Non-Hodgkin’s lymphoma in a hemophilic patient with a traumatic hematoma

Abstract

To the editor,Hemophilia A, the most common severe inherited bleeding disorder, is characterized by FVIII deficiency. The use of recombinant FVIII products and improved purity of plasma-derived concentrates have decreased the risk of HIV, and hepatitis B and C virus transmission in patients with hemophilia. Malignancies reported in hemophilic patients are usually associated with HIV, and hepatitis B and C infection. The incidence of non-infection-related malignancy is not known due to the limited quantity of data in the literature [1]. Herein we report a boy with hemophilia A that was followed-up with the initial diagnosis of a neck hematoma; examination of a subsequent excisional biopsy specimen resulted in the diagnosis of nonHodgkin's lymphoma (NHL).A 12-year-old boy with mild hemophilia A (FVIII coagulant activity 7%; vWF Ag: 78%; Ricof: 72%) had been followed-up at another center since he was 5 years old. Six months before presentation at our institution the patient had a tooth extracted and developed a mass in the neck. Initially, a muscle hematoma was suspected. As the mass enlarged, needle aspiration was performed, and the result showed reactive hyperplasia. The patient was referred to our clinic for further investigation.The patient did not have symptoms suggesting lymphoma or any other malignancy. Physical examination was normal, except for a 2×1.5-cm soft mass in the neck. Full blood count, peripheral blood smear, sedimentation rate (7 mm/h), and lactate dehydrogenase (LDH: 184 IU/L) were normal. Cervical magnetic resonance imaging (MRI) showed a heterogenous solid mass between the submandibular gland and sternocleidomastoid muscle. Thoracic and abdominal computed tomography (CT) results were normal. Positron emission tomography (PET) showed hypermetabolic lymphadenopathies in the left inferior cervical and supraclavicular fossa. Excisional biopsy under factor replacement showed T cell-rich diffuse B cell NHL. There was no bone marrow or cerebrospinal fluid involvement, and he was classified as stage 2 NHL. Viral serology, including HIV, and hepatitis B and C viruses was negative. The patient was treated according to the BFM-NHL 95 protocol and did not have any severe bleeding episodes during chemotherapy. Moreover, no complications occurred during cerebrospinal fluid tap or bone marrow aspiration/biopsy.

Surgery in a Patient with Haemophilia A and Lymphoma

“…Close follow-up for malignancies in these patients is therefore recommended [11]. In fact, several cases of haemophilia patients with tumours that were initially thought to be haematoma have been reported [12,13]. Simple haematomas have also been mistaken for tumours [14][15][16]; nevertheless, differential diagnosis of posttraumatic haematoma in patients with haemophilia should include the consideration of malignancy [13].…”