From a review of the literature and an analysis of 277 patients with Hodgkin's disease admitted to the Clinical Center of the NIH from 1953 to 1968, it is apparent that histopathological subtype of the original diagnostic biopsy is related to a number of other parameters of the disease. Lymphocytic predominance is associated strongly with clinical Stages I and II, while lymphocytic depletion is seen primarily with clinical Stages III and IV. Mixed cellularity occurs in all clinical stages without any strong associations. Nodular sclerosis is associated predominantly with clinical Stage II and is the one histological subtype with an apparently distinctive pattern of anatomic distribution, namely a strong propensity to involve the lower cervical lymph nodes, mediastinum, and contiguous structures. The other three histological groups exhibit variable degrees of association with clinical stages, but within clinical stages they do not appear to have different sites of predilection.

In contrast to the other three histological subtypes, nodular sclerosis occurs primarily in females and this prediection for females is present in alla ge groups and even within the clinical stage in which it most commonly presents. It also has a younger age distribution than the other subtypes. in this series, 80% of all patients with nodular sclerosing Hodgkin's disease were between 15 and 34 years of age, and this subtype was particularly infrequent in patients over 50 years of age.

With regard to survival, the prognostic advantage of nodular sclerosis is largely restricted to patients in clinical Stages I and II. There is no significant evidence of a survival advantage in Stage III or IV, with the possible exception of patients staged as IV on the basis of contiguous spread to the lung or anterior chest wall sufficiently circumscribed to be amenable to aggressive radiotherapy.

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