Problems in the Staging of Hodgkin Disease

To the Editor.— In hospitals where patients with Hodgkin disease are not entered into protocol studies, staging is discontinued when enough information has been gathered to make a decision about treatment procedures—radiotherapy, chemotherapy, or the combined modalities. The following report demonstrates how mediastinoscopy may be useful in arrival at the stage III designation when a patient presents with disease below the diaphragm. Report of a Case.— A 20-year-old man with a three-week history of fever and night sweats had a 4×4 cm right lower quadrant mass without other adenopathy or splenomegaly and nodular sclerosing Hodgkin disease on biopsy. Other studies showed leukopenia, anemia, and a hypercellular bone marrow. A right upper lobe pneumonitis that occurred postoperatively after the biopsy cleared completely with antibiotic treatment. Negative staging procedures included tomographic liver scan, intravenous pyelogram, closed liver biopsy, and peritoneoscopy with multiple liver biopsies. A second bone marrow biopsy showed early fibrosis