Extranodal Hodgkin's Lymphoma Research Articles

Clinical outcomes in patients diagnosed with extra-nodal Hodgkin lymphoma: a 20-year retrospective analysis of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database

Clinical outcomes in patients diagnosed with extra-nodal Hodgkin lymphoma: a 20-year retrospective analysis of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database

The Effects of Social Vulnerability on the Prognosis and Outcomes of Hodgkin's Lymphoma in Adults across the United States

Introduction: Hodgkin's Lymphoma (HL) is a common presentation of lymphoma in the United States, representing 10% of all newly diagnosed lymphomas or around 8540 cases annually. With an estimated 5-year survival of 88%, HL generally follows a more indolent course compared to other hematologic malignancies, necessitating patients with HL receiving longer follow up care. Therefore, social determinants of health (SDoH) have ample opportunity to impact care; individual SDoH factors, such as race or lower socioeconomic status (SES), have already been identified as contributing poorer prognosis. However, SDoH is realistically multifaceted and combining multiple factors of SDoH to assess HL outcomes has not yet been well characterized. Here, we compare aggregated SDoH encapsulated by the social vulnerability index, a tool created by the Centers for Disease Control (CDC) using census data, to determine how SDoH impacts prognosis and outcomes in patients with HL. Methods: All adult patients with HL as tracked in the Surveillance, Epidemiology, and End Results (SEER) Program were geographically matched to determine social vulnerability using the Social Vulnerability Index (SVI) at the time of diagnosis. Extranodal HL manifestations were excluded as this was a much rarer form with a different presentation. SVI dynamically weights 15 SDoH considerations into 4 themed domains, including SES, minority status & language, household composition & disability, and housing type & transportation, at the census tract, or county level in sparsely populated areas, to provide a percentile rank ranging from 0 (least vulnerable) to 1 (most vulnerable) across the United States. HL patients were grouped into equivalently sized relative-SVI quintiles based on actual SVI scores ranging from lowest to highest vulnerability. Data was analyzed for HL months surveyed and then patients lost to follow up were excluded to assess mortality in HL months survival for the established quintiles as seen in figure 1. Univariate linear regressions were used to determine significance. Similar methodologies and analyses were also conducted for the 4 SVI domains. Results: Overall, 49366 individuals were identified in SEER (113±105 months), with 17597 of those individuals included in months survival analysis (76±96 months). All groups were statistically significant (P<0.001) with both overall and SVI domains demonstrating decreasing months surveyed or survival with increasing social vulnerability. Additionally, as seen in table 1, a 31.2% decrease in months surveyed and a 48.9% decreased in months survival was noted for overall SVI when comparing the highest vulnerability (most negative SDoH profile) to the lowest vulnerability quintile (most positive SDOH profile). Substantial decreases were also seen in SES (34.3%, 35.2%), minority status & language (13.7%, 21.8%), household composition & disability (15.8%, 18.8%), and housing type & transportation (22.5%, 36.5%) for months surveyed and months survival respectively between the two groups. Conclusion: Higher overall SVI scores and specific social vulnerability domain scores correlated with statistically decreased months surveyed and months survival in patients with HL. Furthermore, the size of difference noted between high and low vulnerability groups in both categories indicate the substantial role SDoH has in both patient follow up and mortality and may suggest differing impact across various SDoH domains. Despite established management for HL, consequential health disparities are clearly still present affecting multiple avenues of care. With such a large and encompassing data set, greater power and statistical certainty can be generated. This work highlights the need for specific initiatives to target SDoH in HL to bridge the gap in providing equitable treatment for all. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A remarkable case of extranodal Hodgkin lymphoma monitored with F-18 FDG PET/CT

Although lymphomas are typically defined by enlarged lymph nodes and the involvement of other lymphoid tissues, Hodgkin’s disease may rarely present with extranodal disease. F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is the current state-of-the-art imaging technique in evaluating (Hodgkin) lymphoma and is very appropriate to reveal extranodal disease. In this case, the diagnostic PET/CT scan shows that, in addition to numerous enlarged and metabolically active lymph nodes, non-lymphoid organs are also affected. In particular, the involvement of the stomach wall and the pancreas is exceptional. Furthermore, this case reflects well the value of F-18 FDG PET/CT imaging during and after treatment.

Incidence and survival of Hodgkin lymphoma patients treated at a national cancer center in a middle-income country from 1999-2018: A report of 1,382 cases.

e19523 Background: Hodgkin lymphoma (HL) is classically described as a malignancy with a good prognosis and bimodal pattern. We aim to describe the incidence and survival of HL patients treated at the National Cancer Institute (NCI) in Peru. Methods: We evaluated the database at the NCI Epidemiology Department in Peru from 1999-2018. The international classification of diseases (ICD)-10 codes C810-C813, C817, C819 and ICD for Oncology (version 3) codes 96503-96533, 96573-96593, 96533-96553, 96573, 99903 were used to classify both nodal and extra-nodal HL. The estimate of overall survival (OS) curves was performed by the Kaplan-Meier method, and the difference was computed by the log-rank test. Results: During the study period 12,092 patients with lymphoma were found, of which 1,382 (11.4%) were HL. The median age was 24 years (range 2-88). Male patients were 62.4%. Patients of ≤14 years were 32.9%, with the most frequent 5-year interval group those aged 5-9 years-old representing 16.7% of patients. The adolescent and young adults (AYA) (15-39 years) group represented 38.4%. A total of 1,360 (98.4%) were classified as nodal HL. The classification according to the subtypes was as follows: 1,148 (83.1%) were one of the five subtypes [classical HL (cHL) and nodular lymphocyte-predominant HL (NLPHL)], 196 (14.2%) were HL, not otherwise specified, and 38 (2.7%) were HL without pathological confirmation. The classifiable 1,148 patients were categorized as follows: 1,107 patients (96.4%) were cHL and 41 (3.6%) were NLPHL. The cHL patients were classified as mixed cellularity HL (MCHL) in 52.3%, nodular sclerosis HL (NSHL) in 36.7%, lymphocyte-rich HL (LRHL) in 8.1%, and lymphocyte-depleted HL (LDHL) in 2.9%. The whole classifiable cohort (n = 1,148) showed a trimodal pattern. The MCHL subtype was most frequent in the 5-9 years group and in the 60-64 years group. The NSHL subtype was most frequent in the 20-24 years group. The median 5-year OS of the entire cohort (n = 1,382) was 86.3% (95%CI, 83.9-88.5). The OS according to the interval age groups were as follows: for the 0-14 years group the 5-yr OS was 94.9% (95%CI, 91.8-96.8), for the 15-39 years was 84% (95%CI, 79.5-87.68), for the 40-64 years group was 82.5% (95%CI, 75.2-87.8), and for the ≥65 years group was 58.6% (95%CI, 43.4-71.1). The OS according to age range showed a statistically significant difference p &lt; 0.01. Conclusions: In our study, patients with HL are younger compared to those in developed countries. The most frequent 5-year interval group is the 5-9 years group. HL incidence had a trimodal pattern. Extra-nodal presentation was extremely rare. NLPHL was also rare. The most frequent subtype was MCHL, however, in AYA patients the most frequent subtype was NSHL. Better OS was seen in the 0-14 year group, this being statistically significant compared to the older groups. Worse OS was observed in patients aged 65 and older.

A rare case of extranodal Hodgkin's lymphoma of the palate

AbstractIntraoral extranodal Hodgkin's lymphoma is rare. We present the case of a 66‐year‐old gentleman who was treated for necrotizing ulcerative gingivitis of the UR6 tooth by his dentist which failed to resolve. Biopsy and histopathology revealed that this was, in fact, a rare presentation of primary (Stage I) extranodal oral Hodgkin's lymphoma. We present this case, and a review of the relevant literature.

Prognosis of HIV-Associated Hodgkin Lymphoma in the Antiretroviral Therapy Era: Analysis of the National Cancer Data Base (NCDB)

▪Background: The incidence of Hodgkin lymphoma (HL) among HIV-positive (HIV+) patients remains high despite the use of antiretroviral therapy. HIV+HL is characterized by a higher prevalence of the mixed cellularity (MC) subtype and by expression of Epstein-Barr virus-encoded genes. Despite poor historical outcomes, recent studies show similar overall survival (OS) among HIV+ and HIV-negative HL patients who receive standard therapy. We examined the actual proportions of HIV+HL patients receiving chemotherapy in the United States (US), and their OS, using the NCDB-a clinical oncology database capturing >70% of incident cancer cases in the US.Methods: We analyzed classical HL cases reported to the NCDB between 2004 and 2012, with recorded HIV status. Factors associated with non-receipt of chemotherapy were studied in a mixed-effects logistic model clustered on hospital. OS was compared in Cox models adjusting for age, sex, race, stage, B symptoms and socioeconomic status, reporting adjusted hazard ratio (HR) and 95% confidence intervals (CI). CD4 counts, chemotherapy details or HL recurrences were not available in the NCDB.Results: We identified 2,090 HIV+HL and 24,889 HIV-negative patients. HIV+ patients were on average older (median age 43 vs. 39 years in HIV-negative), more often male (80% vs. 53%), black (37% vs. 12%) or Hispanic (17% vs. 8%%, all P <.00001). The proportion of black patients increased from 31% in 2004 to 49% in 2012. HIV+HL patients had also more often advanced-stage (III/IV) disease (66% vs. 40%), B symptoms (64% vs. 41%), extranodal HL (5% vs. 3%), MC (22% vs. 12%), lymphocyte-depleted (LD, 3% vs. 1%) or undetermined histology (HL-NOS, 40% vs. 26%), and less nodular sclerosis (NS) subtype (32% vs. 57%, all P<.00001).Early (I/II) stage HIV+HL patients were more often treated with chemotherapy alone (51% vs. 46% of HIV-negative), less frequently with combined modality (28% vs. 42%), and 18% received no treatment (vs. 9%, P<.0001). Similarly, in advanced stage they were less likely to receive chemotherapy than HIV-negative patients (84% vs. 91%, P<.0001). The proportion of all HIV+HL cases receiving any chemotherapy was 81%, unchanged between 2004 and 2012 (P =.29). Their risk of not receiving chemotherapy increased with age, and was significantly higher for patients who were black (odds ratio, OR, vs. white, 1.55, CI, 1.14-2.09), uninsured (OR, 1.65, CI, 1.08-2.51), or with HL-NOS (OR vs. NS, 1.73, CI, 1.27-2.35). It varied significantly by hospital (intraclass correlation, 9%, CI, 4-20%), but without difference between community and academic centers (P =.47).OS at 5 years for HIV+HL patients was 66.1% overall (95% CI, 63.7-68.4%), 78.7% in stage I/II, and 59.9% in stage III/IV. Among patients who received chemotherapy, these estimates were 73.0%, 83.5% and 68.0%, respectively. OS did not improve between 2004 and 2011 (P =.18). When HIV+ and HIV-negative HL patients were compared in models adjusting for confounders (Table), OS was not significantly different in the classic NS or MC subtypes as long as patients received chemotherapy. In contrast, HIV+ HL-NOS had significantly worse OS even with chemotherapy, similar to OS of HIV-negative patients with the unfavorable LD subtype.Conclusions: This large contemporary analysis confirms similar survival of HIV- and HIV+HL patients with the classical NS/MC histologies as long as they receive chemotherapy. HL of undetermined histologic subtype (possibly because of atypical, aggressive morphology or difficulty in obtaining an excisional nodal specimen) identifies HIV+ patients with poor prognosis despite standard therapy, who might benefit from novel, alternative approaches. As of 2012, half of HIV+HL patients in the US are black, and they are at high risk of not receiving curative chemotherapy, although it is unclear whether this is because of health care-related factors or worse immune deficiency status.Table 1HistologyAll patientsPatients receiving chemotherapy5-year OS (%)Cox model5-year OS (%)Cox modelHIV+HIV-HRPHIV+HIV-HRPNS74.585.31.42.000180.287.11.14.23MC73.073.11.31.02677.676.81.14.37Lymphocyte-rich74.181.81.25.5971.183.71.49.38LD57.555.41.09.7669.062.90.95.89HL-NOS55.172.01.85<.000163.577.31.57<.0001 DisclosuresOlszewski:Genentech, Inc.: Research Funding; Bristol-Myers Squibb, Inc.: Consultancy.

Clinicopathologic analysis of five cases of cutaneous intravascular natural killer/T-cell lymphoma

Objective To improve the understanding of cutaneous intravascular natural killer/T-cell lymphoma (CIVNKTC). Methods Clinical data on five cases of CIVNKTC were collected. The histopathological feature, treatment and prognosis of CIVNKTC were retrospectively analyzed and discussed. Results Of the 5 patients, 1 was male and 4 were female. The age of onset ranged from 38 to 83 years (average, 56.2 years). All the patients presented with multiple plaques and nodules as the primary symptoms. Histopathological examination revealed vasodilatation in the dermis and subcutaneous tissue, as well as atypical lymphoid cells with large hyperchromatic nuclei containing 1 -2 small nucleoli in dilated veins. Immunohistochemical studies of tumor cells showed positive staining for CD3e, cytotoxic proteins (including T cell-restricted intracellular antigen-1, granzyme B and perforin) and Epstein-Barr virus (EBV)-encoded microRNA, but negative staining for cytokeratin, CD20, CD79a, CD4 and CD8. Furthermore, the tumor cells stained positive for CD56 in two patients. Among the 5 patients, only 2 received chemotherapy and the remaining received no treatment. During a 24-month follow-up, 4 patients died, and only 1 survived with the tumor. Conclusion CIVNKTC is a rare extranodal Hodgkin's lymphoma with distinct histologic manifestations and immunophenotypes, rapid and aggressive clinical course, and poor prognosis. Key words: Lymphoma, extranodal NK-T-cell; Skin manifestations; Pathological processes; Immunohistochemistry; Intravascular lymphoma

English

INTRODUCTION: Lymphomas are heterogeneous group of malignant lympho- proliferative disorders. Broadly categorized into Non-Hodgkin's lymphoma (NHLs) and Hodgkin's lymphoma (HL). Decades back one of the challenging topics in morphologic pathology was accurate diagnosis and classification of lymphoma. Studies on lymphoma with clinicopathologic correlation were found to be much significant. STUDY OBJECTIVES: This was a retrospective study aimed to describe lymphomas on histo morphology and thus classify NHLs using working formulation for clinical usage (1982) and HL using Rye (1966) classification respectively. To attempt clinicopathologic correlation. METHODS: The study was done in the department of pathology, Mahadevappa Rampure Medical College, Gulbarga during the period 1989-1999. Formalin fixed paraffin wax embedded tissue blocks previously diagnosed as lymphomas in the department were used. Morphologic details by light microscopy on haematoxylin and eosin (H&E) stained sections were noted. Clinical history of each case were analysed from hospital records. Clinical and pathologic correlation was done. Special stains Reticulin (Gomori) and Periodic acid Schiff's stain (PAS) was done in relevant cases. RESULTS: Study of total 102 cases of lymphoma it was observed NHLs formed 70 cases with an incidence of 68.3%. HL accounted for 32 cases with incidence of 37.2%. NHLs commonly presented in fifth decade 24.2%, followed by fourth and sixth decade. Sex distribution showed Male: Female ratio as 2.5:1. Majority of cases presented with cervical and axillary lymphadenopathy at 41% and 20% respectively. The most frequent grade was clinically aggressive intermediate grade NHLs seen in 80% of all cases. 20 cases of NHLs were of extranodal in origin. The most common site was gastrointestinal tract (60%) and head and neck region with (30%). The major histologic type in both nodal and extranodal NHLs was diffuse small cleaved cell type (DSCC). HL showed sex ratio of 1.8:1.The common age group was in third and second decade. Mixed cellularity was most frequent type. No extranodal HL was noted. CONCLUSION: This study confirmed the usefulness of histomorphology in diagnosis of lymphomas and its basis used in the classification systems. Clinicopathologic correlation was significant. The Result was comparable with various author study series. A relook into the still clinical usefulness of the above classification system in this

Primary Extranodal Hodgkin's Lymphoma presenting with a Single Pelvic Mass

ABSTRACTIntroductionAlthough lymphomas can arise from a wide variety of tissues, primary extranodal presentation is predominantly a feature of non-Hodgkin's lymphomas. Primary pelvic extranodal Hodgkin's lymphoma is a rare malignancy. We presented a case of primer retroperitoneal Hodgkin's lymphoma initially presumed gynecologic malignancy. We discussed its rarity, staging and management.Case ReportA 75-year-old woman was referred to our hospital with persisting pelvic mass. Pelvic examination revealed an ill-defined immobile mass with hard in consistency. The mass 100 × 75 mm in diameter, invading right parametrium, perivesical space and bladder wall was detected in CT and there were no signs of metastases or enlarged lymph nodes. Diagnostic laparoscopy was suggested but the patient refused the surgery due to her advanced age. One year later, she presented with the symptoms of fever, sweats and fatigue. Hodgkin's lymphoma was diagnosed via laparoscopic biopsy of the mass located at retroperitoneal space anteriorly to the uterus. CT examination revealed multiple swollen lymph nodes and a pulmonary nodule; thus, stage 4 disease was established. International prognostic score was 2, indicating 67% progression free survival; however, patient died due to respiratory failure after the first course of ABVD chemotherapy.ConclusionAlthough gynecologists rarely experience primary extranodal lymphomas particularly Hodgkin's disease, lymphoid malignancies should be kept in mind in differential diagnosis of pelvic masses. This disease can rarely arise adjacent to gynecologic organs in retroperitoneal space, and this presentation can be misinterpreted as a gynecological malignancy.How to cite this articleKiran G, Canaz E, Sayar H, Serin S, Balakan O. Primary Extranodal Hodgkin's Lymphoma presenting with a Single Pelvic Mass. J South Asian Feder Obst Gynae 2014;6(3):183-186.

Primary extranodal Hodgkin′s lymphoma of the faucial tonsil

Primary extranodal involvement of Waldeyer's ring by Hodgkin's lymphoma (HL) is a rare occurrence and only isolated cases have been described. The aims of the study were to review primary extranodal HL of the tonsillar region and to present a new case without evidence of systemic involvement. The differential diagnoses, immunologic findings, and features of these rare tumors are discussed. All manuscripts published on primary extranodal HL of the pharynx were retrieved from the literature, using PubMed as a search engine, and the data compared with a case diagnosed in a 64-year-old male. Although a diagnosis of HL is not considered generally in the differential diagnosis of the pharyngeal mass, histopathologists should be aware of its possible occurrence.

Hodgkin's lymphoma involving extranodal sites: potential association with HIV infection and the implications for clinical management

We commend Li et al.[1] for their article “Clinical characteristics of the patients with Hodgkin's lymphoma involving extranodal sites” (published in the Chinese Journal of Cancer in July 2012). We agree that in comparison with extranodal non-Hodgkin's lymphoma (NHL), the incidence of extranodal Hodgkin's lymphoma (HL) is much rarer and thus described much less frequently in the literature. We would like add a few points to complement the above mentioned article. Patients with extranodal lymphoma (either NHL or HL) have a higher risk of being infected with the human immunodeficiency virus (HIV) than do those with lymphoma confined to the lymphoreticular system. As a corollary, HIV-infected patients who develop lymphomas are more likely to manifest extranodal disease compared with the non-HIV-infected population. Indeed, various series consistently showed that more than 50% of HIV-associated lymphomas present with extranodal disease[2]–[5]. HL patients with HIV infection, especially those carrying a high risk of extranodal involvement, are nearly always co-infected with the Epstein-Barr virus and often have other high risk features, such as (but not limited to) B symptoms, high stage at presentation, and poor outcome to standard therapy[3]–[5]. Bearing the above points in mind, we suggest that every patient with extranodal HL should be evaluated to assess the HIV status and also to ascertain the CD4+ T cell count. If done, the highly active anti-retroviral therapy could be initiated to improve CD4+ T cell counts, which in turn could improve patient survival by reducing the risk of infection-related deaths and indirectly improving patient tolerance for chemotherapy[6],[7]. Lastly, we also suggest the routine use of whole body 18-fluorodeoxyglucose positron emission tomography scan among all HIV-positive individuals who develop lymphomas to detect foci of extranodal involvement that would otherwise be missed.

Multiple primary enoral soft tissue manifestations of a Hodgkin lymphoma—case report and literature review

Hodgkin lymphoma (HL) are lymphoproliferative neoplasms, histologically comprising of mononuclear and multinucleated Hodgkin and Reed Sternberg cells (HRS). About 4 % of all lymphatic malignancies of the head and neck are HL. The typical disease presents itself as a nodal lesion. Extranodal, enoral soft tissue involvement by HL is very rare. A 73-year-old man with a suspect, ulcerating lesion in the left retromolar region of the mandible was assigned to our hospital. Prior anti-inflammatory therapy has been without success. Subsequently, three biopsies were taken which could only show inflammation. Finally, two biopsies from the left retromolar region and the left inner cheek showed HRS cells with positive expressions of CD15 and CD30 corresponding to a Hodgkin lymphoma. No lymphatic node or bone involvement could be detected. The patient was designated to receive radio-chemotherapy, but died 3 weeks after diagnosis of multiple organ failure. In a literature review, together with this report, nine cases were found concerning primary HL of the oral mucosa. Accordingly, this is the first case of primary multiple extranodal HL in the oral mucosa in absence of lymphatic node involvement. Neither clinical features nor radiological appearances of HL presenting as primary enoral lesions are pathognomonic. Especially when only small biopsy specimens are available, histological diagnosis remains challenging, may lead to a delay in therapy and may result in a significant worse prognosis.

Hodgkin lymphoma of the Maxillary Sinus: An Unusual Occurrence

The maxillary sinus is a rare anatomic site for Hodgkin lymphoma, as only 1 such case has been previously reported in the literature. Nevertheless, we recommend that lymphoma be considered in the differential diagnosis of a mass that involves the maxillary sinus or any other unusual extranodal site in the head and neck. Lymphoma in a patient who presents with disease in an unusual site and without lymphadenopathy is difficult to diagnose. We report the case of a 60-year-old woman who presented with nasal congestion and obstruction. Examination revealed an abnormal-appearing mucosa involving the maxillary sinus. Subsequent evaluation led to a diagnosis of Hodgkin lymphoma. Because making such a diagnosis is difficult, close attention to radiologic and pathologic findings is important. Our review of the literature revealed that treatment commonly includes chemotherapy and radiotherapy, which yield excellent outcomes. The current standard of care for patients with similar-stage Hodgkin lymphoma at other sites can guide the treatment course for patients with extranodal Hodgkin lymphoma.

Primary extranodal lymphoma of the maxilla: a case report with imaging features and dynamic data analysis of magnetic resonance imaging

Malignant lymphoma is the second-most common malignancy in the head and neck region. Waldeyer's ring is the most common site of extranodal Hodgkin's lymphoma (NHL) in that region, and a small percentage of primary extranodal NHL occurs in the oral cavity. The most common sites of extranodal NHL in the oral region are the palate and maxilla, and nearly half of extranodal NHL cases arise from bone. It is difficult to diagnose extranodal NHL because of the variety of its radiological features. We report a case of primary extranodal NHL of the maxilla in a 68-year-old female patient with atypical imaging findings, along with the results of analysis of dynamic magnetic resonance imaging (MRI).

Lymphoma Masquerading as Acute Abdomen

Purpose: 45-year-old male presented to the hospital with sudden onset of right upper quadrant pain. The patient described the pain as sharp, intense, non-radiating which was preceded by one episode of non-bilious vomiting. Review of systems was positive for nausea, vomiting and chills. Past medical history was noncontributory. Physical examination revealed a young male who was visibly distressed secondary to pain. He was afebrile and hemodynamically stable. The abdomen was tender to palpation in the epigastric and right paraumblical region with presence of guarding. There was no rebound tenderness and bowel sounds were present. Remainder of the exam was unremarkable. Laboratory evaluation demonstrated normocytic normochromic anemia (Hct-33), fairly unremarkable blood chemistry and liver function tests. A CT of the abdomen revealed closed loop obstruction with the segment of abnormal bowel extending from the proximal to mid jejunum to the distal ileum. There was a diffuse circumferential irregular wall thickening of the dilated small bowel in the right upper quadrant which could be related to wall edema or mass/neoplasm. There was a 5x3.4x3.4 cm circumscribed mass in the central mesentry with mixed attenuation with some central mesenteric adenopathy. The patient underwent diagnostic laparoscopy and small bowel resection. He was found to have a 5 cm tumor of the proximal small bowel which on pathology was a follicular diffuse large B-cell lymphoma (CD20 positive). The rest of the abdominal exploration was normal with normal small bowel and colon. GI tract is the predominant site of extra-nodal Hodgkin Lymphoma. Both Hodgkin and NHL can involve the GI tract but Hodgkin is very rare. Lymphomas can be primary when they arise in the GI tract and secondary when they involve the GI tract as an extension from another primary source. Predisposing conditions for intestinal lymphoma include autoimmune diseases, immunodeficiency syndromes (e.g. AIDS), long-standing immunosuppressive therapy (e.g. post transplantation), Crohn's disease, radiation therapy and Nodular lymphoid hyperplasia. Contrast radiography is usually the initial diagnostic modality for detecting small bowel lymphomas. IPSID (Immunoproliferative Small Intestinal Disease) associated lymphomas generally appear as a diffuse infiltrating lesion, sometimes resembling cobblestoning and are more common in the proximal small intestine. Western-type non-IPSID lymphomas may appear as ulcerated, protruding, or infiltrating mass lesions and the distal small intestine is the most common site of involvement. Barium enema, Endoscopic Ultrasound and laparotomy are also used for diagnosis.

Primary Extranodal Hodgkin Lymphoma of the Colon Masquerading as New Diagnosis of Crohn's Disease

Primary Extranodal Hodgkin Lymphoma of the Colon Masquerading as New Diagnosis of Crohn's Disease

Positron Emission Tomography With 2-[18F]-Fluoro-2-Deoxy-D-Glucose For Initial Staging Of Hodgkin Lymphoma: A Single Center Experience In Brazil

BACKGROUND:2-[18F]-Fluoro-2-Deoxy-D-Glucose (FDG-PET) is a well established functional imaging modality for the initial staging of Hodgkin lymphoma (HL) in patients from Western Europe and North America. The reliability of FDG-PET in populations of different ethnic groups is unclear, as all investigations published to date have come from developed countries.PURPOSE:The aim of the present study was to investigate the effectiveness of FDG-PET in the initial staging of HL patients in a Brazilian population.METHODS:Eighty-two patients with newly diagnosed HL were prospectively included in the study. All patients were staged with both conventional clinical staging (CCS) methods, including computed tomography (CT) and whole-body FDG-PET methods. A standard of reference for the nodal regions and the extranodal organs was determined using all available information, including the CCS methods, FDG-PET, the diagnostic histology and the follow-up examinations. The results of the CCS were then compared to the FDG-PET results.RESULTS:The sensitivity of FDG-PET was higher for nodal staging than that of CT (87.8% vs. 61.6%, respectively). FDG-PET was also more sensitive than CT in regard to evaluating the extranodal organs for lymphomatous involvement (96.2% vs. 40.0%, respectively). FDG-PET detected all 16 patients who were characterized by a positive bone marrow biopsy and identified an additional 4 patients with bone marrow disease. The incorporation of FDG-PET coupled with CCS in the staging procedure upstaged 20% (17/82) of the patients and downstaged 11% (9/82) of the patients. As a result of these changes in staging, 15% (13/82) of the patients would have received a different therapeutic regimen.CONCLUSIONS:The FDG-PET method is superior to CT for the detection of nodal and extra-nodal HL. The observation that the FDG-PET method upstaged the disease was the most common result (20% of patients) brought about by the addition of PET to the staging algorithm, even in a population of patients with a high incidence of advanced disease. However, changes in stages based on FDG-PET results should be confirmed by biopsy.

Fine‐needle aspiration of extranodal Hodgkin's lymphoma misinterpreted as carcinoma

Fine‐needle aspiration of extranodal Hodgkin's lymphoma misinterpreted as carcinoma

Oral Hodgkin lymphoma: a wolf in wolf’s clothing

Hodgkin lymphoma typically presents as a nodal lesion and infrequently involves extranodal sites. The English language literature contains only 7 reports of primary Hodgkin lymphoma arising in the oral mucosa in the absence of nodal disease. We report a case of primary, extranodal Hodgkin lymphoma in the palatal mucosa of a 79-year-old white female. An incisional biopsy revealed a diffuse, mixed cellular infiltrate, consisting of benign lymphocytes, plasma cells, histiocytes, and foci rich in eosinophils. Within this background was a scattering of large, atypical cells, including Reed-Sternberg forms that exhibited immunoreactivity for CD30 and CD20 and nonreactivity for CD15 and CD45RO, supporting a diagnosis of classical Hodgkin lymphoma. Positron emission tomography exhibited a single focal area of abnormal hypermetabolic activity involving the left palate area, without involvement of any other site. The clinical stage was Ann Arbor I-A. The primary tumor and submandibular and upper neck lymph nodes were treated with a 6-MV photon beam to a total dose of 4000 cGy. There was no evidence of disease at 15-month follow-up.

Primary Hodgkin’s lymphoma of the caecum

Extra-nodal Hodgkin's lymphoma (HL) represents 15% of all Hodgkin's lymphomas; the primary intestinal site accounts for 1% and with involvement of the ascending colon being rare. We present the case of a patient of 62 years of age diagnosed as having acute appendicitis. Anatomopathology on the excised appendectomy tissue indicated nodular lymphocytic predominant Hodgkin's lymphoma (NLPHL). The morphology indicated isolated L&H (lymphocytic or histiocytic) cells or in groups, surrounded by T lymphocytes, in an environment of germinal centres together with phenomena that would be interpreted as progressive transformation. Immunohistochemistry staining of the HL cells were positive for CD45, CD20, Bc16, EMA and MUM1 and negative for CD15 and CD30. No complementary treatment was administered. Following a literature search, the present case would appear to be the first of its kind.