Med Oncol (2010) 27:62–64 DOI 10.1007/s12032-009-9172-5
Coexistence Hodgkin’s lymphoma and colonic adenocarcinoma: a case report Umut Demirci Æ Su¨leyman Bu¨yu¨kberber Æ Gu¨ldal Yılmaz Æ ¨ ztu¨rk Æ Nalan Akyu¨rek Æ Ramazan Yıldız Æ Banu O ¨ nder Tonyalı Æ Ug˘ur Cos¸ kun Æ Mustafa Benekli O
Received: 8 January 2009 / Accepted: 21 January 2009 / Published online: 10 February 2009 Ó Humana Press Inc. 2009
Abstract We present the case of a patient having colonic adenocarcinoma and also incidentally found Hodgkin’s lymphoma which involved a single mesenteric lymph node dissected from the sigmoidal resection performed for colonic carcinoma. The disease was confirmed with the removal of right posterior cervical lymph node. Coexistence of colonic carcinoma and lymphoma in the same patient is an uncommon event. Keywords Hodgkin’s lymphoma Colon Adenocarcinoma Coexistence
Introduction Hodgkin’s lymphoma (HL) is a lymphoproliferative disease characterized by Reed-Sternberg cells (RS) which arises from lymphoid tissue. HL constitutes about 30% of all lymphomas. Colorectal cancer is the third most frequently diagnosed cancer in men and women. The rate of synchronous colonic carcinoma and lymphoma is 2%.  Synchronous colonic adenocarcinoma and HL have been reported in the literature [2–4]. We present a patient having metastatic sigmoid adenocarcinoma who is found to have HL incidentally at the same time.
¨ ztu¨rk R. Yıldız U. Demirci S. Bu¨yu¨kberber (&) B. O ¨ . Tonyalı U. Cos¸ kun M. Benekli O Department of Medical Oncology, Gazi University Medical Faculty, 06500 Bes¸ evler, Ankara, Turkey e-mail: [email protected]
G. Yılmaz N. Akyu¨rek Department of Pathology, Gazi University Medical Faculty, 06500 Bes¸ evler, Ankara, Turkey
Case report A 72-year-old man was admitted to our department with hematochesia that was continuing for a month duration. There were no other complaints like weight loss, night sweats, fever, or chills. The physical examination was negative and performance status was ECOG class 1. Colonoscopy was performed and an ulcerovegetant mass was seen at 40th cm which obstructed the lumen almost completely. Biopsy sampled from the mass was reported as adenocarcinoma. Abdominal computerized tomography showed that liver parenchyme was heterogeneous including indefinite hypodense lesions (metastases?). In the left low quadrant compatible with 8 cm of sigmoidal colon segment, there was a diffuse intestinal wall thickening (max. 11 mm). Then operation was planned and sigmoidal resection with end to end anastomosis was made and in intraoperative examination multiple liver and peritoneal metastases were seen, although spleen viewed as normal. Histopathological examination of the specimen revealed an intermediate grade adenocarcinoma with neuroendocrine differentiation. Serosa was infiltrated by the tumor. There were perineural and angiolymphatic invasion. Three of eight lymph nodes were metastatic. Resection borders were intact. However, a small lymph node was found to be infiltrated by Hodgkin’s lymphoma characterized with Reed-Sternberg cells stained for CD30, immunohistochemically (Fig. 1). Also, there were foci of metastatic adenocarcinoma in the liver wedge resection specimen. General surgery consulted us the patient after this point. We found a 2.5 cm mobile but firm lymphadenopathy in right posterior cervical chain. This lymph node was removed and was reported as Hodgkin’s lymphoma, nodular sclerosan type, grade 2 (Fig. 1). The patient was discussed and eventually decided to treat with a chemotherapy regimen; XELOX (including oxaliplatin
Med Oncol (2010) 27:62–64
Fig. 1 a Adenocarcinoma of colon, moderately differentiated (HE940), b lymph node of colon with Hodgkin lymphoma (CD30940), c cervical lymph node with Hodgkin’s lymphoma, nodular sclerosing type (HE940), d cervical lymph node with Hodgkin’s lymphoma, nodular sclerosing type (CD30940)
(130 mg/m2) day 1, capecitabine (1500 mg/m2) day 1–14, and dexamethasone (40 mg) day 1–4). After surgery and second cure of chemotherapy, the patient’s condition became progressively worse because of severe diarrhea and reduced his performance status to ECOG class III. After second cure CEA (14–18) and CA19-9 (60–294) began to increase and progression was detected by abdominal CT scan in liver metastases. After 3 months of diagnosis, he died because of progressive disease.
Discussion We searched in literature for malignancies which have correlation with gastrointestinal adenocarcinomas and Hodgkin’s lymphoma. It has been estimated that the probability of having lymphoma in a patient with existing colonic carcinoma was approximately 2% . The correlation of HL and colonic adenocarcinoma has been reported as coexistence [2–4]. However, the correlation of HL and gastrointestinal adenocarcinoma has been reported metachronous  and synchronous . Coexistence of adenocarcinoma with non-Hodgkin’s lymphoma seems much more than Hodgkin’s lymphoma. The occurrence of HL and other malignancies included that gastric adenocarcinoma, small-cell lung cancer, astrocytoma, nonHodgkin’s lymphoma, acute megakaryocytic leukemia, cervix carcinoma, and testicular cancer have been reported in the literature [5–13].
Mesenteric lymph node involvement by HL is also uncommon (1%–4%) . Our patient was diagnosed as HL by detection of a single infiltrated mesenteric lymph node dissected from a sigmoid resection performed for colonic adenocarcinoma. The disease was confirmed with the removal of right posterior cervical lymph node. This type accounts for about 70% of classical HL . Although liver can be involved with both HL and colon adenocarcinoma, our patient’s liver specimen was reported as metastatic adenocarcinoma. HL infrequently presents below the diaphragm, and its occurrence in elderly males is more common in these sites. Patients presenting with central abdominal involvement made up 20% of cases of subdiaphragmatic HL . Mesenteric lymph node involvement is uncommon (5%). There have been studies that proposed possible factors and mechanisms that may play a role in the occurrence of synchronous colonic carcinoma and lymphoma. The implicated factors include environmental agents, viral, immune abnormalities, and genetic constitution of the patient. Studies suggested that the lymphomatous process may be the initial event that compromises the patient’s immune defenses against the development of colon cancer . In this patient with attentive pathological investigation by experienced pathologist; Hodgkin’s lymphoma was detected in mesenteric lymph node in postoperative specimen and confirmed with cervical lymph node biopsy.
Conclusion We present the patient diagnosed as HL for the first time by detecting a single mesenteric lymph node dissected from a sigmoid resection performed for colonic carcinoma. Coexistence occurrence of these two malignancies has not been reported in the literature so far.
References 1. Barron BA, Localio SA. A statistical note on the association of colorectal cancer and lymphoma. Am J Epidemiol. 1976;104: 517–22. 2. Quilon JM, Day S, Lasker JC. Synchronous tumors: Hodgkin disease presenting in mesenteric lymph nodes from a right hemicolectomy for colon carcinoma. South Med J. 2004;97: 1133–5. doi:10.1097/01.SMJ.0000140827.40139.82. 3. Petros JG, Argy O. Hodgkin’s disease in the mesenteric lymph nodes in a patient with colon carcinoma. Mt Sinai J Med. 1990;57:368–70. 4. Chazouilleres O, Andreani T, Boucher J, et al. Adenocarcinome rectal associe a un lymphome (‘‘collision tumor’’). Gastroenterol Clin Biol. 1990;14:185–6. 5. Comez G, Pehlivan Y, Kalender ME, et al. Synchronous Hodgkin’s disease and gastric adenocarcinoma. Oncology. 2007;73(5– 6):422–5. 6. Hamaloglu E, Topaloglu S, Ozdemir A, Ozenc A. Synchronous and metachronous occurrence of gastric adenocarcinoma and gastric lymphoma: a review of the literature. World J Gastroenterol. 2006;12:3564–74.
Med Oncol (2010) 27:62–64 7. Rubiales AS, Martinez G, Aller JL, Roig V, del Valle ML. Synchronous diagnosis of small-cell lung cancer and Hodgkin lymphoma. An Med Interna. 2006;23:301–2. 8. Prabhash K, Babu KG, Balu S, Haritha C, Bapsy PP. Hodgkin’s disease and pilocytic astrocytoma—a synchronous presentation. J Assoc Physicians India. 2003;51:833–4. 9. Bhanote M, Choksi M, Cassar P, et al. Metastatic adenocarcinoma of the colon and follicular lymphoma within the same lymph node: a case report and review of the literature. Int J Gastrointest Cancer. 2005;36:171–5. doi:10.1385/IJGC:36:3:171. 10. Adnan E, Nicholas S, Madras R, Ashraf AM. Synchronous Hodgkin’s disease and non-Hodgkin’s lymphoma. Acta Oncol. 1996;35:755–7. doi:10.3109/02841869609084011. 11. Vukelja SJ, Krishnan J, Ward FT, Redmond JIII. Synchronous Hodgkin’s disease and myelofibrosis terminating with granulocytic sarcoma and acute megakaryocytic leukemia. South Med J. 1990;83:1317–20. 12. Lovell MO, Valente PT. Unique collision of Hodgkin lymphoma and adenosquamous carcinoma in the uterine cervix: synchronous malignant neoplasms of the cervix. J Low Genit Tract Dis. 2003;7:307–11. doi:10.1097/00128360-200310000-00015. 13. Gerl A, Clemm C, Salat C, Mittermuller J, Bomfleur W, Wilmanns W. Testicular cancer and Hodgkin disease in the same patient. Cancer. 1993;71:2838–40. doi:10.1002/1097-0142(1993 0501)71:9\2838::AID-CNCR2820710926[3.0.CO;2-I. 14. Hoppe RT, Mauch PM et al. Hodgkin lymphoma. 2nd ed. Lippincott Williams & Wilkins; 2007. 15. Stein H, Delsol G, Pileri S, et al. Classical Hodgkin lymphoma. In: Jaffe ES, Harris NL, Stein H, Vardiman JW, editors. World health organization classification of tumours. Pathology and genetics of tumours of haematopoietic and lymphoid tissues. Lyon, France: IARC Press; 2001. p. 244–53. 16. Krikorian JG, Portlock CS, Maunch PM. Hodgkin’s disease presenting below the diaphragm: a review. J Clin Oncol. 1986;4: 1551–62.