Viadana E, Bross I D, Pickren J W
Oncology. 1976;33(3):123-31. doi: 10.1159/000225125.
An autopsy study was performed on 190 cases with Hodgkin's disease and on 134 cases with reticulum cell sarcomas. It was found that a cascade spread of metastases, as opposed to a random spread, was detectable in patients with Hodgkin's disease, but not in patients with reticulum cell sarcoma. Metastatic key-sites for both lymphomas are defined as those organs whose chance of being seeded by the primary tumor is the highest; these sites are the spleen, liver, bone marrow and lungs. This study could not demonstrate in Hodgkin's cases that metastases in the liver and bone marrow were spleen dependent, but rather it showed that the spleen, liver and bone marrow acted as three independent sources of generalized metastases. Explanations proposed to account for the different metastatic spread in Hodgkin's disease and reticulum cell sarcomas, included different intrinsic cellular characteristics of the two lymphomas. the different location of the primary tumor either because of nodal, or of extra nodal origin, or because the primary tumor was located either in the upper or in the lower torso or in both areas. Malignant cells in the kidney, central nervous system and endocrine system were either released by the spleen via the lungs, or released by the liver and the lungs, or they were bone marrow dependent. The cascade spread of metastases hold true only for Hodgkin's disease. In cases with reticulum cell sarcomas, metastases appeared to spread at random from the primary tumor throughout the body, with rare exceptions such as metastases in the central nervous system, which originated either in the liver or in the spleen, lungs, kidney and bones.
对190例霍奇金病患者和134例网状细胞肉瘤患者进行了尸检研究。结果发现，霍奇金病患者可检测到转移的级联扩散，而非随机扩散，而网状细胞肉瘤患者则未发现。两种淋巴瘤的转移关键部位定义为原发肿瘤播散至其可能性最高的那些器官；这些部位是脾脏、肝脏、骨髓和肺。该研究未能在霍奇金病病例中证明肝脏和骨髓中的转移依赖于脾脏，而是表明脾脏、肝脏和骨髓是全身转移的三个独立来源。为解释霍奇金病和网状细胞肉瘤转移扩散不同而提出的解释包括两种淋巴瘤不同的内在细胞特征。原发肿瘤的不同位置，要么是因为起源于淋巴结或淋巴结外，要么是因为原发肿瘤位于上半身或下半身或两个区域。肾脏、中枢神经系统和内分泌系统中的恶性细胞要么由脾脏经肺释放，要么由肝脏和肺释放，要么依赖于骨髓。转移的级联扩散仅适用于霍奇金病。在网状细胞肉瘤病例中，转移似乎从原发肿瘤随机扩散至全身，罕见的例外情况如中枢神经系统的转移，其起源于肝脏或脾脏、肺、肾和骨骼。
