Leukemia occurring in treated Hodgkin’s disease: Two neoplasms or one?

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The origin of the malignant cell in Hodgkin’s disease and the increased incidence of second malignancies in patients with Hodgkin’s disease remain unsolved problems.1–4 The results of cytochemical, immunomicroscopic, immunologic, and ultrastructural studies of the neoplastic cells5–17 have failed to identify their origin, but suggest either a histiocytic or B-lymphocytic derivation. Similar studies in acute leukemias18, 19 arising in patients with Hodgkin’s disease have suggested differences between the leukemic cells and the cells of Hodgkin’s disease. We report a case of Hodgkin’s disease in which an apparent second neoplasm developed. Sequential studies of the neoplastic cells suggest that radical changes occurred in the cell type during evolution of the disease. Such changes may reflect treatment-mediated or naturally occurring evolution of the neoplastic cell lines of Hodgkin’s disease, rather than a second neoplasm originating from a different cell line.

Clinical summary

A 44-year-old white male was well until September 1974 when progressive shortness of breath developed. A diagnosis of nodular sclerosing Hodgkin’s disease, Stage I, involving a left scalene lymph node was made at another hospital (Fig. 1). The patient received 4000 rads to the right and left supraclavicular lymph node areas. He was referred to the Cleveland Clinic 8 months later for consideration of chemotherapy. At this time there was evidence of radiation pneumonitis. The blood count showed hemoglobin, 8.7 g/dl and white blood cell count (WBC), 8.3 × 109/1 with a normal differential count. A biopsy specimen of the left posterior iliac crest revealed a marrow of normal cellularity containing . . .



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