The spread of HD occurs mostly by contiguity from one chain of lymph nodes to another. Involvement of the left supraclavicular nodes often follows abdominal paraaortic node involvement, whereas involvement of the right supraclavicular nodes tends to be associated with mediastinal adenopathy. Para-aortic node involvement commonly occurs in association with involvement of the spleen, which in turn is commonly followed by liver or bone marrow involvement, or both. Nodular sclerosis of all histologic types shows the greatest propensity to spread by contiguity, whereas noncontiguous dissemination, when it occurs, is more than twice as frequent in the mixed cellularity and lymphocyte depletion histologic types.
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