Role of the spleen in the transdiaphragmatic spread of Hodgkin's disease

Results of detailed staging laparotomy for Hodgkin's disease with supradiaphragmatic presentation in 78 patients showed 28 with subdiaphragmatic involvement. All 28 patients with intra-abdominal disease had splenic involvement. On the basis of findings of this study and published series on staging laparotomy, it is proposed that the spleen is the first site of intra-abdominal disease in this group of patients, and that Hodgkin's disease spreads to the intra-abdominal lymph nodes, liver, and bone marrow from the spleen.