• The spleen is commonly enlarged on physical examination or by 99mTc-sulfur colloid scan. However, its size is not indicative of splenic involvement with HD.

• In 13% of cases, the spleen is the only site of subdiaphragmatic disease. Spleen is involved in 26% of spleens resected in staging laparotomy. It is very important to determine splenic disease. On CT the accuracy of the "splenic index"* is only 59%. Fluorodeoxyglucose-positron emission tomography (FDG-PET) scan appears to be more sensitive (about 92% accuracy) in the identification of splenic HD.

• The frequency of splenic involvement correlates with the histopathologic type: Lymphocyte predominance—16%

Nodular sclerosis—35% Mixed cellularity—59% Lymphocyte depletion—83%

• Both the para-aortic and splenic hilar nodes are involved in approximately 50% of patients with involved spleens.

*The splenic index is defined as the measurement of the spleen on CT scan. It is the product of the length x width x thickness of the spleen. If the splenic index (in cm3) exceeds 500 + 20 x age (in years) it is considered positive for splenic enlargement.

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