Lymphocyte Depleted Hodgkin’s Lymphoma Presented with Haemolytic Anemia: A Case Report and Literature Review

  • Ravinder Singh
  • Soheyl Sheikh
  • Shambulingappa Pallagatti
  • Amit Aggarwal
  • Deepak Gupta
  • Roopika Handa
  • Gaurav Goyal
  • Raman Kumar
Case Report

Abstract

Hodgkin’s lymphoma accounts for ten per cent of all lymphomas. Lymphomas represent the third most frequent neoplasia on a worldwide scale and constitute 3 % of malignant tumors. In the United States, there are about 8,000 new cases every year. This case report describes a case of lymphocyte-depletion Hodgkin’s lymphoma (LDHL) manifested by anemia. LDHL is the least common of the types of Hodgkin’s disease, comprising less than 1 % of all cases of this cancer. A 19-year-old Indian male presented with complaint of huge asymptomatic swelling in the right lateral part of neck since 8 months. All the lymph nodes of the right side submandibular, submental, cervical and axillary lymph nodes were rubbery in consistency, tender and were palpable. The CBC revealed hemoglobin of 7.4 gm/dL and ESR count was highly raised up to 125 mm/first hour. Direct Coomb’s test detected multiple antibodies IgG type, which was consistent with the diagnosis of Haemolytic anemia. Ultrasonography of the neck showed enlarged discrete lymph nodes on the right side of the neck. For further evaluation patient was subject for ultrasonography of the abdomen which revealed there was of enlargement of both spleen and liver. Lymph node FNAC revealed classic LDHL. Anemia and swelling resolved after completion of chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) after 6 cycles. The literature review and our case report discuss the optimal management of this Hodgkin’s lymphoma. To our knowledge, this is the first case of LDHL with Haemolytic Anemia treated with only ABVD regime.

Keywords

Hodgkin’s lymphoma Lymph nodes Swelling Anemia Ultrasonography ABVD 

References

  1. 1.
    Lu P (2005) Staging and classification of lymphoma. Semin Nucl Med 35:160–164CrossRefPubMedGoogle Scholar
  2. 2.
    Inchingolo F, Tatullo M, Abenavoli FM, Marrelli M, Inchingolo AD, Inchingolo AM, Dipalma G (2011) Non-Hodgkin lymphoma affecting the tongue: unusual intra-oral location. Head Neck Oncol 3(1):1–5. doi: 10.1186/1758-3284-3-1 Google Scholar
  3. 3.
    Jaffe ES, Harris NL, Stein H (2002) World Health Organization classification of tumours, pathology and genetics, tumours of haematopoietic and lymphoid tissues. Ann Oncol 13:490–491CrossRefGoogle Scholar
  4. 4.
    Buglio D, Younes A (2010) Histone deacetylase inhibitors in Hodgkin lymphoma. Invest New Drugs 28(suppl 1):S21–S27. doi:10.1007/s10637-010-9588 CrossRefPubMedGoogle Scholar
  5. 5.
    Hurtado-Cordovi JM, Verma V, Gotlieb V, Frieri M (2011) Lymphocyte rich Hodgkin’s lymphoma presented with warm hemolytic anemia: a case report and literature review. Case Rep Hematol: 385408. doi: 10.1155/2011/385408
  6. 6.
    Banerjee D (2011) Recent advances in the pathobiology of Hodgkin’s lymphoma: potential impact on diagnostic, predictive, and therapeutic strategies. Adv Hematol 439456:11–26. doi:10.1155/2011/439456 Google Scholar
  7. 7.
    Malis DD, Moffat D, McGarry GW (1998) Isolated nasopharyngeal Hodgkin’s disease presenting as nasal obstruction. Int J Clin Pract 52:343–346PubMedGoogle Scholar
  8. 8.
    Aloulou S, Farhat H, Bosq J, Vanel D, Ribrag V, Turhan AG, Girinsky T, Fermé C (2002) Hodgkin’s disease primarily involving the oropharynx: case report and review of the literature. Hematol J 3:164–167CrossRefPubMedGoogle Scholar
  9. 9.
    Whitt JC, Dunlap CL, Martin KF (2007) Oral Hodgkin lymphoma: a wolf in wolf’s clothing. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 104:e45–e51CrossRefPubMedGoogle Scholar
  10. 10.
    Kapadia SB, Roman LN, Kingma DW, Jafe ES, Frizerra G (1995) Hodgkin’s disease of Waldeyer’s ring: clinical and immunophenotypic findings and association with Epstein-Barr virus in 16 cases. Am J Surg Pathol 19:1431–1439CrossRefPubMedGoogle Scholar
  11. 11.
    Dinand V, Dawar R, Arya LS et al (2007) Hodgkin’s lymphoma in Indian children: prevalence and significance of Epstein-Barr virus detection in Hodgkin’s and Reed-Sternberg cells. Eur J Cancer 43:161–168. doi:10.1016/j.ejca.2006.08.036 CrossRefPubMedGoogle Scholar
  12. 12.
    Feng Q, Zak D, Daya R (2012) Autoimmune hemolytic anemia and classical Hodgkin lymphoma: a case report and literature review. Clin Adv Hematol Oncol 10:270–277PubMedGoogle Scholar
  13. 13.
    Lechner K, Chen YA (2010) Paraneoplastic autoimmune cytopenias in Hodgkin lymphoma. Leuk Lymphoma 51:469–474CrossRefPubMedGoogle Scholar
  14. 14.
    Siddiqui N, Aleem A (2009) Autoimmune haemolytic anaemia preceding the diagnosis of Hodgkin’s disease: a report of two cases and review of the literature. J Park Med Assoc 59:316–318Google Scholar
  15. 15.
    Kant JA, Hubbard SM, Longo DL, Simon RM, DeVita VT Jr, Jaffe ES (1986) The pathologic and clinical heterogeneity of lymphocyte-depleted Hodgkin’s disease. J Clin Oncol 4:284–294PubMedGoogle Scholar
  16. 16.
    Canello George P (2005) Chemotherapy alone for early Hodgkin’s lymphoma: an emerging option. J Clin Oncol 23:4574–4576CrossRefGoogle Scholar
  17. 17.
    van Leeuwen FE, Klokman WJ, Veer MB, Hagenbeek A, Krol AD, Vetter U, Schaapveld M, van Heerde P, Burgers JM, Somers R, Aleman BM (2000) Long-term risk of second malignancy in survivors of Hodgkin’s disease treated during adolescence or young adulthood. J Clin Oncol 18:487–497PubMedGoogle Scholar
  18. 18.
    Straus DJ, Portlock CS, Qin J, Myers J, Zelenetz AD, Moskowitz C, Noy A, Goy A, Yahalom J (2004) Results of a prospective randomized clinical trial of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by radiation therapy (RT) versus ABVD alone for stages I, II, and IIIA nonbulky Hodgkin disease. Blood 104:3483–3489CrossRefPubMedGoogle Scholar

Copyright information

© Association of Oral and Maxillofacial Surgeons of India 2013

Authors and Affiliations

  • Ravinder Singh
    • 1
  • Soheyl Sheikh
    • 1
  • Shambulingappa Pallagatti
    • 1
  • Amit Aggarwal
    • 1
  • Deepak Gupta
    • 1
  • Roopika Handa
    • 1
  • Gaurav Goyal
    • 1
  • Raman Kumar
    • 1
  1. 1.Department of Oral Medicine and RadiologyM.M. College of Dental Sciences and ResearchMullana, AmbalaIndia

Personalised recommendations