Hodgkin's lymphoma rectosigmoid in a patient with ulcerative colitis on long-term azathioprine therapy

Abstract

Hodgkin's lymphoma complicating chronic ulcerative colitis is extremely rare. We report a case of extranodal Hodgkin's lymphoma involving rectosigmoid in a patient of chronic ulcerative colitis on long-term azathioprine. A 67-year-old man presented with extensive ulcerative colitis, on follow-up since September 2005. He received long-term steroids, mesalamine and azathioprine. Serial surveillance colonoscopic examinations and colonic biopsies were performed. Surveillance colonoscopy performed 8 years after the onset of disease showed multiple deep ulcers and nodular masses involving the rectum and sigmoid colon. Histological examination of rectosigmoid biopsies showed classic Hodgkin's disease. Azathioprine was withdrawn. He received mechlorethamine, vincristine, procarbazine and prednisone (MOPP) chemotherapy protocol and was planned for total colectomy in follow-up. We believe patients with ulcerative colitis on long-term azathioprine should be on vigil for development of lymphomas by protocol surveillance colonoscopic examinations and biopsies. The risk of lymphoma in such patients is small and outweighs the benefits of long-term azathioprine therapy.

Diagnostic challenge of soft tissue extranodal Hodgkin lymphoma in core-needle biopsy: case report

“…3,4 Among Chine patients the most commonly involved extranodal sites of HL are the liver and lung, followed by the bones. 5 Rare cases are also described as primary breast, 6,7 parotid gland, 8 thyroid, 9 rectosigmoid, 10,11 ileum, 12 and head and neck 13,14 HL. It is essential to determine whether extranodal involvement represents a primary manifestation or dissemination of systemic disease.…”

A Case Followed as Having Multiple Sclerosis but Diagnosed with Secondary Brain Lymphoma

“…The exact effect of azathioprine on the increase in cranial lesions cannot be determined in this case; however, the fact that lesions progressed during treatment creates enough basis for suspicion. Although the toxicity debate remains controversial in patients with renal failure, we believe our patient may have been subjected to higher than needed dosages (3,9,10,11,12,13).…”