Hodgkin lymphoma involving the Brain; A Rare Case report

Abstract

Abstract Introduction/Objective Hodgkin lymphoma (HL) is a systemic disease that usually affects the cervical, mediastinal, and supraclavicular lymph nodes. Involvement of the central nervous system (CNS) by primary or systemic HL is extremely rare, and it is usually associated with severe systemic relapse disease. Methods/Case Report A 31-year-old male presented with severe hypercalcemia and months of dry cough and B symptoms including night sweats and weight loss. The CT of the chest and abdomen was significant for splenomegaly and perihilar/subcarinal mass. The patient was diagnosed with classic HL stage IVB and was started on Adriamycin, Vinblastine Sulfate, Dacarbazine (AVD), and Brentuximab regimen. A month later the patient exhibits neurological symptoms, and an MRI of the brain showed 1 x 1 x 1.1 cm a spherical lesion near the gray-white matter differentiation of the right anterior temporal pole. Histologically, the resection specimen consists of sheets of atypical pleomorphic cells. Some with bilobated to multilobated nuclei, a prominent eosinophilic nucleolus, and ample amphophilic cytoplasm consistent with Reed- Sternberg cells (RSC), diagnostic of classic HL. Immunohistochemically, the RSC and variants were positive for CD15, CD30 (weak), CD79 a, and PAX5. The weak expression of CD30 was secondary to treatment with anti-CD30 antibodies. The malignant cells were negative for CD3, CD10, CD45, Bcl-2, ALK1, MUM-1, and SV40. Results (if a Case Study enter NA) NA Conclusion CNS involvement in HL is rare, but it must be considered in patients with previous history of HL who present with intracranial lesion. A multidisciplinary approach is needed for these cases because there is no consensus on the best treatment, and surgery followed by targeted radiotherapy and systemic chemotherapy should be considered on individual basis and according to the complexity of each case. At present, the prognosis of this rare complication is poor and needs to be improved.