Unusual Presentation of Hodgkin's Disease Mimicking Inflammatory Bowel Disease

Abstract

A case of a 32-years old man with a long lasting history of inflammatory bowel disease (IBD) is described. He was treated in the past with adequate medical therapy with considerable improvement of the symptoms. However, after the resolution of the last episode of abdominal pain and diarrhoea, because of multiple protruding masses and sub-stenotic regions found during a colonoscopy, the patient underwent a right enlarged hemicolectomy with jejunal resection. During the surgical procedure 16 enlarged lymphnodes were removed. The histological examination of the surgical specimen showed the presence of numerous Reed-Sternberg cells, compatible with a diagnosis of Hodgkin's disease (HD). None of the removed lymphnodes showed the presence of tumor cells, and in addition the systemic staging procedure was negative. After staging, the ABVD regimen was started, achieving a complete clinical and pathological response. This is a rare case of primary extranodal HD localized to the colon, in a patient with a long standing history of IBD, who showed an optimal response to chemotherapy. The case and the differential diagnosis with other pathological entities of the bowel is discussed.

CEPP regimen (cyclophosphamide, etoposide, procarbazine and prednisone) as initial treatment for Hodgkin lymphoma patients presenting with severe abnormal liver function

“…As per American Cancer Society’s estimates for HL in the United States, the 5-year and 10-year survival rates reached 85% and 80%, respectively [11]. However atypical presentations continue to pose a challenge [2,12]. …”

An Unusual Presentation of Liver Failure in a Patient with Primary Gastrointestinal Hodgkin's Lymphoma

“…Primary GI HL involving the bowel has been associated with inflammatory bowel disease (IBD) in several case reports [9][10][11][12]. Kumar et al reported 4 cases of GI HL with concurrent EBV infection, with two of the cases occurring in patients with Crohn's disease.…”

Evaluating Lymphoma Risk in Inflammatory Bowel Disease

“…There are abundant reports of lymphoma of the gastro-intestinal tract mimicking presentations of Crohn's disease (Kashi et al, 2010, Kang et al, 2007, Hurlstone, 2002, Jouini et al, 2001, Vincenzi et al, 2001, Camera et al, 1997, Maaravi et al, 1993, Scully et al, 1993. Medline cited publications regarding lymphoma risk in IBD patients since 1950.…”