To the Editor.—
The case report " `Ivory Vertebra' in Hodgkin's Disease' " by Hertz et al (238:2402, 1977) is an interesting demonstration that a sclerotic bone lesion in Hodgkin's disease may respond to radiotherapy. However, both their analysis of the case and the treatment given their patient appear inadequate. Their patient had both a normal lymphangiogram and a normal laparotomy. Nevertheless, the authors conclude that this probably represents a case of local extension from nodal disease. This conclusion is illogical and is not adequately supported by the cited references, which merely suggest that solitary bone involvement by a hematogenous route is uncommon.Although we agree that local pressure or extension may cause osteosclerotic changes, we see no reason to conclude that this occurred in their patient. Instead, with no evidence of local disease, it appears more likely that this represents hematogenous spread. This distinction is not academic since the presence of
Stein RS, Flexner JM. Ivory Vertebra in Hodgkin's Disease. JAMA. 1978;239(24):2550. doi:10.1001/jama.1978.03280510034008
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