Bone involvement in Hodgkin's disease usually occurs late in the course of the illness, together with extensive nodal involvement. In the past 5 years, we have seen four adolescents with Hodgkin's disease who presented with primary bone lesions. All had disseminated lymphoid involvement when the final diagnosis was made 3–11 months later. A review of the literature showed 13 more cases of similar presentation. The patient characteristics are discussed and the diagnostic difficulties are emphasized. Hodgkin's disease should be considered in the differential diagnosis of primary osseous malignancies.