Ptosis: a rare presentation of Hodgkin lymphoma

Response and Relapses in Pediatric Hodgkin's Lymphoma Treated with Chemotherapy Alone

Aims: The aims of this study were to analyze the sociodemographic profile, disease characteristics, event-free survival (EFS), overall survival (OS), and risk factors for relapse in patients with Hodgkin's lymphoma (HL) treated with only chemotherapy as per unit protocol. Subject and Methods: Case records of children with HL diagnosed and treated at our center between January 2005 and December 2014 were retrospectively analyzed. Results: A total of 90 patients with mean age of 8.13 ± 2.65 years (median age 8 years; range 4.5–15 years) were diagnosed and treated for HL during the study period. Male-to-female ratio was 7.2:1. Almost 12.2% and 87.8% of patients had early and advanced stage disease, respectively. B symptoms were present in 87.8% of patients. Mean duration of symptoms was 9.66 ± 6.30 months (median 8 months; range 2–36 months). Mixed cellularity was the most common histologic type. Multiagent chemotherapy was mainstay of treatment. OS and EFS were 88.8% and 84.5%, respectively. OS in patients with or without bulky disease was 53.3% and 92.2%, respectively. Older age (≥10 years), presence of bulky disease, low hemoglobin (≤7.0 g/dl), and high leukocyte count (≥12000/mm3) at the time of diagnosis, and protocol used (cyclophosphamide, vincristine, procarbazine, and prednisone) were the risk factors for relapse. Conclusions: Our patient population had younger age, advanced disease, more B symptoms, and bulky disease. Still, we achieved good OS and EFS with chemotherapy-alone protocols. Patients with bulky disease had poor OS and EFS. If radiotherapy is included in the protocol for bulky disease, the survival rates can be improved further.

Mantle Cell Lymphoma Presenting with Acute Bilateral Ophthalmoplegia

A 72-year-old woman presented with acute onset of double vision, bilateral complete blepharoptosis, and nearly complete ophthalmoplegia. Orbital and brain magnetic resonance imaging were normal. Further investigation revealed bicytopenia with hepatosplenomegaly. Liver biopsy revealed mantle cell lymphoma. Cytology later showed the presence of mantle cells in cerebrospinal fluid analysis. Her ophthalmoplegia improved from her first cycle of systemic and intrathecal chemotherapy. To the best of our knowledge, this is the second case in the literature of mantle cell lymphoma with central nervous system involvement presenting with ophthalmoplegia. This symptom should be considered one of the initial signs of mantle cell lymphoma.