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Abdominal Lymphocyte-Depleted Hodgkin Lymphoma: A Rare Presentation

Authors Kasinathan G, Kori AN, Hassan N

Received 24 September 2019

Accepted for publication 14 October 2019

Published 6 November 2019 Volume 2019:12 Pages 405—409


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Ganesh Kasinathan,1,* Ahlam Naila Kori,1,* Nurhidayah Hassan2,*

1Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia; 2Histopathology Unit, Department of Pathology, Tengku Ampuan Afzan Hospital, Kuantan, Pahang, Malaysia

*These authors contributed equally to this work

Correspondence: Ganesh Kasinathan
Haematology Unit, Tengku Ampuan Afzan Hospital, Kuantan 25100, Pahang, Malaysia
Tel +60126238014

Background: Hodgkin lymphoma (HL) is a type of lymphoma that arises from the B lymphocytes. The four main subtypes of HL are the nodular sclerosing, mixed cellularity, lymphocyte rich and the lymphocyte depleted. Nodular sclerosis subtype accounts for majority of all classical HL, whereas lymphocytic depletion type accounts for less than 1%. The main objective of reporting this case is to share with the medical fraternity a rare presentation of abdominal lymphocyte-depleted classical Hodgkin lymphoma.A 47-year-old gentleman of Malay ethnicity with no known pre-morbidities, presented to the haematology unit with a 2-month history of night fever, loss of weight, malaise, anorexia and abdominal swelling. Abdominal examination revealed a periumbilical and lower epigastric swelling measuring 6x6 cms. The swelling was non-tender, firm in consistency and smooth on palpation. The Contrast Enhanced Computed Tomography (CECT) imaging revealed an enlarged mesenteric mass measuring 5.8x6.9x5.7 cm and multiple enlarged aorta-caval lymph nodes. The mesenteric tumour histology and immunohistochemistry were consistent with lymphocyte depleted HL. He completed six cycles of intravenous ABVD polychemotherapy consisting of doxorubicin (Adriamycin) 25mg/m2, Bleomycin 10mg/m2, Vinblastine 6mg/m2 and Dacarbazine 375mg/m2. The Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG PET /CT) imaging post 2 cycles and 6 cycles of ABVD polychemotherapy showed complete metabolic response to chemotherapy.
Conclusion: Lymphocyte-depleted classical Hodgkin lymphoma (LDcHL) is a rare entity and is mostly diagnosed at a later stage rendering it a disease with poor prognostic outcomes. Early detection and prompt institution of therapy is crucial in the management of this disease.

Keywords: lymphocyte depleted, mesenteric tumour, Hodgkin lymphoma, polychemotherapy

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