In cases of chronic lymphogranulomatous disease, particularly when the gross or the histologic lesions accessible for examination are not pathognostic of any one recognized entity, both clinical and histologic diagnoses may be confused. This is especially true in cases of Hodgkin's disease when it is unusual in character. In some cases of atypical disease the diagnosis may be made because no other classification is possible in the light of present knowledge, and in others, as in the one reported here, it may be mistaken for other diseases. The final diagnosis is often established at necropsy, when all available data are at hand.
In the present case Hodgkin's disease was suspected early in the course, but because of the unusual onset with the earliest and most prominent lesions in the skin and the absence of demonstrable enlarged lymph nodes and later because of the histologic changes in excised bits of tissue
REIMANN HA, HAVENS WP, HERBUT PA. HODGKIN'S DISEASE WITH SPECIFIC LESIONS APPEARING FIRST IN THE SKIN. Arch Intern Med (Chic). 1942;70(3):434-443. doi:10.1001/archinte.1942.00200210089007