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Case Report
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| Isolated intracranial relapse of hodgkin lymphoma in a child | ||||||
| Harriet Holme1, Niharendu Ghara2, Thomas S Jacques3, Paul Humphries4, Stephen Daw1, Ananth Shankar1 | ||||||
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1Department of Paediatric and Adolescent Oncology, University College, London NHS Foundation Trust Hospitals, 6th Floor central, 250 Euston Road, London, NW1 2PG.
2Department of Paediatric and Adolescent Oncology, University College London NHS Foundation Trust Hospitals, 6th Floor central, 250 Euston Road, London, NW1 2PG. 3Neural Development Unit, UCL Institute of Child Health and Department of Histopathology Great Ormond Street NHS Foundation Trust, London. 3Department of Radiology, University College London NHS Foundation Trust Hospitals, 3rd Floor west 250 Euston Road, London, NW1 2PG. | ||||||
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| How to cite this article: |
| Holme H, Ghara N, Jacques TS, Humphries P, Daw S, Shankar A. Isolated intracranial relapse of hodgkin lymphoma in a child. International Journal of Case Reports and Images 2012;3(10):12–15. |
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Abstract
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Introduction:
Although involvement of the central nervous system (CNS) is well described in non-Hodgkin lymphoma (NHL) at diagnosis and/or at relapse, there are few reports in the pediatric literature of primary or relapsed CNS Hodgkin lymphoma (HL).
Case Report: We report dural disease as the only site of relapse of HL in an immunocompetent seven-year-old child, presenting with diplopia. Imaging demonstrated a well-circumscribed dural-based mass at the base of the skull involving the clivus and enveloping the pituitary. Restaging did not show disease elsewhere, with normal bone marrow trephine biopsies and cytological examination of the cerebrospinal fluid. Biopsy of the dural-based tumor confirmed classical HL. Eleven months before, he was diagnosed with stage IIIA HL nodular sclerosis subtype and underwent four courses of combination chemotherapy with a complete metabolic response on early response assessment. Forty-eight months after completing treatment for relapsed HL, he remains well in complete remission, although future relapse of HL cannot be excluded. Conclusion: There were no specific risk factors predictive of relapse in this child. He had responded well to standard chemotherapy as early response assessment after two courses showed complete metabolic response. Treatment of this child at relapse was challenging, since standard salvage chemotherapy regimens comprise drugs not well known to traverse the blood brain barrier. This case highlights the rarity of intracranial HL in children and difficulty with regards to the diagnosis, evidence based treatment and overall prognosis. We suggest that irrespective of any imaging abnormality, histological confirmation should be sought before commencement of definitive treatment. | |
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Key Words:
Lymphoma, CNS relapse, Pediatric hematology/oncology, Hodgkin lymphoma
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Author Contributions:
Harriet Holme – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Niharendu Ghara – Acquisition of data, Analysis and interpretation of data, Final approval of the version to be published Thomas S Jacques – Acquisition of data, Analysis and interpretation of data, Final approval of the version to be published Paul Humphries – Acquisition of data, Analysis and interpretation of data, Final approval of the version to be published Stephen Daw – Acquisition of data, Analysis and interpretation of data, Final approval of the version to be published Ananth Shankar – Acquisition of data, Analysis and interpretation of data, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Harriet Holme et al. 2012; This article is distributed the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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