Surgical Staging of Abdominal Involvement in Unselected Patients with Hodgkin's Disease

Glatstein, Eli; Hw, Trueblood; Lp, Enright; Rosenberg, S A; Hs, Kaplan

doi:10.1148/97.2.425

Cited by 132 publications

(17 citation statements)

References 4 publications

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“…Undoubtedly enlargement of the spleen may be a foreboding of subsequent lymphoma, and information derived from diagnostic laparotomy and staging splenectomy in Hodgkin's disease indicates that considerably enlarged spleens may be free from disease (Glatstein et al, 1970;Ell et al, 1975). We believe that two of the patients (Cases 4 and 9) are probably examples of the syndrome previously described as idiopathic, non-tropical splenomegaly (Dacie et al, 1969) or primary splenic hyperplasia (Weinstein, 1964).…”

Section: Discussionmentioning

confidence: 70%

Splenectomy for undiagnosed splenomegaly

Goonewardene

Bourke

Ferguson

et al. 1979

Journal of British Surgery

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During the 9-year period 1968-76 116 splenectomies were performed at the General Hospital, Nottingham. Of these, 13 (11 per cent) were undertaken for unexplained splenomegaly. In 6 patients a diagnosis was established by the operative procedure (2 with sarcoidosis, 2 splenic cysts, 1 Gaucher's disease and 1 haemangiosarcoma). Histological examination of the excised spleens in the remaining 7 patients showed no specific features. Two of these patients benefited considerably from removal of very large spleens. Another patient died from lymphosarcoma which was diagnosed 21 months after splenectomy. In the remaining 4 patients with mild to moderate splenomegaly, there were no real diagnostic or therapeutic advantages. It is concluded that splenectomy should always be considered in patients with unexplained moderate or gross splenomegaly but it may not be helpful in the patient whose spleen is only midly enlarged.

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Section: Discussionmentioning

confidence: 70%

Splenectomy for undiagnosed splenomegaly

Goonewardene

Bourke

Ferguson

et al. 1979

Journal of British Surgery

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“…The spleen, although often abnormal in Hodgkin's disease, is not usually grossly enlarged and may be of normal size. 16 The inability of CT to detect disease in these organs reflects both the limitations of using the criterion of enlargement alone and the inherent limitations of the technique at present. CT, however, has definite advantages over lymphography.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography of abdomen in staging and clinical management of lymphoma.

Best¹,

Blackledge²,

Forbes³

et al. 1978

BMJ

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“…Thus, in two large series of patients subjected to systematic laparotomy and splenectomy in Hodgkin's disease, no instance of liver involvement was noted without concomitant splenic involvement (Glatstein et al, 1970;Zarembok et al, 1972).…”

Section: Discussionmentioning

confidence: 94%

A case of primary lymphoma of the liver.

Chambers¹,

O’Donoghue²,

Stansfeld³

1976

J Clin Pathol

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SYNOPSIS A case of primary malignant lymphoma of the liver is described. Presenting with epistaxis, he died in hepatic encephalopathy with an intractable bleeding post-bulbar duodenal ulcer.Although lymphomatous involvement of the liver is common in generalized lymphoma, lymphoma con-fined to the liver is exceptionally rare. Only three previous cases have been documented. The case described here is also unusual in being complicated by bleeding from a post-bulbar duodenal ulcer. Case reportA 55-year-old bank official presented at his local hospital with a severe epistaxis. He gave a six-week history of fatigue, anorexia, and loss of weight. His wife had noticed that at times he was confused and his speech was slurred.In 1945 he had developed malaria. This was treated routinely and there were no recurrences. Splenomegaly was noted at that time. There was no history of excess alcohol intake.On examination there was hepatosplenomegaly and he was admitted for further investigation. Over the next 48 hours he passed both fresh and altered blood per rectum. The prothrombin time and platelet count were normal, but his haemoglobin was 6-3 g/dl. Barium studies showed a post-bulbar duodenal ulcer and possible oesophageal varices. He was transfused 11 units of blood and transferred to St Bartholomew's Hospital.Examination on admission revealed a confused man with a marked flapping tremor and extrapyramidal rigidity. Foetor hepatis was present. There was no bruising of the skin nor petechial haemorrhages. Hepatosplenomegaly was present but there was no lymphadenopathy. None of the stigmata of chronic liver disease was present.Investigations at this time showed a post-transfusion haemoglobin of 13 g/dl, white cell count of 3800 cells/mm3, and a platelet count of 108 000/ mm3. Blood urea and serum electrolytes were normal.Received for publication 23 March 1976 Total protein was 4-4 g/dl, of which 2-3 was albumin. The bilirubin was 2.7 mg/dl, the alkaline phosphatase 575 IU/I, and the serum aspartate aminotransferase was 273 IU/I.It was thought that he had cirrhosis of the liver, and in view of the severity of his liver dysfunction no surgery was undertaken initially. Routine measures to combat hepatic encephalopathy were started but no improvement was noted. Six days after admission he again passed a melaena stool and became clinically shocked. Emergency endoscopy showed that the bleeding was from a post-bulbar duodenal ulcer. Oesophageal varices were not seen.At laparotomy later the same day the ulcer, measuring 2 x 1 cm, was located on the medial aspect of the second part of the duodenum. This was oversewn and a truncal vagotomy and Finney pyloroplasty were performed. The liver had a strange mottled appearance and a wedge biopsy was taken before the abdomen was closed.Postoperatively the patient failed to regain consciousness and continued to lose blood from the gastrointestinal tract. There was no evidence of disseminated intravascular coagulation. He failed to respond to transfusions of fresh blood and fresh frozen plasm...

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Surgical Staging of Abdominal Involvement in Unselected Patients with Hodgkin's Disease

Cited by 132 publications

References 4 publications

Splenectomy for undiagnosed splenomegaly

Splenectomy for undiagnosed splenomegaly

Computed tomography of abdomen in staging and clinical management of lymphoma.

A case of primary lymphoma of the liver.

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