    Lukes RJ: Criteria for involvement of lymph node, bone marrow, spleen and liver in Hodgkin’s disease. Cancer Res 31: 1755–1767, 1971.PubMedGoogle Scholar
  20. 20.
    Butler JJ: The natural history of Hodgkin’s disease and its classification. In: The Reticuloendothelial System. Monographs in Pathology 16. Rebuck JW, Berard CW, Abell MR (eds). Baltimore, Williams and Wilkins, 1975, pp 184–212.Google Scholar
  21. 21.
    Lennert K: Malignant lymphomas other than Hodgkin’s disease. New York, Springer-Verlag, 1978.Google Scholar
  22. 22.
    Poppema S, Kaiserling E, Lennert K: Hodgkin’s disease with lymphocyte predominance, nodular type (nodular paragranuloma) and progressively transformed germinal centers - a cytohistological study. Histopathology 3: 295–308, 1979.PubMedCrossRefGoogle Scholar
  23. 23.
    Colby TV, Warnke RA, Burke JS, Dorfman RF: Differentiation of chronic lymphocytic leukemia from Hodgkin’s disease using immunologic marker studies. Am J Surg Pathol 5: 707–710, 1981.PubMedCrossRefGoogle Scholar
  24. 24.
    Bennett MH: Sclerosis in non-Hodgkin’s lymphoma. Br J Cancer 31: 44–52, 1975.Google Scholar
  25. 25.
    Frizzera G, Moran EM, Rappaport H: Angioimmunoblastic lymphadenopathy. Diagnosis and clinical course. Am J Med 59: 803–811, 1975.PubMedCrossRefGoogle Scholar
  26. 26.
    Lukes RJ, Tindle EH: Immunoblastic lymphadenopathy. A hyperimmune entity resembling Hodgkin’s disease. N Engl J Med 292: 1–8, 1975.PubMedCrossRefGoogle Scholar
  27. 27.
    Waldron JA, Leech JH, Glick AD, Flexner JM, Collins RD: Malignant lymphoma of peripheral T-lymphocyte origin: Immunologic, pathologic and clinical features in six patients. Cancer 40: 1604–1617, 1977.PubMedCrossRefGoogle Scholar
  28. 28.
    Watanabe S, Shimosato Y, Shimoyama M: Lymphoma and leukemia of T-lymphocytes. In: Pathology annual 16, part 2. Sommers SC, Rosen PP (eds), New York, Appleton-Century- Crofts, 1981, pp 155–204.Google Scholar
  29. 29.
    Kim H, Nathwani BN, Rappaport H: So-called ‘Lennert’s lymphoma’ - Is it a clinicopathologic entity? Cancer 45: 1379–1399, 1980.PubMedCrossRefGoogle Scholar
  30. 30.
    Doggett RS, Colby TV, Dorfman RF. Interfollicular Hodgkin’s disease. Am J Surg Pathol 7: 145–149, 1983.PubMedCrossRefGoogle Scholar
  31. 31.
    Dorfman RF, Remington JS: Value of lymph node biopsy in the diagnosis of acute acquired toxoplasmosis. N Engl J Med 289: 878–881, 1973.PubMedCrossRefGoogle Scholar
  32. 32.
    Dorfman RF, Warnke R: Lymphadenopathy simulating the malignant lymphomas. Hum Pathol 5: 519–550, 1974.PubMedCrossRefGoogle Scholar
  33. 33.
    Butler JJ: Personal communication.Google Scholar
  34. 34.
    Banks PM: Sarcomatous lacunar cell Hodgkin’s disease: A morphologic variant of the nodular sclerosing type. Lab Invest (Abstract) (44A), 3A, 1981.Google Scholar
  35. 35.
    Williams JW, Dorfman RF: Lymphadenopathy as the initial manifestation of histiocytosis X. Am J Surg Pathol 3: 405–421, 1979.PubMedCrossRefGoogle Scholar
  36. 36.
    Kjeldsberg CR, Kim H: Eosinophilic granuloma as an incidental finding in malignant lym-phoma. Arch Pathol Lab Med 104: 137–140, 1980.PubMedGoogle Scholar
  37. 37.
    Burns B, Colby TV, Dorfman RF: Langerkans cell granulomatosis (Histiocytosis X) associated with malignant lymphomas. Am J Surg Pathol. In press.Google Scholar
  38. 38.
    Kadin ME. Possible origin of the Reed-Sternberg cell from an interdigitating reticular cell. Cancer Treat Rep 33: 601–608, 1982.Google Scholar
  39. 39.
    Colby TV, Hoppe RT, Warnke RA: Hodgkin’s disease at autopsy. Cancer 47: 1852–1862, 1981.PubMedCrossRefGoogle Scholar
  40. 40.
    Keller AR, Hochholzer L, Castleman B: Hyaline-vascular and plasma cell types of giant lymph node hyperplasia of the mediastinum and other locations. Cancer 29: 670–783, 1972.PubMedCrossRefGoogle Scholar
  41. 41.
    Colby TV, Dorfman RF: Unpublished observations.Google Scholar
  42. 42.
    Choi H, Keller RH: Coexistence of chronic lymphocytic leukemia and Hodgkin’s disease. Cancer 48: 48–57, 1981.PubMedCrossRefGoogle Scholar
  43. 43.
    Rappaport H, Thomas L: Mycosis fungoides. The pathology of the extracutaneous involvement. Cancer 34: 1198–1229, 1974.PubMedCrossRefGoogle Scholar
  44. 44.
    Donald D, Green JA, White M: Mycosis fungoides associates with nodular sclerosing Hodgkin’s disease: A case report. Cancer 46: 2505–2508, 1980.PubMedCrossRefGoogle Scholar
  45. 45.
    Colby TV, Burke JS, Hoppe RT: Lymph node biopsy in mycosis fungoides. Cancer 47: 351–359, 1981.PubMedCrossRefGoogle Scholar
  46. 46.
    Dick FR, Maca RD: The lymph node in chronic lymphocytic leukemia. Cancer 41: 283–292, 1978.PubMedCrossRefGoogle Scholar
  47. 47.
    Kim H, Hendrickson MR, Dorfman RF: Composite lymphoma. Cancer 40: 959–976, 1977.PubMedCrossRefGoogle Scholar
  48. van den Tweel, Lukes RJ, Taylor CR: Pathophysiology of lymphocyte transformation. A study of so-called composite lymphomas. Am J Clin Pathol 71: 509–519, 1979.PubMedGoogle Scholar
  49. 49.
    Massarelli G, Tanda F, Denti S: Primary Kaposi’s sarcoma and Hodgkin’s disease in the same lymph node. Am J Clin Pathol 78: 107–111, 1982.PubMedGoogle Scholar
  50. 50.
    Rappaport H, Berard CW, Butler JJ, Dorfman RF, Lukes RJ, Thomas LB: Report of the committee on histopathological criteria contributing to staging of Hodgkin’s disease. Cancer Res 31: 1864–1865, 1971.PubMedGoogle Scholar
  51. 51.
    Kadin ME, Glatstein E, Dorfman RF: Clinicopathologic studies of 117 untreated patients subjected to laparotomy for the staging of Hodgkin’s disease. Cancer 27: 1277–1294, 1971.PubMedCrossRefGoogle Scholar
  52. 52.
    Strum SB, Rappaport H: Interrelations of the histologic types of Hodgkin’s disease. Arch Pathol 91: 127–134, 1971.PubMedGoogle Scholar
  53. 53.
    Colby TV, Warnke RA: The histology of the initial relapse of Hodgkin’s disease. Cancer 45: 289–292, 1980.PubMedCrossRefGoogle Scholar
  54. 54.
    Seenmayer TA, Lagace R, Schurch W: On the pathogenesis of sclerosis and nodularity in nodular sclerosing Hodgkin’s disease. Virchows Arch A Path Anat and Histol 385: 283–291, 1980.CrossRefGoogle Scholar
  55. 55.
    Keller AR, Kaplas HS, Lukes RJ, Rappaport H: Correlation of histopathology with other prognostic indicators in Hodgkin’s disease. Cancer 22: 487–499, 1968.PubMedCrossRefGoogle Scholar
  56. 56.
    Coppelson LW, Rappaport H, Strum SB, Rose J: Analysis of the Rye Classification of Hodgkin’s disease. The prognostic significance of cellular composition. J Natl Cancer Inst 51: 379–390, 1973.Google Scholar
  57. 57.
    Patchefsky AS, Brodovsky H, Southard M, Menduke H, Gray S, Hoch WS: Hodgkin’s disease: A clinical and pathologic study of 235 cases. Cancer 32: 150–161, 1973.PubMedCrossRefGoogle Scholar
  58. 58.
    Dolginow D, Colby TV: Recurrent Hodgkin’s disease in treated sites. Cancer 48: 1124–1126, 1981.PubMedCrossRefGoogle Scholar
  59. 59.
    Poppema S, Lennert K: Hodgkin’s disease in childhood: Histopathologic classification and relation to age and sex. Cancer 45: 1443–1447, 1980.PubMedCrossRefGoogle Scholar
  60. 60.
    Rappaport H, Berard CW, Butler JJ, Dorfman RF, Lukes RJ and Thomas LB: Report of the Committee on Histopathological Criteria Contributing to Staging of Hodgkin’s Disease. Cancer Res 31: 1864–1865, 1971.PubMedGoogle Scholar
  61. 61.
    Weiss RB, Brunning RD, Kennedy BJ: Hodgkin’s disease in the bone marrow. Cancer 36: 2077–2083, 1975.PubMedCrossRefGoogle Scholar
  62. 62.
    Kim H, Dorfman RF, Rosenberg SA: Pathology of malignant lymphomas in the liver: application in staging. In: Progress in liver disease. Popper H, Schaffner F (eds), V. New York, Grune and Stratton, 1976, pp 683–698.Google Scholar
  63. 63.
    Kadin ME, Donaldson SS, Dorfman RF: Isolated granulomas in Hodgkin’s disease. N Engl J Med 283: 859–861, 1970.PubMedCrossRefGoogle Scholar
  64. 64.
    Pak HY, Friedman NB: Pseudosarcoid granulomas in Hodgkin’s disease. Hum Pathol 12: 832–837, 1981.PubMedCrossRefGoogle Scholar
  65. 65.
    Kaplan HS: Hodgkin’s disease, 2nd ed. Cambridge Massachusetts, Harvard University Press, 1980.Google Scholar
  66. 66.
    Dorfman RF: Unpublished observations, 1981.Google Scholar
  67. 67.
    Smith JL, Butler JJ: Skin involvement in Hodgkin’s disease. Cancer 45: 354–361, 1980.PubMedCrossRefGoogle Scholar
  68. 68.
    Colby TV, Carrington CB: Malignant lymphoma of the lung simulating lymphomatoid granulomatosis. Am J Surg Pathol 6: 19–32, 1982.PubMedCrossRefGoogle Scholar
  69. 69.
    Krikorian JG, Burke JS, Rosenberg SA, Kaplan HS: Occurrence of non-Hodgkin’s lymphoma after therapy for Hodgkin’s disease. N Engl J Med 300: 452–458, 1979.PubMedCrossRefGoogle Scholar
  70. 70.
    Colby TV: Unpublished observations, 1982.Google Scholar
  71. 71.
    Fisher RI, DeVita Jr, Bostick F, Vanhaelen C, Howser DM, hubbard SM, Young RC: Persistent immunologic abnormalities in long-term survivors of advanced Hodgkin’s disease. Ann Int Med 92: 595–599, 1980.PubMedGoogle Scholar
  72. 72.
    Miller GA Jr. Jarowski CH, Coleman M, Cibull ML, Posteraro AF, Weksler ME: Incidental discovery at radical mastectomy of inapparent Hodgkin’s disease in long term survivors. Cancer 42: 318–325, 1978.PubMedCrossRefGoogle Scholar

Copyright information

© Martinus Nijhoff Publishers, Boston. 1983

Authors and Affiliations

  • Thomas V. Colby

There are no affiliations available

Personalised recommendations