An unusual Hodgkin's lymphoma case presenting with upper extremity multiple masses

Dirim, Berna; Karakas, Levent; Oyar, Orhan; Bener, Sadi; Şener, Muhittin; Yagtu, Mehmet; Erdoğan, Nuri; Uluc, Engın; Altay, Canan

doi:10.1016/j.clinimag.2012.01.006

Cited by 3 publications

(2 citation statements)

References 8 publications

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“…To the best of our knowledge, there has been only two reported cases that presented as an extremity subcutaneous mass. 4,5 One of them was suggested to arise from brachial lymph nodes similar to the present patient. 4 We therefore recommend that clinicians should keep in mind that HL lesions can appear as subcutaneous masses although the clinical presentation of this patient may be rare.…”

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confidence: 79%

Hodgkin's lymphoma presenting as subcutaneous masses in the left upper arm

Makino

Hara

Hamashima

et al. 2016

The Journal of Dermatology

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Hodgkin's lymphoma presenting as subcutaneous masses in the left upper armDear Editor, Hodgkin's lymphoma (HL) is a lymphoproliferative disorder characterized by Hodgkin and Reed-Sternberg cells. HL frequently involves the lymph nodes of the head and neck region. 1 Extranodal soft tissue manifestation of HL is rare. 2 We herein report a case of HL presenting as subcutaneous masses in the upper arm.A 47-year-old Japanese man presented with two subcutaneous masses without pain and tenderness in his left upper arm, measuring 4.0 cm 9 3.0 cm and 2.0 cm 9 1.0 cm in size ( Fig. 1a). His left axillary lymph node was slightly swollen. No other lymph node was palpable and no other skin lesion was observed. The patient had initially noticed a single mass at 45 years of age; thereafter, the size of the mass gradually increased. Approximately 6 months before visiting our hospital, a new mass developed on the proximal side of the initial mass. Positron emission tomography revealed three isolated lesions in the left axillary region and upper arm. No other abnormality was detected in the lymph nodes or internal organs. Magnetic resonance imaging (MRI) of the left upper arm revealed ovoid masses with low and high signal intensities on T 1 -and T 2 -weighted images, respectively (Fig. 1b). A similar mass was also detected in the left axillary region. A histological examination of a tissue sample obtained from the mass revealed Figure 1. (a) Subcutaneous masses were observed in the left upper arm. (b) A coronal fat-saturated T 2 -weighted image shows multiple masses within the subcutaneous fat tissue of the left upper arm with a high signal intensity. The arrows indicate the masses. (c) Histological examination revealed mononucleated and binucleated large-sized cells among fre quent small-and medium-sized lymphocytes. (hematoxylin-eosin, original magnification 9200). The tumor cells expressed (d) CD15, (e) CD30 and (f) PAX-5 (all 9200). Arrowhead indicates a PAX-5-positive tumor cell. (g) Epstein-Barr virus (EBV) was detected in the nuclei of the tumor cells using in situ hybridization with EBV small RNA-1 (9200).

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confidence: 79%

Hodgkin's lymphoma presenting as subcutaneous masses in the left upper arm

Makino

Hara

Hamashima

et al. 2016

The Journal of Dermatology

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“…HLs predominantly involve the lymph nodes and only ~5% arise in extranodal sites, in contrast to 30% of non-HL cases presenting in extranodal sites ( 3 ). Primary extranodal lymphoma is less common and is predominately non-HL ( 4 – 7 ).…”

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confidence: 99%

Primary extranodal head and neck classical Hodgkin lymphoma: A rare clinical case report

Men

Sun

Wei

et al. 2016

Experimental and Therapeutic Medicine

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The subcutaneous soft tissue of the forehead is a rare anatomic site for Hodgkin lymphoma (HL), and no such case has previously been reported in the literature, to the best of our knowledge. HLs commonly present in the nodal regions in the majority of patients, rarely occurring in extranodal sites, whereas primary extranodal lymphoma is less common and is more typical in cases of non-HL. The present study reports a novel case of extranodal head and neck classical HL (cHL), initially diagnosed as frontal fibroma. The present study describes an unusual case of subcutaneous soft tissue involvement of HL, aiming to enhance current levels of awareness for patients with extranodal symptoms. A 25-year-old male, who inadvertently detected a hard painless mass above the right superciliary arch 2 months prior to admission in April 2013 was eventually diagnosed with mixed cellularity cHL. Subsequent to six cycles of doxorubicin (Adriamycin), bleomycin, vindesine and dacarbazine chemotherapy, followed by four cycles of ifosfamide, gemcitabine, vinorelbine and prednisone chemotherapy, a satisfactory curative effect was obtained. In conclusion, it is proposed that lymphoma should be considered in the differential diagnosis of a mass involving the subcutaneous soft tissue.

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