Problems of interpretation of liver biopsy in Hodgkin's disease

Abstract

Review of 115 autopsy cases of Hodgkin's disease showed hepatic involvement in 73 patients (63%). Review of 86 liver biopsy specimens from 65 patients with Hodgkin's disease disclosed hepatic involvement in 9 patients (14%). Pre‐biopsy evaluation of the liver was in disagreement with biopsy findings in about one third of the patients; alkaline phosphatase was the most sensitive parameter evaluated and liver scan the least sensitive. All positive liver biopsies were wedge specimens, most obtained from areas considered grossly suspicious by the surgeon. Despite modern staging methods, the liver remains a “blind area” and inspection of the liver by the surgeon at laparotomy is a valuable staging technique. Ten patients with liver biopsy had hepatic lesions lacking Sternberg‐Reed cells but otherwise consistent with Hodgkin's disease. In view of the profound effect of liver biopsy findings on therapy decisions, it is recommended that diagnostic certainty be reserved for hepatic lesions containing Sternberg‐Reed cells.

Hodgkin's disease presenting as a cholestatic febrile illness: incidence and main characteristics in a series of 421 patients

“…A small proportion of HD patients show hepatic abnormalities at disease presentation, with tumoral liver infiltration being the most common underlying mechanism [1,8]. The finding of liver involvement by HD varies depending on the method by which the liver specimen is obtained and its size.…”

“…The finding of liver involvement by HD varies depending on the method by which the liver specimen is obtained and its size. Thus, only 5% of samples taken by percutaneous liver biopsy display histologic changes consistent with tumor involvement, but a twofold frequency is registered when peritoneoscopy-guided biopsy is performed, especially if gross abnormalities are observed on the liver surface [1,8,11,20]. In the present series, initial liver involvement by HD was demonstrated in 7.4% of the patients.…”

“…The frequency of liver involvement is low at presentation of Hodgkin's disease (HD) [1,8] but increases in the advanced phases of the disease, becoming as high as 60% in autopsy series [8]. At diagnosis, hepatic infiltration by HD is observed in 5-14% of HD patients [1], depending on both the method of liver sampling and the size of the sample [5,20].…”

Reevaluation of alkaline phosphatase measurement during Hodgkin's disease by electrophoretic isoenzyme separation

“…However, the lesions oberved can be the source of debate, since even intense portal lymphocytic infiltration is insufficient for diagnosis (Bagley et al, 1973;Givler et al, 1971;Lukes, 1971).…”

“…Clinical examination to detect hepatomegaly (Bagley et al, 1973;Glastein et al, 1969;Givler et al, 1971), liver scans (Givler et al, 1971), ultrasonography (Caroll & Ta, 1980;Ginaldi et al, 1980) and CT all give numerous false positives or negatives. Biological tests such as the bilirubin concentration, BSP retention, gammaglutamyl transpeptidase, oxaloacetic or glutamatepyruvate transaminases, or 5-nucleotidase (which is useful in the case of malignant lymphomas) are not commonly employed (Belliveau et al, 1974;Deeble & Goldberg, 1980).…”