Primary EBV-positive Hodgkin's lymphoma of the CNS under azathioprine treatment: case report and review of the literature.
BACKGROUND
Retrospective and prospective cohort studies suggest that central nervous system involvement occurs in approximately 0.5% of patients with advanced Hodgkin's lymphoma. The isolated primary intracranial manifestation of Hodgkin's lymphoma is an extremely rare finding, with few cases reported in the literature. Little is known about the optimal treatment and prognosis of these tumors. Here, we present a case report with a review of the literature.


METHODS
A 47-year-old Caucasian man with persistent frontal headache and unspecific vertigo for half a month was diagnosed with nodular space-occupying lesions in the cerebellum. His medical history included multiple sclerosis, which was treated for 20 years with the immunosuppressive drug azathioprine. Further staging revealed no additional lesions suspected of being malignant. The patient underwent total tumor resection. Immunohistopathological examination showed Epstein-Barr virus-associated classic Hodgkin's lymphoma. Diagnostic bone marrow punction excluded lymphoma involvement of the bone marrow. The patient had no B symptoms. Consequently, the patient was classified as having stage IEA disease according to the Modified Ann Arbor Classification of Hodgkin Lymphoma and received systemic chemotherapy followed by radiation therapy for the former cerebellar tumor region. He was in complete clinical remission at the last follow-up 9 months after the initial diagnosis.


CONCLUSIONS
This case report and literature review suggest that multimodal treatment leads to a remarkable clinical outcome in Hodgkin's lymphoma with intracranial involvement.
Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany.
Christoph
C
Henkenberens
Anke
A
Franzke
Peter
P
Raab
Ilske
I
Oschlies
Wolfram
W
Klapper
Hans
H
Christiansen
D001379:Azathioprine / Q000009:adverse effects* / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy; D003399:Craniotomy; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy*; D006689:Hodgkin Disease / Q000139:chemically induced* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D014057:Tomography, X-Ray Computed
D007166:Immunosuppressive Agents; D001379:Azathioprine