Hodgkin's disease (HD) is a nodal malignancy with a characteristically
axial pattern of spread and with contiguous progression via lymphatic
channels. Even when dissemination occurs beyond the lymphoreticular s
ystem, certain patterns of associated spread are frequently evident. W
e describe a case of nodular sclerosis HD with a 12-year indolent cour
se and late involvement of the gluteal muscle. Initially, stage was IV
b with spleen and bone marrow involvement, complicated by a Coomb's po
sitive hemolytic anemia. Following chemotherapy, the patient had a par
tial response with the subsequent long course of slowly progressive di
sease invading first the urinary bladder and, later, the gluteus. Invo
lvement of the gluteal muscle is a rare event in HD. Spread to the glu
teus occurred most likely by contiguity, via retroperitoneal lymphnode
s.