Autoimmune haemolytic anaemia, immune thrombocytopenia, and leucopenia - an unusual presentation of hodgkin's disease

We report an unusual case of modular sclerosing Hodgkin's disease in a 17 year old women presenting with intermittent fever, progressive weight loss and enlarged cervical and anxillary lymp nodes. Laboratory test revealed severe Coombs' positive haemolytic anaemia, and progressive thrombocytopenia and leucopenia, associated with erythroid, myeloid and megakaryocytic hyperplasia, but with no evidence of lymphomatous infiltration in the bone marrow. Transfusion of compatible blood became possible only after prednisone therapy and a single intravenous dose of vincristine. Appropriate chemotherapy led to normalization of the peripheral blood counts and a negative direct Coombs' test.(AU)

Human T-lymphotropic virus type I DNA in spinal cord of tropical spastic paraparesis with concomitant human T-lymphotropic virus type I negative Hodgkin's disease

We studied a 58 year old black women from Barbados who simultaneously developed myelopathy and lymphoma with human T-lymphotropic virus type I (HTLV-I) antibodies in serum and cerebrospinal fluid and died 3 years after onset. Neuropathological examination showed typical tropical spastic paraparesis (TSP). The polymerase chain reaction (PCR) demonstrated defective proviral genome retaining the HTLV-I pX and env regions in thoracic spinal cord, the level most severely affected. Defective HTLV-I in the nervous system retaining the pX region may be relevant to pathogenesis because circulating CD8+ cytotoxic lymphocytes specific for HTLV-I pX occur in HTLV-I myelopathy. This patient's lymph node biopsy specimen was consistent with Hodgkin's disease (HD), nodular sclerosis subtype, of B-cell origin. The PCR in the paraffin-embedded lymph node involved by HD failed to amplify HTLV-I proviral sequences. Complete HTLV-I proviral amplification was obtained in paraffin-embedded lymph node form positive controls (adults T-cells leukemia). To our knowledge the association of TSP and HD has not been reported previously. Despite claims the HD may be associated with HTLV-I, we demonstrated absence of HTLV-I infected T-cell in the lymphoid infiltrate of HD in this case, positive HTLV-I serology notwithstanding.(AU)

Molecular epidemiology of HTLV-I-associated non-Hodgkin's lymphomas in Jamaica

As part of epidemiologic studies of human T-lymphotropic virus (HTLV)-I-associated malignancies in Jamaica, the authors evaluated 26 patients with non-Hodgkin's lymphoma for the presence of integrated HTLV-I provirus in their malignant cells. Fifteen of 26 patients had integrated provirus. All 15 also were HTLV-I antibody positive. Eleven patients did not have integrated provirus, and all 11 were antibody negative. All of the antibody-positive cases had onset of their disease in adulthood (age range, 21-57 years) as opposed to the broad age range of negative cases (4-66 years). Clinical features which were more common in provirus positive than negative patients included leukemic phase, skin involvement, and hypercalcemia, which are all features frequently seen in HTLV-I-associated adult T-cell leukemia/lymphoma (ATLL). The presence of skin involvement, circulating malignant cells, abnormal liver function tests, or the presence of two or more of these four features were statistically significantly different between virus-positive and virus-negative cases. Although the survival of positive cases (6 months) was shorter than that of negative cases (9 months), this was not statistically significant. The only significant determinant of survival was hypercalcemia, with those who developed hypercalcemia at some point in their disease course, independent of their HTLV-I status, surviving a mean of 5 months as compared to a mean of 17.5 months in those who never became hypercalcemic. The six HTLV-I-positive lymphomas that underwent cell typing were all primarily OKT4 positive, whereas two HTLV-I antibody-negative cases that were typed were B-cell lymphomas. (AU)

Hodgkin's disease in Jamaica: response to treatment

This paper reviews the response to treatment in 34 patients with Hodgkins disease studied at the University Hospital of the West Indies between January 1970 and June 1979. Ten patients (Stage IA to Stage IIIA) had radiotherapy with curative intent. Nine of these achieved complete remission (CR) and one had a partial remission (PR). No death was recorded in this group. The median survival in the 20 patients treated with MOPP chemotherapy was 23 manths. Only six of these patients achieved (CR), 3 percent of these having a disease-free-survival of 7 to 44 months up to the end of the period of observation. Twelve patients treated with MOPP achieved PR and had a median survival of 22 months. Two patients did not respond to treatment. The poor response to MOPP therapy was due to poor patient compliance. Two patients achieved CR on COP therapy, and one had a PR on single-agent therapy (AU)

Hodgkin's disease in Jamaica: presenting clinical features

The presenting clinical features, including the results of laboratory investigations, in 34 patients with Hodgkin's disease seen at the University Hospital of the West Indies between January, 1970 and July, 1979 are described and compared with those of other investigators. There was a single peak age at occurrence, in young adults. Males predominated and there was a long delay between onset of symptoms and presentation or diagnosis. Most patients had advanced disease (Stage IIIB or IV). Lymphadenopathy and pain were the most common modes of presentation. Hypoalbuminaemia, raised serum alkaline phosphatase levels and lymphopenia usually indicated advanced disease (AU)

Hodgkin's disease in Jamaica: changing patterns in histological subtypes

Over a ten year period January, 1970 to July, 1979, 34 cases of Hodgkin's disease were reviewed at the University Hospital of the West Indies. Nodular sclerosis (NS) was the most frequent subtype followed by mixed cellularity (MC). There were no patients with lymphocyte depletion (LD) type NS occurred most commonly in the 15 - 29 age group while MC was relatively evenly distributed among the age groups. These findings are at a variance with an earlier report from our institution which indicated that MC was the most frequent subtype (AU)

Leptospirosis: a review of the Jamaican experience compared with other Caribbean territories

A review of the current literature relating to leptospirosis and its recent increased incidence in Jamaica has been undertaken. The data up to 1979 revealed that the greatest number of cases occurred in the parishes of Kingston and St. Andrew, St. Thomas, St. Catherine and Manchester. A more recent report, however, has shown that the largest number of cases came from the western parishes. Leptospirosis is an occupational hazard for field and factory workers, and these occupational groups demonstrated the highest incidence of the disease. Control of leptospirosis involves treatment of affected cases and attempts at eliminating carriers (AU)

Hodgkin's disease: histopathology and clinico-pathological correlations

Within the framework of the activities of the EORTC (European Organization for Research on Treatment of Cancer) 2 groups of Hodgkin's patients were uniformly staged and treated. Each group consisted of more than 300 patients with Hodgkin's disease in clinical stages I and II. The Rye classification divides Hodgkin's disease into 4 different types. This study was done to achieve clearer lines of demarcation between these types, through an analytic description of histological sections. The prognostic meaning of these types, while undergoing modern therapeutic measures, could be evaluated. Finally, the study results are discussed

Intestinal perforation in ascariasis: case report

Two cases of intestinal perforation in association with ascariasis are described. In both cases adult ascarids were found either in the gut or lying free in the peritoneal cavity. Neither patient had typhoid fever, one had Hodgkin's lymphoma. The authors believe that the perforations were directly caused by the ascarids. Both patients died (Summary)

Hodgkin's disease and hypertrophic pulmonary osteoarthropathy

A case of mediastinal Hodgkin's disease associated with hypertropic pulmonary osteoarthropathy (HPOA) is described. The lung lesions almost completely cleared and the HPOA disappeared with adequate doses of radiation therapy (AU)

Hodgkin's disease in pregnancy: a report of three cases

Three cases of Hodgkin's Disease in pregnancy, presenting at 26, 37 and 16 weeks respectively have been treated at this institution during the past five years. A successful outcome was achieved following conservative therapy. Problems associated with the management of these patients are reviewed, and therapy under the peculiar circumstances discussed (AU)

Clinico-pathological study of malignant lymphoma in Jamaica

A clinico-pathological study of malignant lymphoma in Jamaica was undertaken to examine the disease pattern in a predominantly Negro population of West African origin. During a 9-year period (1958-66) 260 histologically verified cases of malignant lymphoma were encountered. The distribution of the different histological types was as follows: Hodgkin's disease 50.9 percent, lymphoma 1.9 percent. No cases of Burkitt's tumour were encountered. This study indicates that malignant lymphoma is not uncommon in Jamaica, and that its distribution pattern is similar to that observed in Europe and North America, except for the apucity of giant follicular lymphoma, and is different from the pattern observed in parts of Africa populated by Negroes, where Burkitt's tumour is the most common type, and where Hodgkin's disease is relatively uncommon. The age and sex incidence was in general similar to other reported series, but the duration of symptoms was short. The majority of patients presented with generalised periperal lymphadenopathy. Hepatosplenomegaly and anaemia were common on admission. The prognosis was generally poor in comparison with European and North American series due to advanced stage of disease on presentation.(Summary)