Abstract
The aim of this report is to describe a result of staging laparotomy in a child case of Hodgkin's disease and to discuss the usefulness of the procedure.
A 9-year-old boy was well until he himself noticed rapid enlargement of left cervical lymphnodes. Without any beneficial effects with antibiotics prescribed by a local phisician, he was referred to our hospital. He had no weight loss, fever or night sweating.
Three months after onset, histological examination of the lymph node biopsy revealed some Hodgkin cells and a mixture of lymphocytes, eosinophils and histiocytes, consistent with Hodgkin's disease of mixed cellularity type. Clinical and laboratory studies, including chest x-rays, chest tomography, 99mTc-Sn-colloid liver and spleen scintigraphy, 67Ga scintigraphy, bone x-rays, bone scintigraphy and bipedal lymphography were all negative. Therefore the clinical stage was decided as IA. But according to former reports, mixed cellularity type was frequently associated with high pathological stages, we performed staging laparotomy. This showed miliary infiltration in spleen and two splenic hilar lymphnodes. Then the pathological stage was IIIA.
The patient was treated with radiotherapy (Mantle field: 4,000 rads, left cervical field: 5,000 rads, paraaortic and splenic hilar field: 2,400 rads), followed by COPP therapy of 20 courses. Eight months after discontinuation of the immunosuppresive therapy, he is now in good health and enjoying school life.
Because of a lack of accurate noninvasive method to search for occult involvement in upper abdomen, staging laparotomy with splenectomy can be a useful and necessary procedure, in spite of a possible hazard of an overwhelming infection.
