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Pulmonary hodgkin lymphoma in a patient with Crohn's disease.

Park JY, Lee J - Korean J Pathol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea.

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Interestingly, patients with a history of inflammatory bowel disease (IBD) who are treated with immunosuppressants have been noted to have an increased risk of lymphoma; most cases that have been identified in this setting involve non-Hodgkin lymphoma (NHL)... IBD-affected patients treated with immunosuppressive agents such as thiopurine (azathioprine) and anti-TNF-α (infliximab, adalimumab, etc.) are at increased risk of malignant lymphoma... Recently, some cases of classical HL arising in the setting of iatrogenic immunodeficiency have been reported; these diseases usually present in lymph nodes and are commonly associated with Epstein-Barr virus (EBV) infection... Treatment with immunosuppressive agents, including TNF-α antagonists, changes the immunologic state of patients, and thus may lead to the development of lymphoma... The interval between the initiation of therapy with TNF-α antagonists and the development of lymphoma, including HL, was very short (median, 8 weeks) in that study; therefore, we suggest that in this case, the pathogenesis of HL may have involved the patient’s treatment with TNF-α antagonist... In our case, the patient had a four-year history of CD and received azathioprine therapy with prednisone and mesalazine... Primary intestinal HL, as a consequence of underlying CD, may have a strong association with EBV... EBV-associated HL usually involves the colorectal regions... Dahhan et al. reported that EBV was positive only in blood serology, and absent in both bone marrow and lymph node biopsy specimens, in primary HL in a CD patient... EBV-related lymphomas are associated with methotrexate, suggesting that defective immunosurveillance is important in lymphomagenesis... In conclusion, many factors may influence the development of lymphoma in patients with CD, and we were not able to clearly define the role of any specific immunomodulating drug in lymphomagenesis in this particular case... Although the patient’s CD and associated treatment were of relatively short duration, the cumulative dose of azathioprine over four years and recent additional therapy of TNF-α antagonist may have influenced the pathogenesis of HL... Thus, in treating patients with CD using immunosuppressive therapy, it is important to closely follow patients and be aware of this potential complication.

No MeSH data available.


Related in: MedlinePlus

The wedge resection specimen of the lung mass shows classic signs of Hodgkin lymphoma. (A) At low power, the neoplastic mass exhibits a dense cellular area with a nodular pattern separated by fibrous bands. (B) Reed-Sternberg cells are scattered in a background of small lymphocytes. Hodgkin and Reed-Sternberg cells are positive for CD30 (C) and PAX5 (D).
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f2-kjpathol-48-5-387: The wedge resection specimen of the lung mass shows classic signs of Hodgkin lymphoma. (A) At low power, the neoplastic mass exhibits a dense cellular area with a nodular pattern separated by fibrous bands. (B) Reed-Sternberg cells are scattered in a background of small lymphocytes. Hodgkin and Reed-Sternberg cells are positive for CD30 (C) and PAX5 (D).

Mentions: The histopathologic findings of the lung showed a nodular growth pattern, separated by fibrous bands. The lymphoid nodule included scattered large atypical cells, resembling Hodgkin and Reed-Sternberg cells, in abundant reactive and inflammatory background including lymphocytes, plasma cells and histiocytes (Fig. 2B). The atypical large lymphoid cells were positive for CD30, CD15, and PAX5 (Fig. 2C, D), and negative for CD3 and CD20. These cells were negative for Epstein-Barr encoding region in situ hybridization. The histologic diagnosis, even conjunction with immunohistochemical stainings, was consistent with classical HL, nodular sclerosis type. Adjacent lung parenchyma was unremarkable with fibrinous exudates and foamy histiocytes in the air spaces at the edge of mass (Fig. 2A). The mediastinal lymph node was biopsied and exhibited the same histologic findings of classical HL. Segmental resection of the small bowel was histologically compatible with CD, and there was no evidence of malignancy. A tuberculosis–polymerase chain reaction study was negative.


Pulmonary hodgkin lymphoma in a patient with Crohn's disease.

Park JY, Lee J - Korean J Pathol (2014)

The wedge resection specimen of the lung mass shows classic signs of Hodgkin lymphoma. (A) At low power, the neoplastic mass exhibits a dense cellular area with a nodular pattern separated by fibrous bands. (B) Reed-Sternberg cells are scattered in a background of small lymphocytes. Hodgkin and Reed-Sternberg cells are positive for CD30 (C) and PAX5 (D).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4215967&req=5

f2-kjpathol-48-5-387: The wedge resection specimen of the lung mass shows classic signs of Hodgkin lymphoma. (A) At low power, the neoplastic mass exhibits a dense cellular area with a nodular pattern separated by fibrous bands. (B) Reed-Sternberg cells are scattered in a background of small lymphocytes. Hodgkin and Reed-Sternberg cells are positive for CD30 (C) and PAX5 (D).
Mentions: The histopathologic findings of the lung showed a nodular growth pattern, separated by fibrous bands. The lymphoid nodule included scattered large atypical cells, resembling Hodgkin and Reed-Sternberg cells, in abundant reactive and inflammatory background including lymphocytes, plasma cells and histiocytes (Fig. 2B). The atypical large lymphoid cells were positive for CD30, CD15, and PAX5 (Fig. 2C, D), and negative for CD3 and CD20. These cells were negative for Epstein-Barr encoding region in situ hybridization. The histologic diagnosis, even conjunction with immunohistochemical stainings, was consistent with classical HL, nodular sclerosis type. Adjacent lung parenchyma was unremarkable with fibrinous exudates and foamy histiocytes in the air spaces at the edge of mass (Fig. 2A). The mediastinal lymph node was biopsied and exhibited the same histologic findings of classical HL. Segmental resection of the small bowel was histologically compatible with CD, and there was no evidence of malignancy. A tuberculosis–polymerase chain reaction study was negative.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Kyung Hee University School of Medicine, Seoul, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Interestingly, patients with a history of inflammatory bowel disease (IBD) who are treated with immunosuppressants have been noted to have an increased risk of lymphoma; most cases that have been identified in this setting involve non-Hodgkin lymphoma (NHL)... IBD-affected patients treated with immunosuppressive agents such as thiopurine (azathioprine) and anti-TNF-α (infliximab, adalimumab, etc.) are at increased risk of malignant lymphoma... Recently, some cases of classical HL arising in the setting of iatrogenic immunodeficiency have been reported; these diseases usually present in lymph nodes and are commonly associated with Epstein-Barr virus (EBV) infection... Treatment with immunosuppressive agents, including TNF-α antagonists, changes the immunologic state of patients, and thus may lead to the development of lymphoma... The interval between the initiation of therapy with TNF-α antagonists and the development of lymphoma, including HL, was very short (median, 8 weeks) in that study; therefore, we suggest that in this case, the pathogenesis of HL may have involved the patient’s treatment with TNF-α antagonist... In our case, the patient had a four-year history of CD and received azathioprine therapy with prednisone and mesalazine... Primary intestinal HL, as a consequence of underlying CD, may have a strong association with EBV... EBV-associated HL usually involves the colorectal regions... Dahhan et al. reported that EBV was positive only in blood serology, and absent in both bone marrow and lymph node biopsy specimens, in primary HL in a CD patient... EBV-related lymphomas are associated with methotrexate, suggesting that defective immunosurveillance is important in lymphomagenesis... In conclusion, many factors may influence the development of lymphoma in patients with CD, and we were not able to clearly define the role of any specific immunomodulating drug in lymphomagenesis in this particular case... Although the patient’s CD and associated treatment were of relatively short duration, the cumulative dose of azathioprine over four years and recent additional therapy of TNF-α antagonist may have influenced the pathogenesis of HL... Thus, in treating patients with CD using immunosuppressive therapy, it is important to closely follow patients and be aware of this potential complication.

No MeSH data available.


Related in: MedlinePlus