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

The causes of mortality in Hodgkin's disease patients are insufficiently known. Autopsy study is the fundamental procedure in the investigation 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 the postmortem findings.

A total of 486 patients diagnosed as having Hodgkin's disease between 1967 and 1996 were assessed. Autopsy was performed in 40 of the 144 deceased patients (28%). We reviewed the pathological findings, effects of treatment, discordance between the clinical diagnosis and the outcome of autopsy, and cause of death in each case.

The most common clinical causes of death in those patients with autopsy study were tumor progression (37%) and infections (43%) in those patients with autopsy study. The rate of discordance between the clinical and autopsy diagnoses in this study was 43%. The most frequent location of residual Hodgkin's disease was in the lymph nodes.

Autopsy study in Hodgkin's disease confirms a high rate of discrepancy between final clinical diagnosis and postmortem lesions despite advances in diagnostic methods. Autopsy revealed causes of death directly related 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.