Hodgkin's disease: Correlation between causes of death at autopsy and clinical diagnosis

Purpose:The causes of mortality in Hodgkin's disease patients areinsufficiently known. Autopsy study is the fundamental procedure in theinvestigation of these causes. The present study analyzes the autopsiesperformed in a series of patients diagnosed as having Hodgkin's disease,determining the cause of death in each case and comparing the premortemclinical data and the postmortem findings.Patients and methods:A total of 486 patients diagnosed as havingHodgkin's disease between 1967 and 1996 were assessed. Autopsy was performedin 40 of the 144 deceased patients (28%). We reviewed the pathologicalfindings, effects of treatment, discordance between the clinical diagnosis andthe outcome of autopsy, and cause of death in each case.Results:The most common clinical causes of death in thosepatients with autopsy study were tumor progression (37%) and infections(43%) in those patients with autopsy study. The rate of discordancebetween the clinical and autopsy diagnoses in this study was 43%. Themost frequent location of residual Hodgkin's disease was in the lymph nodes.Conclusions:Autopsy study in Hodgkin's disease confirms a highrate of discrepancy between final clinical diagnosis and postmortem lesionsdespite advances in diagnostic methods. Autopsy revealed causes of deathdirectly related to the treatment, as well as some lesions directly relatedto patient death and secondary to treatment. Infectious processes are likelyto remain undetected and their symptoms can mimic tumor progression.