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Hodgkin Lymphoma Presenting With Spinal Cord Compression: Challenges for Diagnosis and Initial Management.

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cam.issuedOnline2021-08-24
dc.contributor.authorBloxham, Nicola
dc.contributor.authorCross, Justin
dc.contributor.authorGarnett, Matthew
dc.contributor.authorBewick, Jessica
dc.contributor.authorArmon, Kate
dc.contributor.authorHook, C Elizabeth
dc.contributor.authorMurray, Matthew J
dc.contributor.orcidMurray, Matthew J [0000-0002-4480-1147]
dc.date.accessioned2022-05-16T18:00:28Z
dc.date.available2022-05-16T18:00:28Z
dc.date.issued2022
dc.date.updated2022-05-16T18:00:27Z
dc.description.abstractHodgkin lymphoma (HL) can present with extra-nodal disease, but spinal cord compression is exceptionally rare. We describe a 15-year-old presenting with hip/back pain with normal initial examination. Persistent pain and raised inflammatory markers prompted further investigation with MRI, which revealed an epidural mass causing spinal cord compression. On examination, there was no palpable lymphadenopathy or cauda equina syndrome, but absent lower limb reflexes were noted. Following multidisciplinary discussion, it was determined that cauda equina syndrome was imminent and therefore surgical debulking was undertaken, both to prevent this complication and establish a diagnosis. At surgery, the tumor was highly vascular. Frozen section confirmed lesional material. Following surgery, and given the frozen section findings, a short course of steroids was commenced to reduce any peri-surgical edema. Unfortunately, histopathology was ultimately non-diagnostic, due to failure of immunohistochemistry on technically challenging material. Consequently, ultrasound-guided excision biopsy of a (non-palpable) cervical lymph node was performed five days later; histopathology showed typical effacement of the normal architecture and a conspicuous population of CD15/CD30-positive larger pale cells present, confirming nodular sclerosis classic HL, despite recent steroids. We review the available literature for HL presenting with spinal cord compression and describe the challenges for diagnosis and initial management in such cases.
dc.identifier.doi10.17863/CAM.84618
dc.identifier.eissn1615-5742
dc.identifier.issn1093-5266
dc.identifier.other10.1177_10935266211033269
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/337200
dc.languageen
dc.language.isoeng
dc.publisherSAGE Publications
dc.publisher.urlhttp://dx.doi.org/10.1177/10935266211033269
dc.subjectHodgkin
dc.subjectcord compression
dc.subjectdiagnosis
dc.subjectmanagement
dc.subjectspinal cord
dc.subjectAdolescent
dc.subjectCauda Equina Syndrome
dc.subjectHodgkin Disease
dc.subjectHumans
dc.subjectImmunohistochemistry
dc.subjectMagnetic Resonance Imaging
dc.subjectSpinal Cord Compression
dc.titleHodgkin Lymphoma Presenting With Spinal Cord Compression: Challenges for Diagnosis and Initial Management.
dc.typeOther
dcterms.dateAccepted2021-06-25
prism.endingPage173
prism.issueIdentifier2
prism.publicationNamePediatr Dev Pathol
prism.startingPage168
prism.volume25
rioxxterms.freetoread.startdate2021-08-24
rioxxterms.licenseref.startdate2021-08-24
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1177/10935266211033269

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