BENIGN PROLIFERATIVE LESIONS MIMICKING RECURRENCE OF HODGKINS-DISEASE

Salvage treatment in patients with recurrent Hodgkin's disease is more effective when tumor burden is minimal. That is why more intensive fo llow-up strategies,including frequent imaging tests, have been recentl y developed for the detection of early relapse. However, as screening procedures become more sensitive, there is an increasing risk of false -positive results, demonstrating nonmalignant proliferative disorders. We describe th ree young patients who had lymphocyte-predominant or m ixed-cellularity Hodgkin's disease and were in clinical complete remis sion for 2.5-3 years after a combined treatment with chemotherapy and radiation. Imaging tests revealed new gallium-avid lymphadenopathy in the chest in two cases. Pathologically enlarged pelvic lymph nodes wer e identified in another case, after a diagnosis of recurrent disease i n axilla. Those findings were interpreted as relapse, and the patients underwent thoracotomy and laparotomy, respectively, for histologic co nfirmation. The results showed progressively transformed germinal cent ers and sarcoid-like lesions, two benign proliferative disorders. When patients with Hodgkin's disease in remission show new lymphadenopathy , even with positive gallium scan, it seems mandatory to obtain tissue for histologic examination, even through invasive procedures such as laparotomy and thoracotomy, to avoid wrong diagnosis and unnecessary t reatment. (C) 1997 Wiley-Liss, Inc.