History Of Hodgkin Lymphoma Research Articles

HL-358 Metachronous Endometrial Carcinoma in a Patient With a History of Hodgkin Lymphoma

HL-358 Metachronous Endometrial Carcinoma in a Patient With a History of Hodgkin Lymphoma

Metachronous Endometrial Carcinoma in a Patient With a History of Hodgkin Lymphoma

Metachronous Endometrial Carcinoma in a Patient With a History of Hodgkin Lymphoma

Arterial stiffness and aortic hemodynamics as predictors for new or worsening cardiovascular events in childhood cancer survivors: A report from the St. Jude lifetime cohort.

e24006 Background: Survival following childhood cancer has improved due to advances in treatment and supportive care. However, survivors are at high risk of cardiovascular diseases (CVDs) later in life. Aortic artery stiffening, captured by measuring the speed and magnitude of forward and reflected pulse waves, is an independent predictor of CVD and mortality in the general population. Methods: We evaluated associations between vascular function and new or worsening CVDs [coronary artery disease (CAD), cardiomyopathy, and hypertension (HTN)] among a subset (n = 249) of St. Jude Lifetime Cohort (SJLIFE) participants who had baseline vascular function assessment and returned for a standard follow up study visit (mean age at baseline (years) ± standard deviation: 34 ± 9 years, follow-up: 39 ± 9 years). CVD conditions were graded (dichotomized as grades 0-1 and 2-4) using the Common Terminology Criteria for Adverse Events (CTCAE). Aortic stiffness, brachial and aortic blood pressure (BP), and aortic wave reflection (augmented pressure, augmentation index (AIx), AIx adjusted to a heart rate of 75 beats/min (AIx75), time and magnitude of the forward and reflected waves) were assessed using wave separation analyses. T-tests were used to test mean values between the groups with higher (2-5) and lower (0-1) grades. These tests informed the selection of identified variables for multivariate logistic models, which were adjusted for age, sex, race, body mass index, physical activity, smoking status, drinking behavior and vasoactive medications. Results: Most participants had a history of Hodgkin lymphoma (53.8%) or leukemia (20.5%) and 25.7% other diagnoses. There were 169 (67.9%) participants who had cranial/neck radiation, 167 (67.9%) received anthracyclines, and 150 (60.2%) alkylating agents. At baseline 38.2% had ≥grade 2 HTN, 9.2% cardiomyopathy, and 4% CAD. Having ≥ grade 2 CVDs was significantly associated with augmented markers of brachial and aortic BP, arterial stiffness, and wave reflection. Regression analyses revealed that AIx75 ≥ 17% was associated with an increased risk of new or worsening HTN (odds ratio (OR) 3.29, 95% confidence interval (CI) 1.03-10.48) and new or worsening cardiomyopathy (OR 4.06, 95% CI 1.02-16.16) an average of 5 years after baseline vascular testing. Conclusions: Childhood cancer survivors diagnosed with grades 2-4 CVDs at a baseline visit had elevated aortic stiffness and augmented indices of wave reflection compared to those with < grade 2 CVDs. Elevated AIx75 was associated with new or worsening HTN and cardiomyopathy five years later. Early detection and treatment of vascular dysfunction may ameliorate CVD late effects in childhood cancer survivors.

HL-214 Breast Pleomorphic Liposarcoma in a Case With a History of Hodgkin Lymphoma

HL-214 Breast Pleomorphic Liposarcoma in a Case With a History of Hodgkin Lymphoma

POSTER: HL-214 Breast Pleomorphic Liposarcoma in a Case With a History of Hodgkin Lymphoma

POSTER: HL-214 Breast Pleomorphic Liposarcoma in a Case With a History of Hodgkin Lymphoma

Immunodeficiency with susceptibility to lymphoma with complex genotype affecting energy metabolism (FBP1, ACAD9) and vesicle trafficking (RAB27A).

Inborn errors of immunity (IEI) are characterized by a dysfunction of the immune system leading to increased susceptibility to infections, impaired immune regulation and cancer. We present a unique consanguineous family with a history of Hodgkin lymphoma, impaired EBV control and a late onset hemophagocytic lymphohistiocytosis (HLH). Overall, family members presented with variable impairment of NK cell and cytotoxic T cell degranulation and cytotoxicity. Exome sequencing identified homozygous variants in RAB27A, FBP1 (Fructose-1,6-bisphosphatase 1) and ACAD9 (Acyl-CoA dehydrogenase family member 9). Variants in RAB27A lead to Griscelli syndrome type 2, hypopigmentation and HLH predisposition. Lymphoma is frequently seen in patients with hypomorphic mutations of genes predisposing to HLH. We hypothesize that the variants in FBP1 and ACAD9 might aggravate the clinical and immune phenotype, influence serial killing and lytic granule polarization by CD8 T cells. Understanding of the interplay between the multiple variants identified by whole exome sequencing (WES) is essential for correct interpretation of the immune phenotype and important for critical treatment decisions.

Lymphadenopathy secondary to tattoo ink in a patient with a history of Hodgkin lymphoma.

The finding of lymphadenopathy on physical examination and radiographically can suggest a wide range of differential diagnoses for patients, including a benign inflammatory process, infection, or malignancy. This article describes a patient with a history of Hodgkin lymphoma who developed postremission left axillary lymphadenopathy caused by deposits of tattoo ink in the node.

Rash in an immunocompromised patient

A 47-year-old man presented to the emergency department with rapidly worsening skin lesions and malaise. The patient had scattered pink papules, some with overlying ulceration and hemorrhagic crust, that had started on his back and chest and spread to his face, buttocks, and extremities. Closer examination of his abdomen and neck revealed vesicles on an erythematous base. The patient had a history of Hodgkin lymphoma and a bone marrow transplant complicated by graft versus host disease.What’s your diagnosis?

Image-guided lymph node fine-needle aspiration: the Johns Hopkins Hospital experience.

Although the diagnostic utility of lymph node fine-needle aspiration (FNA) is well established in the evaluation of metastatic malignancy, its value in the diagnosis of lymphoma is more controversial; yet, there is a growing trend among practitioners towards less-invasive procedures such as FNA and core needle biopsy (CNB). The guidelines recently published by the American Society for Clinical Pathology/College of American Pathology (CAP) regarding the workup of lymphoma include recommendations on the value and limitations of FNA. We reviewed 1237 image-guided lymph node aspirates from 695 procedures (410 nodes from 360 ultrasound [US]-guided cases, 799 from 309 endobronchial ultrasound [EBUS], 25 from 23 endoscopic ultrasound [EUS], and 3 from 3 computed tomography [CT]). The majority (40 of 46, 87%) of lymph nodes suspected of lymphomatous involvement were aspirated under ultrasound. Core needle biopsy [CNB] was obtained for 41 (89%) lymph nodes, including all 40 US specimens. Flow cytometry (FC) was performed on 37 (80%) aspirates; aspirates without FC were from patients who had a history of Hodgkin lymphoma, or showed granulomata or non-hematologic malignancy onsite. Thirty-one (67%) lymph nodes were sent for review by hematopathology. Forty-two (91%) lymph node FNA/CNB yielded actionable diagnoses. Seventeen of 241(7%) cases aspirated for other indications (14 US, 3 EBUS) were involved by a lymphoproliferative process. All were reviewed by hematopathology. All 14 US cases had FC and CNB. Our institutional approach towards lymph node cytopathology for lymphoma workup appears to be in accordance with the new CAP guidelines, and demonstrates a potential triage and workflow model for lymph node FNA specimens that allows for accurate diagnosis in cases where lymphoma is a consideration.

Missed irradiation of cellular blood components for vulnerable patients: Insights from 10 years of SHOT data.

BackgroundIrradiation of cellular blood components is recommended for patients at risk of transfusion‐associated graft‐vs‐host disease (TA‐GvHD). Prestorage leucodepletion (LD) of blood components is standard in the UK since 1999.Study Design and MethodsAnalysis of 10 years' reports from UK national hemovigilance scheme, Serious Hazards of Transfusion (2010‐2019), where patients failed to receive irradiated components when indicated according to British Society for Haematology guidelines (2011).ResultsThere were 956 incidents of failure to receive irradiated components all due to errors. One hundred and seventy two incidents were excluded from analysis, 125 of 172 (72.7%) because of missing essential information. No cases of TA‐GvHD were reported in this cohort. The 784 patients received 2809 components (number unknown for 67 incidents). Most failures occurred in patients treated with purine analogues (365) or alemtuzumab (69), or with a history of Hodgkin lymphoma (HL) (192). Together these make up 626 of 784 (79.9%). Poor communication is an important cause of errors.ConclusionLeucodepletion appears to reduce the risk for TA‐GvHD. None of 12 cases of TA‐GvHD reported to SHOT prior to introduction of LD occurred in patients with conditions recommended for irradiated components by current guidelines. Irradiation indefinitely for all stages of HL is not based on good evidence and is a difficult guideline to follow. Further research on long‐term immune function in HL is required. Variation between different national guidelines reflects the very limited evidence.

Transforaminal Endoscopic Approach for Large-Sample Tumor Biopsy using Beveled Working Channel for Core Technique: A Technical Note

Identifying the histopathological diagnosis of a spinal tumor is the necessary step prior to pursuing subsequent treatment. Both minimally invasive and open spinal procedures have been described as useful methods of obtaining tumor tissue for diagnosis but differ by their limitations. Minimally invasive techniques, such as computed tomography-guided biopsies, can expose the patient to radiation, and the tissue obtained may be nondiagnostic. Tubular and open procedures require collateral soft-tissue damage and may require bony removal leading to iatrogenic injury. Endoscopic approaches to the spine can be employed to avoid treatment delay in diagnosis, decrease length of stay, and provide adequate tissue for diagnosis. We describe the surgical planning, tumor localization, and transforaminal endoscopic approach for tissue diagnosis of a lumbar spinal mass in a patient with a known history of Hodgkin lymphoma and non-Hodgkin lymphoma after a nondiagnostic computed tomography- guided biopsy. Final histopathological diagnosis of the lumbar spinal mass was consistent with large B-cell non-Hodgkin lymphoma. We demonstrate the application of an endoscopic transforaminal approach in spine oncology. We also describe our technique on how we use a beveled working channel to obtain a large tissue core sample for definitive diagnosis.

SUDDEN PARADOXICAL DEVELOPMENT OF HEART FAILURE FOLLOWING PERICARDIOCENTESIS FOR CARDIAC TAMPONADE CALLED AS PERICARDIAL DECOMPRESSION SYNDROME (RARE, UNDERREPORTED CONDITION)

Pericardial decompression syndrome (PDS) is an infrequent, life-threatening complication following pericardial drainage for cardiac tamponade physiology. A 56-year-old woman with history of Hodgkin lymphoma came to an emergency with dyspnea for 2 weeks. Vitals showed blood pressure 90/60 mmHg,

Expanded neuromuscular morbidity in Hodgkin lymphoma after radiotherapy.

Our study aims to quantitate neuromuscular morbidity from radiotherapy in Hodgkin lymphoma including: (i) frequency and (ii) time of onsets for neurological localizations; (iii) degree of disabilities and (iv) number of clinical visits compared to cardiopulmonary Hodgkin lymphoma-radiation complications. Medical records from Mayo Health systems were retrieved; identifying neuromuscular radiation treated Hodgkin lymphoma-complications from 1 January 1994 to 31 December 2016. Of an estimated 4100 post-radiotherapy Hodgkin lymphoma patients, 4.6% (189) were identified with complications. Mean latency to physician visit for symptoms was 23.7 years (range: 1–50). Most commonly identified complications included: head drop 10% (19) with or without myopathy, myopathy 39% (73), plexopathy 29% (54), myelopathy 27% (51) and polyradiculopathy 13% (24). Other findings included benign and malignant nerve sheath tumours 5% (9), phrenic and long thoracic mononeuropathies 7% (14) and compressive spinal meningioma 2% (4). Patients frequently had multiple coexisting complications (single = 76% [144], double = 17% [33], triple = 4% [8], quadruple = 2% [4]). Cardiac 28% (53) and pulmonary 15% (29) complications were also seen in these patients. History of Hodgkin lymphoma was initially overlooked by neurologists (14.3%, 48/336 clinical notes). Hospital and outpatient visits for complications were frequent: neuromuscular 19% (77/411) versus cardiopulmonary 30% (125/411). Testing was largely exclusionary, except when imaging identified secondary malignancy. Modified Rankin score at diagnosis varied: 0–1 (55.8%), 2–3 (5.8%) and 4–5 (38.3%). Neuromuscular complications among post-radiation Hodgkin lymphoma are diverse, occurring in ∼1 of 20 having markedly delayed onsets often eluding diagnosis. Frequent care visits and major morbidity are common. Survivorship recommendations should recognize the diverse neurological complications.

Percutaneous Closure of Intra-MitraClip Leak: Impact of Occluder Device Type on Closure Success and Hemolysis

A 76-year-old man with a history of Hodgkin lymphoma, chest radiation, and severe mitral regurgitation treated with 2 MitraClip devices 2 years previously presented with worsening dyspnea (Class III). Echocardiography revealed severe regurgitation between the 2 MitraClip devices, located at a

Abstract P343: Utility of Autonomic Testing for the Diagnosis of Neurogenic Orthostatic Hypotension and Subsequent Management With Droxidopa

A 62-year-old man with a history of Hodgkin lymphoma, lupus, type 2 diabetes mellitus, neuropathy, hypercholesterolemia, hypothyroidism, and orthostatic hypotension who was taking gabapentin, saxagliptin, pravastatin, levothyroxine sodium, omeprazole, prednisone, midodrine, and fludrocortisone was evaluated for syncope, collapse, and fluctuating blood pressure (BP). He reported a 2-year history of syncope, with progressive worsening over a 3-month period. Initially, his episodes of syncope were preceded by dizziness and nausea, but began to occur without warning. He also reported a 5-year history of orthostatic hypotension, with supine BP of 100/60 mmHg and standing BP of 50-60/40 mmHg. Treatment with midodrine (10 mg three times daily) and fludrocortisone (0.1 mg twice daily [BID]) did not relieve his symptoms. Initial cardiac evaluation revealed a systolic murmur, but was otherwise unremarkable. Autonomic function tests, including continuous electrocardiography, BP and heart rate monitoring at 2-min intervals, and transcranial Doppler, were performed in the supine and 80° head-up tilt positions. A BP drop from 112/68 mmHg to 76/60 mmHg occurred within 2 min of tilt, accompanied by dizziness and presyncope. Heart rate with deep breathing revealed a depressed baseline autonomic tone, and a Valsalva maneuver test showed a depressed Valsalva response (Valsalva ratio: 1.15). Taken together, these results indicated a diagnosis of neurogenic orthostatic hypotension (nOH). Treatment with droxidopa (100 mg BID) was initiated; this dose was titrated to 100 mg once daily due to hypertension, for which, a nitroglycerin patch (0.2 mg nightly) was prescribed. All other medications were continued. Treatment with droxidopa significantly improved his symptoms; he no longer loses consciousness upon positional change, but still experiences some symptoms of presyncope (eg, slight lightheadedness, dizziness). This has allowed greater integration into activities of daily living and a less strenuous routine for the patient and his caretakers . In conclusion, autonomic function testing in this patient effectively led to a timely diagnosis of nOH which, in turn, allowed for implementation of appropriate pharmacologic intervention to manage symptoms.

Osteoma cutis, a propósito de un caso

El osteoma cutis (OC) es una lesión compuesta de tejido óseo en dermis y/o hipodermis. Se clasi can en primarios, cuando se desarrollan en piel sana, y secundarios, cuando aparecen sobre lesiones preexistentes. Mujer de 61 años con antecedente de linfoma de Hodgkin en remisión, presentó una lesión de lar- ga data, desarrollada en piel sana, en primer dedo de la mano izquierda, que cursaba con brotes recurrentes y autolimitados de dolor y aumento de temperatura local. La exploración física mostró un nódulo pétreo, con úlcera de fondo calcáreo. El es- tudio histopatológico de la biopsia escisional reveló tejido óseo, sin otras lesiones cutáneas asociadas. El estudio complementa- rio, incluyendo hemograma, función renal y hepática, calcio y fósforo séricos, PTH, TSH, vitamina D y calciuria fue normal. Descartándose alteraciones en el metabolismo calcio-fosforo y otras lesiones cutáneas preexistentes, se realizó el diagnostico de OC primario en forma de placa. El OC es una lesión be- nigna, pudiendo ser primario o secundario. Los secundarios representan cerca del 85% y se originan por la osi cación de lesiones preexistentes tumorales o in amatorias. Los OC pri- marios se presentan aislados o formando parte de síndromes como la brodisplasia osi cante progresiva, la osteodistro a hereditaria de Albright y la heteroplasia osi cante progresiva. A pesar de la asociación a mutaciones en GNAS de OC y estos síndromes, el diagnóstico de ambos es fundamentalmente clí- nico. Los OC primarios sin síndrome asociado, se dividen en osteomas miliares de la cara y osteomas en forma de placa (pla- te-like OC), como este caso. Ante un OC primario, debemos descartar síndromes asociados a osi caciones heterotópicas.

Mucocele-like lesions diagnosed on breast core biopsy: Low risk of upgrade and subsequent carcinoma.

Mucocele-like lesions of the breast diagnosed on core biopsy are usually excised to exclude the possibility of partial sampling of an invasive mucinous carcinoma. The goal of this study was to correlate the pathologic and radiologic features of mucocele-like lesions to determine if excision is mandatory. Over a 16 year period we identified 32 patients with mucocele-like lesions diagnosed on 27 (84%) stereotactic and 5 (16%) ultrasound-guided core biopsies. The indications for core biopsy were: calcifications in 24 (75%), a mass in 7 (22%), and a mass with calcifications in 1 (3%). There were 22 (69%) mucocele-like lesions without atypia and 10 (31%) with atypical ductal hyperplasia or detached groups of atypical cells. Of the 22 mucocele-like lesions without atypia, 19 (86%) were excised: 15/19 (79%) were benign, 3/19 (16%) had atypical ductal hyperplasia and 1/19 (5%) had ductal carcinoma in situ. None of the patients with mucocele-like lesions without atypia were upgraded to invasive carcinoma. The single patient who was upgraded to low-grade ductal carcinoma in situ had a history of ductal carcinoma in situ in the same breast. Of the 10 patients with mucocele-like lesions with atypia, 9 (90%) were excised: 5/9 (56%) were benign, 1/9 (11%) had atypical ductal hyperplasia and 3/9 (33%) had invasive carcinoma. Of the patients with mucocele-like lesions with atypia who were upgraded to invasive carcinoma, one had a BIRADS 5 mass and discordant pathology and one had a history of Hodgkin lymphoma and mantle radiation. There were 24 patients with mucocele-like lesions with or without atypia who were not upgraded on excision, and none developed breast cancer after a median of 51 months (range 7-192). These findings indicate that mucocele-like lesions without atypia are unlikely to be upgraded on excision and are associated with a low risk for the subsequent development of carcinoma.

Double-lumen duodenum

A 33-year-old man with a history of Hodgkin lymphoma was seen 92 days after allogenic stem cell transplantation; he presented with a 5-day history of large-volume watery diarrhea. The results of laboratory evaluation and stool studies were noncontributory. Flexible sigmoidoscopy with examination of biopsy specimens revealed mild chronic colitis with no evidence of graft-versus-host disease (GVHD). Nevertheless, the patient was given systemic and nonabsorbable steroid agents. However, he continued to have large-volume diarrhea, worsening anorexia, and malnutrition. Colonoscopy with ileal intubation was performed, and examination of biopsy specimens showed positivity for cytomegalovirus (CMV) colitis. Esophagogastroscopy revealed complete mucosal sloughing in the duodenum forming a tubular structure (A, B). The biopsy specimens were consistent with GVHD, histologic grade 3/4 with negative CMV stain. The patient received a therapeutic dose of gancyclovir and escalated doses of systemic steroid agents, cyclosporine, methotrexate, and folic acid. The patient’s overall clinical status improved gradually over a period of 3 weeks. A follow-up esophagogastroscopy after 1 month showed regenerative nodular mucosa (C).

Kikuchi’s Disease Masquerading As Refractory Lymphoma

Positron emission tomographic (PET) scanning with a near-simultaneous computedtomography(CT)scan(ie, integrated PET-CT scan) is the preferred imaging modality for staging lymphomas. PET scanning detects Hodgkin lymphoma as well as the aggressive and most indolent non-Hodgkin lymphomas. PET-CT has become the standardof care for assessment of remission in patients with [F]fluorodeoxyglucose (FDG)-avid lymphomas, including Hodgkin lymphoma. The use of PET-CT scans for restaging is not without pitfalls. Although the sensitivity of a PET scan is nearly 100%, the positive predictive value is lower. We report the case of a woman with a history of Hodgkin lymphoma who was noted to have new lymphadenopathy in a restaging scan, implying progression of the disease. However, on further workup, it was determined that this was not the case.

P334 The breast reconstruction in breast cancer patients with a history of Hodgkin lymphoma

P334 The breast reconstruction in breast cancer patients with a history of Hodgkin lymphoma