Simultaneous presentation of Hodgkins and follicular non-Hodgkins lymphoma in a previously healthy male.

A 53-year-old active duty male with no significant past medical history noted left sided inguinal lymphadenopathy while deployed in Bosnia that did not resolve over a 2-week period. He also noted mild night sweats for 1-2 months and a 15-pound weight loss over several months. An excisional lymph node biopsy was planned. The evening prior to the biopsy of the left inguinal node, the patient additionally noticed right-sided axillary lymphadenopathy. He subsequently underwent excisional biopsy at both sites. Pathologic examination, confirmed on review at the Armed Forces Institute of Pathology, revealed follicular non-Hodgkins lymphoma in the left inguinal node and mixed cellularity Hodgkins lymphoma in the right axillary node. Subsequent staging including PET scan showed evidence of additional disease in the neck, hilum, spleen, retroperitoneum, right inguinal region, and an epidural soft tissue mass with L3/4 nerve root compression requiring urgent radiotherapy. Bone marrow biopsy was negative for involvement with either lymphoma. Systemic treatment for the Hodgkins Lymphoma was subsequently given priority and the patient was treated with ABVD chemotherapy for 6 cycles, resulting in complete remission. The occurrence of both Hodgkins and non-Hodgkins lymphoma in the same patient is a very rare event, and has generally been reported as the later development of HD in a patient with previously recognized NHL. Simultaneous diagnosis of both diseases in a previously well patient is even more uncommon. A literature review will be presented and the implications for management of this patient will be discussed.

CPT Dara D. Bagwell, MD, and MAJ Douglas A. Nelson, MD. Keesler Air Force Base Medical Center, Biloxi, MS.