An early relapse of Hodgkin´s lymphoma that is demonstrated as a paraneoplastic cerebellar degeneration



Year of publication 2008
Type Conference abstract
MU Faculty or unit

Faculty of Medicine

Description Background: Paraneoplastic cerebellar degeneration (PCD) represents the most described paraneoplastic neurological syndrome occurring, in addition to Hodgkins lymphoma (HL), especially at small cell lung cancer and ovary cancer. We always have to distinguish a primary infliction of CNS by imaging and examination of the liquor, which is at HL very rare (incidence of 0,2%) and means a late symptom of an already advanced disease with a worse prognosis. Material and methods: In 11/2005 a 30-year-old man was diagnosed with nodular sclerosis HL stages II B at our clinic. The pt was treated with 4 cycles of the chemotherapy ABVD and the IF radiotherapy (30 Gy) of the retroperitoneum and the mesenteric lymph nodes. According to the CT scan a complete remission was achieved. After 11 months the pt was hospitalized for a gradually progressive ataxia, vertigo, dysartria and nystagmus. Imaging of CNS including MRI and the cytology of the liquor was negative. By the CT scan the mediastinal lymphadenopathy was found out and completing FDG-PET examination confirms the suspicion for an early relapse of HL, which was eventually confirmed by the thoracoscopy. Results: With regard to an early relapse of HL salvage chemotherapy DHAP was indicated. Yet after the 1st cycle of the chemotherapy a distinctive regression of the neurological symptoms which, consequently, went off completely. After the 2nd cycle of the chemotherapy a successful separation of the PBSC came through. Afterwards, the pt took high-dose chemotherapy BEAM with an autologous PBSC support (10/2007). Considering CT scan examinations including whole body FDG-PET showed a complete remission again. Conclusions: The occurrence of an early relapse of HL carried out by the symptoms PCD is presented in the case report. Differential diagnostics can be facilitated by the identification of the HL specific paraneoplastic anti-Tr antibodies (named after its inventor J. Trotter in 1976), that are made against Purkinjes cells in the cerebellum. Their determination in the time of the relapse of our patient was impossible because of the inaccessibility of this method in the Czech Republic.

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