Extranodal Hodgkin disease presenting with gluteal mass and hypercalcemia.To The Editor: We wish to report the case of a 68-year-old male who presented with a gluteal gluteal /glu·te·al/ (gloo´te-al) pertaining to the buttocks. glu·te·al adj. Of or relating to the buttocks. gluteal pertaining to the buttocks. mass and hypercalcemia Hypercalcemia Definition Hypercalcemia is an abnormally high level of calcium in the blood, usually more than 10.5 milligrams per deciliter of blood. . Although gluteal masses have been described in advanced Hodgkin disease, (1) in our patient, the gluteal mass was the presenting sign. Similarly, although hypercalcemia may develop during the course of lung cancer, multiple myeloma, breast cancer and non-Hodgkin lymphoma, it is less frequent in Hodgkin disease. (2) Our patient presented with a history of right gluteal swelling and pain for 2 months. Physical examination revealed a mobile, painless, rubbery, 2 cm inguinal lymphadenopathy as well as a separate mass, approximately 15 cm in diameter, in the right gluteal region. Laboratory evaluations showed hypercalcemia (12.5 mg/dL), anemia (hemoglobin 8.0 g/dL), leukocytosis Leukocytosis Definition Leukocytosis is a condition characterized by an elevated number of white cells in the blood. Description Leukocytosis is a condition that affects all types of white blood cells. (14,100), and mild thrombocytosis. A serum 1,25 (OH)[.sub.2] [D.sub.3] and TSH were normal. Serum parathormone parathormone: see parathyroid hormone. level was decreased at 0.74 pg/mL. Magnetic resonance imagine (MRI) of the gluteal area showed an approximately 15 cm mass infiltrating the gluteal and iliopsoas muscles. There was no sign of contiguous spread of disease from the right inguinal lymph node to the right gluteal region. Histopathological examination of the inguinal lymph node and gluteal mass revealed nodular sclerosing Hodgkin disease. Bone marrow biopsy Bone marrow biopsy A procedure in which cellular material is removed from the pelvis or breastbone and examined under a microscope to look for the presence of abnormal blood cells characteristic of specific forms of leukemia and lymphoma. taken from the right crista crista /cris·ta/ (kris´tah) pl. cris´tae [L.] crest. cris´tae cu´tis dermal ridges; ridges of the skin produced by the projecting papillae of the dermis on the palm of the hand or sole iliaca posterior showed no malignant infiltration in the bone marrow. Whole body bone scintigraphy scintigraphy /scin·tig·ra·phy/ (sin-tig´rah-fe) the production of two-dimensional images of the distribution of radioactivity in tissues after the internal administration of a radiopharmaceutical imaging agent, the images being obtained with [.sup.99m.Tc] was normal. Computed tomographies of the thorax and abdominopelvic region showed no abnormalities except for a 2 X 2.5 cm right inguinal lymphadenopathy. Complete remission was achieved after six cycles of chemotherapy with ABVD (Adriamycin: 25 mg/[m.sup.2], vinblastine vinblastine /vin·blas·tine/ (vin-blas´ten) an antineoplasticvinca alkaloid used as the sulfate salt in the palliative treatment of a variety of malignancies. : 6 mg/[m.sup.2], bleomycin: 10 mg/[m.sup.2], dacarbazine: 375 mg/[m.sup.2]). The patient is alive with a 15-month disease-free survival. Hypercalcemia did not recur after the first cycle of ABVD. Gungor Utkan Abdullah Buyukcelik Bulent Yalcin Ibrahim Tek Hatice Doruk Dilek Dincol Department of Medical Oncology Ankara University School of Medicine Ankara, Turkey Selim Erekul Department of Pathology Ankara University School of Medicine Ankara, Turkey Meltem Baykara Department of Internal Medicine Ankara University School of Medicine Ankara, Turkey References 1. Ariad S, Hatskelzon L Benharroch D, et al. Gluteal manifestation of advanced Hodgkin's disease. Skeletal Radiol 1997;26:622-625. 2. Ellis RD, Beck PR, Mondal BK. Hodgkin's disease presenting with hypercalcaemia. J Clin Pathol 1989;42:1228. |
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