An unusual cutaneous presentation of Hodgkin's disease

An Index Case of Cutaneous Hodgkin Lymphoma and Review of the Literature

Hodgkin lymphoma (HL), although a common hematopoietic malignancy, presents as a primary cutaneous form in extraordinarily rare instances. In this study, we present a remarkable case of a 76-year-old woman with a history of bony metastatic breast cancer who developed multiple subcutaneous nodules on the left neck and scalp. A biopsy revealed the histological and immunohistochemical findings of classic HL. She was treated with systemic chemotherapy and quickly achieved disease remission. Five months later, she was alive and without evidence of lymphoma, consistent with our understanding of primary cutaneous HL as an indolent variant of HL.

Cutaneous involvement in Hodgkin's lymphoma: report of two cases

Hodgkin's lymphoma (HL) comprises 20 to 30% of all lymphomas. Skin involvement is almost always secondary to visceral or nodal involvement. Secondary cutaneous HL is rare, occurring in only 0.5 to 3.4% of the cases. Herein we report two cases of skin involvement in Hodgkin's disease. One was a 25-year-old female admitted with a draining sinus in the neck. The other was a 19-year-old female admitted with a neck mass and skin papules on her chest and arm. Skin involvement may antecede or can be seen during the course of HL. Better understanding of such cutaneous involvement, which occasionally may be the initial sign of HL, is needed, and a biopsy of any suspicious skin lesion should be considered.

Itching attacks with generalized hyperhydrosis as initial symptoms of Hodgkin's disease

BACKGROUND

Clinical signs of Hodgkin's disease are unexplained weight loss, nocturnal sweating, fever and more or less permanent itching or pain around the affected lymphnodes, especially after alcohol consumption. Paraneoplastic symptoms are major challenges to the dermatologist, particularly if these seem harmless, though somewhat strange, as in the following case.

OBSERVATION

A 35-year-old patient had suffered for about 6 months from paroxysmal severe itching. A transient, generalized hyperhydrosis followed these attacks closely. The itching attacks usually began between the fingers and on the palms of the hands, and then spread to become generalized over the entire integument. The itching attacks commonly occurred three times daily for only a few minutes, while the subsequent severe hyperhydrosis, with cold sweat, lasted up to an hour.

CONCLUSIONS

This case illustrates the necessity of considering a malignant underlying disease like Hodgkin's disease, not only in the presence of the well-known B-symptoms, but also when peculiar symptom combinations, like itching attacks and immediately subsequent transient generalized hyperhydrosis are present.