Pathology of Hodgkin’s Disease: Anything New?

Abstract

Following many years of controversy and confusion, the Rye classification (Lukes et al. 1966a) appeared to provide a sound basis for the identification and categorisation of the subtypes of Hodgkin’s disease (HD). This classification was widely adopted by pathologists and clinicians throughout the world and provided an area of agreement in contrast to the chaos and controversy that accompanied the subsequent attempt to restructure the classification of non-Hodgkin’s lymphomas (NHLs). The Rye classification established a framework on which substantial advances were made in the study and treatment of Hodgkin’s disease. To some extent, we are indebted to Samuel Wilkes for introducing the term ‘Hodgkin’s disease’ since, without this unifying eponym, attempts to achieve an international classification might have sunk into the quagmire of semantics (Rose 1981). It is, however, anachronistic that in the late twentieth century our whole categorisation of lymphoreticular neoplasms into HD and NHLs is based on a small series of morbid anatomical descriptions of lymphadenopathy made in the early nineteenth century. [A pathologist, Herbert Fox (1926), looked at histological material from the six patients whom Hodgkin had described in 1832. He diagnosed three cases as HD, one as tuberculosis, one as syphilis and one as NHL.] While Hodgkin provided an eponym (as has Burkitt in more recent years) that allowed us to diagnose, categorise and investigate a disease before we understood its histogenesis, the inherent weakness of this position is beginning to cause problems.