Current Hematologic Malignancy Reports

, Volume 7, Issue 3, pp 186–192 | Cite as

Recognizing Unusual Manifestations of Hodgkin Lymphoma

Lymphomas (J Armitage and P McLaughlin, Section Editors)

Abstract

Hodgkin lymphoma (HL) is a rare malignancy of the lymphatic system that is curable in at least 80 % of patients. Although patients usually present with painless lymphadenopathy, a variety of systemic and organ-specific syndromes may also exist in relation to HL. These syndromes may develop before, during, or after the diagnosis of HL and may also indicate disease relapse. Most of these unusual disorders resolve with successful HL treatment but some may require adjunctive supportive therapies before a response is achieved. Oncologists should be familiar with these syndromes because early recognition may result in a more timely diagnosis of HL which may lead to improved outcomes.

Keywords

Hodgkin lymphoma Paraneoplastic Constitutional B-symptoms Cytokines Cutaneous Glomerulonephropathy Encephalitis Cytopenias Cholestasis 

Notes

Disclosure

No potential conflicts of interest relevant to this article were reported.

References

Papers of particular interests, published recently, have been highlighted as: • Of importance

  1. 1.
    • Bierman PJ, Cavalli F, Armitage JO. Unusual syndromes in Hodgkin Lymphoma. In: Hoppe RT, Mauch PT, Armitage JO, et al., editors. Hodgkin lymphoma. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2007. p. 411–8. A thorough review of less-common manifestations of HL.Google Scholar
  2. 2.
    Carbone PP, Kaplan HS, Musshoff K, et al. Report of the committee on Hodgkin’s disease staging classification. Cancer Res. 1971;31:1860–1.PubMedGoogle Scholar
  3. 3.
    Tubiana M, Attie E, Flamant R, et al. Prognostic factors in 454 cases of Hodgkin’s disease. Cancer Res. 1801;1971:31.Google Scholar
  4. 4.
    National Comprehensive Cancer Network: Hodgkin Lymphoma Guidelines. Available at: www.nccn.org.
  5. 5.
    • Skinnider BF, Mak TW. The role of cytokines in classical Hodgkin lymphoma. Blood. 2002;99:4283–97. An analysis of the role of cytokines in HL, with particular attention to EBV related HL.PubMedCrossRefGoogle Scholar
  6. 6.
    Yosipovitch G. Chronic pruritis: a paraneoplastic sign. Derm Ther. 2010;23:590–6.CrossRefGoogle Scholar
  7. 7.
    Olsson H, Brandt L. Relief of pruritis as an early sign of spinal cord compression in Hodgkin’s disease. Acta Med Scand. 1979;206:319.PubMedCrossRefGoogle Scholar
  8. 8.
    Sonkoly E, Muller A, Lauerma AI, et al. IL-31: a new link between T cells and pruritis in atopic skin inflammation. J Allergy Clin Immunol. 2006;117:411–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Rubenstein M, Duvic M. Cutaneous manifestations of Hodgkin’s disease. Intern J Derm. 2006;45:251–6.CrossRefGoogle Scholar
  10. 10.
    Guitart J, Fretzin D. Skin as the primary site of Hodgkin’s disease and review of its relationship with non-Hodgkin’s lymphoma. Am J Dermatopathol. 1998;20:218.PubMedCrossRefGoogle Scholar
  11. 11.
    Jurisic V, Bogunovic M, Colovic N, et al. Indolent course of cutaneous Hodgkin’s disease. J Cutan Pathol. 2005;32:176.PubMedCrossRefGoogle Scholar
  12. 12.
    Mukesh M, Shuttleworth D, Murray P. Primary cutaneous Hodgkin’s lymphoma. Clin Derm. 2009, 673–5.Google Scholar
  13. 13.
    White RM, Patterson JW. Cutaneous involvement in Hodgkin’s disease. Cancer. 1985;55:1136.PubMedCrossRefGoogle Scholar
  14. 14.
    Simon S, Azevedo SJ, Bynes JJ. Erythema nodosum heralding recurrent Hodgkin’s disease. Cancer. 1985;56:1470.PubMedCrossRefGoogle Scholar
  15. 15.
    • Grimm S, Chamberlain M. Hodgkin’s lymphoma: a review of neurologic complications. Adv Hem. 2011, Article ID 624578. A thorough review of paraneoplastic as well as non-paraneoplastic neurologic manifestations of HL. Google Scholar
  16. 16.
    Strayer DR, Bender RA. Eosinophilic meningitis complicating Hodgkin’s disease. A report of a case and review of the literature. Cancer. 1977;40:406–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Bender BL, Mayernik DG. Hodgkin’s disease presenting with isolated craniospinal involvement. Cancer. 1986;58:1745–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Hammack J, Kotanides H, Rosenblum MD, et al. Paraneoplastic cerebellar degeneration: clinical and immunologic findings in 21 patients with Hodgkin’s disease. Neurology. 1992;42:1938–43.PubMedCrossRefGoogle Scholar
  19. 19.
    Peltola J, Hietaharju A, Lehtinen T, et al. A reversible neuronal antibody (anti-Tr) associated paraneoplastic cerebellar degeneration in Hodgkin’s disease. Acta Neurol Scand. 1998;98:360–3.PubMedCrossRefGoogle Scholar
  20. 20.
    Smitt PS, Kinoshita A, De Leeuw B, et al. Paraneoplastic cerebellar ataxia due to autoantibodies against a glutamate receptor. N Engl J Med. 2000;342:21–7.CrossRefGoogle Scholar
  21. 21.
    Zandi MS, Irani SR, Follows G, et al. Limbic encephalitis associated with antibodies to the NMDA receptor in Hodgkin lymphoma. Neurology. 2009;73:2039–40.PubMedCrossRefGoogle Scholar
  22. 22.
    Younes A, Bartlett NL, Leonard JP, et al. Brentuximab vedotin (SGN-35) for relapsed CD-30 positive lymphomas. N Engl J Med. 2010;363:1812–21.PubMedCrossRefGoogle Scholar
  23. 23.
    Richmond J, Sherman RS, Diamond HD, et al. Renal lesions associated with malignant lymphomas. Am J Med. 1962;32:184.PubMedCrossRefGoogle Scholar
  24. 24.
    Yum MN, Edwards JL, Kleit S. Glomerular lesions in Hodgkin’s disease. Arch Pathol. 1975;99:645.PubMedGoogle Scholar
  25. 25.
    • Audard V, Larousserie F, Grimbert P, et al. Minimal change nephrotic syndrome and classical Hodgkin’s lymphoma: report of 21 cases and review of the literature. Kidney Int. 2006;69:2251–60. A very descriptive and large case series that explains clinical features and outcomes of patients with HL and MCNS.PubMedCrossRefGoogle Scholar
  26. 26.
    • Audard V, Zhang S, Copie-Bergman C, et al. Occurance of minimal change nephrotic syndrome in classical Hodgkin lymphoma is closely related to the induction of c-mip in Hodgkin-Reed Sternberg cells and podocytes. Blood. 2010;115:3756–62. An experimental explanation of the pathophysiology of MCNS in HL.PubMedCrossRefGoogle Scholar
  27. 27.
    Ronco PM. Paraneoplastic glomerulonephropathies: new insignts into an old entity. Kidney Int. 1999;56:355–77.PubMedCrossRefGoogle Scholar
  28. 28.
    Hohaus S, Massini G, Giachelia M, et al. Anemia in Hodgkin’s lymphoma: the role of interleukin-6 and hepcidin. J Clin Oncol. 2010;28:2538–43.PubMedCrossRefGoogle Scholar
  29. 29.
    • Lechner K, Chen Y. Paraneoplastic autoimmune cytopenias in Hodgkin lymphoma. Leuk Lymphoma. 2010;51:469–74. A thorough review of autoimmune cytopenias in HL.PubMedCrossRefGoogle Scholar
  30. 30.
    Xiros N, Binder T, Anger B, et al. Idiopathic thrombocytopenic purpura and autoimmune hemolytic anemia in Hodgkin’s disease. Eur J Haematol. 1988;40:437.PubMedCrossRefGoogle Scholar
  31. 31.
    Hudson BV, Linch DC, MacIntyre EA, et al. Selective peripheral blood eosinophilia associated with survival advantage in Hodgkin’s disease (BNLI Report No 31). J Clin Pathol. 1987;40:247–50.CrossRefGoogle Scholar
  32. 32.
    Von Wasielewski R, Seth S, Franklin J, et al. Tissue eosinophilia correlates strongly with poor prognosis nodular sclerosing Hodgkin’s disease, allowing for known prognostic factors. Blood. 2000;95:1207–13.Google Scholar
  33. 33.
    Menard F, Besson C, Rince P, et al. Hodgkin lymphoma-associated hemophagocytic syndrome: a disorder strongly correlated with Epstein-Barr virus. Clin Infect Dis. 2008;47:531–4.PubMedCrossRefGoogle Scholar
  34. 34.
    Seifter EJ, Parker RI, Gralnick HR, et al. Abnormal coagulation results in patients with Hodgkin’s disease. Am J Med. 1985;78:942–50.PubMedCrossRefGoogle Scholar
  35. 35.
    Slease RB, Schumacher HR. Deficiency of coagulation factors VII and XII in a patient with Hodgkin’s disease. Arch Intern Med. 1977;137:1633–5.PubMedCrossRefGoogle Scholar
  36. 36.
    Fahey JL, Rahbar S, Farbstein MJ, et al. Microcytosis in Hodgkin disease associated with unbalanced globin chain synthesis. 2006;23:123–9.Google Scholar
  37. 37.
    Rieke JW, Donaldson SS, Horning SJ. Hypercalcemia and vitamin D metabolism in Hodgkin’s disease. Cancer. 1989;63:1700.PubMedCrossRefGoogle Scholar
  38. 38.
    Walters EG, Denton RM, Tavare JM, et al. Hypoglycemia due to an insulin-receptor antibody in Hodgkin’s disease. Lancet. 1987;1:241.PubMedCrossRefGoogle Scholar
  39. 39.
    Nadiminiti Y, Wang JC, Chou SY, et al. Lactic acidosis associated with Hodgkin’s disease. N Engl J Med. 1980;303:15–7.CrossRefGoogle Scholar
  40. 40.
    Banerjee D. Recent advances in the pathobiology of Hodkin’s lymphoma: potential impact on diagnostic, predictive, and therapeutic strategies. Adv Hem. 2011, Article ID 439456.Google Scholar
  41. 41.
    Ballonoff A, Kavanagh B, Nash R, et al. Hodgkin lymphoma-related vanishing bile duct syndrome and idiopathic cholestasis: statistical analysis of all published cases and literature review. Acta Oncol. 2008;47:962–70.PubMedCrossRefGoogle Scholar
  42. 42.
    Barta SK, Yahalom J, Shia J, et al. Idiopathic cholestasis as a paraneoplastic phenomenon in Hodgkin’s lymphoma. Clin Lymphoma Myeloma. 2006;7:77–82.PubMedCrossRefGoogle Scholar
  43. 43.
    Tubiana M, Henry-Amar M, Hayat M, et al. Prognostic significance of the number of involved areas in the early stages of Hodgkin’s Disease. Cancer. 1984;54:885–94.PubMedCrossRefGoogle Scholar
  44. 44.
    Hasenclever D, Diehl V. A prognostic score for advanced Hodgkin’s disease. International Prognostic Factors Project on Advanced Hodgkin’s Disease. N Engl J Med. 1998;339:1506–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.University of Nebraska Medical Center Section of Oncology/Hematology, 987680 Nebraska Medical CenterOmahaUSA

Personalised recommendations