We present the case of a 50-year-old male patient with a crisis of profuse sweating, loss of 10% of body weight and pain in the left knee, without fever, of six months' evolution, who consulted for pain and enlargement of the left thigh. His laboratory tests (including LDH) showed no abnormal values and, clinically, he was diagnosed with osteomyelitis of the left trochanter. Radiology of the pelvis showed a single lytic lesion in the left femoral head confirmed by CT, 99Tc and 67Ga scintigraphy. Bone biopsy was reported as lymphoproliferative bone involvement with the possibility of HL.
One month later, referred to our Oncology Unit, the physical examination revealed an adenopathic mass of 7 cm in diameter in the left axilla and bilateral inguinal lymphadenopathies of months of evolution. Previous symptomatology was interpreted as B symptoms and new laboratory data showed a b2µglobulin of 5 mg/l, LDH 670 and negative serology for HIV and hepatovirus.
The axillary mass was biopsied and reported as nodular sclerosis type HL. The lymph node architecture was distorted by fibrous tracts between nodules of lymphocytes, plasma cells, neutrophils, histiocytes and CD-30+ cells, with clear cytoplasm and lobulated nuclei. There was focal positivity for CD-15 and EMA and almost all tumour cells were Ki-67+. Bone marrow biopsy was reported as fibrosis associated with LH infiltration. CT scan showed lymphadenopathy in the left axilla, supraclavicular, mediastinum, retroperitoneum, pelvis and groin.
From 24-2-2000 to 29-9-2000, the patient received seven cycles of QT in ABVD regimen. By the second cycle, the B symptoms and peripheral adenopathies had disappeared. By the fourth, the ß2µglobulin (1.7 mg/l) and LDH (398) values were normal, and by the sixth, the CT scan showed only sclerosis of the left iliac blade, the bone marrow biopsy showed no LH infiltration and the 67Gallium scan was negative. On 15-1-2001, the response was consolidated with 3 cycles of QT in MOPP regimen and RT (36 Gy) on the left femur. To date, the patient is free of relapse.
QT regimens used in the treatment
ABVD (every 2 weeks): Doxorubicin 25 mg/m2 + Bleomycin 10 mg/m2 + Vinblastine 6 mg/m2 + Dacarbazine 375 mg/m2.
COPP (every 4 weeks): Day 1: Cyclophosphamide 650 mg/m2 + Vincristine 1.4 mg/m2 + Procarbazine 100 mg/m2. Day 8: Cyclophosphamide 650 mg/m2 + Vincristine 1.4 mg/m2. Days 1-14: Prednisone 40 mg/m2.