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The response to treatment and survival has been assessed in 61 patients with pathological Stage IIA Hodgkin's disease with mediastinal involvement who were treated initially by supradiaphragmatic radiotherapy alone. Although 57 (93%) obtained complete remission, 29 have relapsed giving a total of 33 (54%) treatment failures. The percentage of patients actuarially disease free at 5 years is 44% although overall survival is 90%. The "bulk" of the mediastinal disease was assessed on a plain chest X-ray by measurement of the widest diameter of the mass compared to thoracic diameters at various levels as well as by determination of the area of the mass. The ratio of the widest diameter of the mass to the widest internal thoracic diameter provided the greatest prognostic information. Patients with a ratio greater than 0.33 (30% of total) had an actuarial disease-free survival of 24% at 5 years compared to 54% in patients with smaller mediastinal masses (P less than 0.05). Mediastinal bulk was not correlated with histological grade. Patients with the largest mediastinal masses (ratio greater than 0.37) (10% of total) have a lesser survival, but in the remainder, measurement of the mediastinal mass did not predict survival, indicative of the excellent salvage rate with subsequent chemotherapy. The implication of these findings for the treatment of stage IIA Hodgkin's disease with mediastinal involvement is discussed.

The experience of the British National Lymphoma Investigation in the treatment of 68 children with Hodgkin's disease is reported over a 14 year period from 1970. The presenting histology was reviewed by a single histopathologist; 87% of the cases were classified as nodular sclerosis (NS) and further subdivided into NSI (53%) and NSII (35%). Primary treatment consisted of local (involved field) or prophylactic (extended field) irradiation, combination chemotherapy alone or low dose irradiation and chemotherapy. An overall 5 year survival of 87% was achieved and a 5 year relapse-free survival of 64%. Eight deaths were reported during the study, all of which occurred in children who presented with NSII histology. Each child was in relapse and undergoing chemotherapy at the time of death. This histological subtype was also associated with both a lower complete remission rate and a reduced response to second line chemotherapy.

A 40-year-old man, with a history of vasectomy 11 years previously, presented with a tumour in his right testis. At orchidectomy a seminoma was found, together with a nodule on the vas deferens. Histological examination of this area in the vas identified the lesion of vasitis nodosa and also showed it to be the site of proliferating germ cells. The pathogenesis of this lesion is discussed.

This report reviews 85 patients entered into the British National Lymphoma Investigation with localised (clinical Stage 1 and 2) Grade 2 non-Hodgkin's lymphoma, who were treated initially with radiotherapy alone. Almost half of all patients presented with extranodal disease. The duration of follow-up was 20-106 months. There were 33 deaths due to non-Hodgkin's lymphoma. The complete local response rate was dependent on the radiotherapy dose and reached 100% for doses of 4500 cGy or more. Most first failures occurred at a distant nodal site or were due to the development of generalised disease. There was a significant difference in actuarial survival between Stage 1 and Stage 2 patients (P less than 0.005). The 5-year survivals were 78% and 40%, respectively. The site of presenting disease was also important. Stage 1 patients with nodal or ear, nose and throat (ENT) disease had an excellent 5-year survival of 84%, but Stage 2 patients with nodal or ENT disease had a 5-year survival of only 46%. As many of these Stage 2 patients rapidly developed disseminated disease, their survival might have been improved by treatment with chemotherapy before radiotherapy.

A histological review of 271 cases of nodular sclerosing Hodgkin's disease, patients presenting with clinical Stage I, II and III disease but not subjected to a staging laparotomy, has been undertaken. Cases were categorised according to the cytological appearances of the cellular nodules and the degree of sclerosis was examined. Cytological subtypes with extensive and easily recognised areas of lymphocyte depletion or numerous pleomorphic Hodgkin's cells were associated with a decreased survival and clinical stage did not appear to be a good indicator of prognosis in these patients. Pronounced nodal sclerosis was associated with a higher relative frequency of mediastinal disease and the lymphocyte-depleted cytological subtypes.

Systemic disturbances in Hodgkin's disease at presentation are not only manifested by 'B' symptoms (weight loss, fever, and night sweats), but are also mirrored in the peripheral blood as raised sedimentation rate, low haemoglobin, low albumin, and abnormal lymphocyte counts. Such systemic disturbance is more common than consideration of classical 'B' symptoms alone would suggest. In a series of 840 patients, 88% had some form of systemic disturbance on these criteria. Survival after treatment was found to be closely and inversely related to the degree of systemic disturbance present before treatment. Patients with no evidence of such disturbance had an almost 100% survival at 10 years. In the absence of 'B' symptoms the sedimentation rate was the most useful prognostic blood parameter, enabling about one third of the patients to be identified as having an excellent chance of survival, and identifying a further 12% as having a survival almost identical to that of patients with 'B' symptoms. The latter patients were those with a sedimentation rate of 60 mm/h or greater, and it is suggested that the term 'Systemic Symptoms' should be broadened to include a sedimentation rate of this magnitude. The degree of malignancy of the tumour, as reflected by histopathology, plays a dominant role in determining the amount of systemic disturbance in the host. However, the amount of disturbance varies amongst individual patients with the same histopathological subtype, reflecting either differences in the malignancy of the tumour within such subtypes, or differences in the constitution of the host.

Eighty-eight patients entered into the British National Lymphoma Investigation with clinical stage I and II, grade I non-Hodgkin's lymphoma were treated initially with involved field radiotherapy alone. Eighty-one per cent presented with nodal disease. The duration of follow-up was 25-116 months, with a median of 54 months. Fifteen patients died of disease and the 5-year survival of the whole group was 83%. The complete response rate was dependent on the radiotherapy dose and was greater than 90% for doses of 3500 cGy and over. Most failures occurred at distant rather than adjacent sites, suggesting that extended field radiotherapy would not have affected the outcome. Second-line treatment induced complete remission in 66% of patients who relapsed. The prognosis was significantly worse in patients with intra-abdominal disease.

Numerous neoplastic states have associated or causal cytogenetic abnormalities. In some cancers, specific chromosomal abnormalities appear to correlate with the clinical characteristics and prognosis. Cytogenetic analysis of Hodgkin's disease is thought to be technically difficult and only a small number of cases with evaluable results have been reported. We have attempted cytogenetic studies of lymph nodes from 37 patients with Hodgkin's disease. In 29 of the 37 patients (78%), successful chromosomal analysis was accomplished. Chromosomal abnormalities were found in 13 patients (45%); five of these patients had been previously treated with chemotherapy. Numerical changes were found in all patients, most commonly involving chromosomes 5, 9, 15, 18, 22, X, and marker chromosomes. Seven patients also had structural abnormalities. The breakpoints 4q32-34, 6q24, 12q13, 12q23-24, and 13p11-13 were each seen in at least two patients. All but two patients had an admixture of normal cells. Three patients had two or more clones, and one had subclones. No statistically significant correlations between chromosomal abnormalities and clinical characteristics were demonstrated, although the number of patients in each subgroup was small. We conclude that chromosomal studies of Hodgkin's disease are likely to be successful. Additional studies are needed to correlate the karyotypical abnormalities in Hodgkin's disease with clinical and biological characteristics.

A review of data from the British National Lymphoma Investigation (BNLI) studies of Hodgkin's disease (HD) done over the past 14 years shows (i) that systemic chemotherapy is appropriate for all clinical stages except I and IIA, and that MOPP (mustine, vincristine, procarbazine, and prednisone) courses are substantially more effective than MOP (the same without prednisone) but no better than the less toxic LOPP combinations (where chlorambucil replaces mustine); (ii) that local involved-field irradiation in stages I and IIA HD is as effective as wide-field in terms of both overall and recurrence-free survival; and (iii) that, histologically, nodular sclerosing HD can be divided into grades 1 and 2, the latter containing areas of lymphocyte depletion or numerous pleomorphic Hodgkin's cells. A multivariate analysis of factors influencing prognosis in clinical stages I and IIA disease shows that laparotomy has no significant effect but that age, sex, erythrocyte sedimentation (ESR), the presence or absence of mediastinal involvement and, especially, pathological grade are the most important factors influencing overall survival, while ESR, pathological grade, and stage of disease (I or II) correlate with recurrence-free time. A prognostic "survival" index was developed; an index of greater than 7.5 indicated a poor prognosis and that chemotherapy was perhaps more appropriate than local radiation. Laparotomy is no longer justified as a routine procedure in staging HD, although it may still be useful in special circumstances and in some research investigations.