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

Purpose: The causes of mortality in Hodgkin's disease patients are insuffic iently known. Autopsy study is the fundamental procedure in the investigati on of these causes. The present study analyzes the autopsies performed in a series of patients diagnosed as having Hodgkin's disease, determining the cause of death in each case and comparing the premortem clinical data and t he postmortem findings. Patients and methods: A total of 486 patients diagnosed as having Hodgkin's disease between 1967 and 1996 were assessed. Autopsy was performed in 40 o f the 144 deceased patients (28%). We reviewed the pathological findings, e ffects of treatment, discordance between the clinical diagnosis and the out come of autopsy, and cause of death in each case. Results: The most common clinical causes of death in those patients with au topsy study were tumor progression (37%) and infections (43%) in those pati ents with autopsy study. The rate of discordance between the clinical and a utopsy diagnoses in this study was 43%. The most frequent location of resid ual Hodgkin's disease was in the lymph nodes. Conclusions: Autopsy study in Hodgkin's disease confirms a high rate of dis crepancy between final clinical diagnosis and postmortem lesions despite ad vances in diagnostic methods. Autopsy revealed causes of death directly rel ated to the treatment, as well as some lesions directly related to patient death and secondary to treatment. Infectious processes are likely to remain undetected and their symptoms can mimic tumor progression.