Tuberculosis Coexistence in Pediatric Hodgkin’s Lymphoma: A Tropical Country Experience

Introduction Hodgkin’s lymphoma (HL), being one of the common cancers among children, may occasionally masquerade as an infectious illness. Similarly, an underlying infection like tuberculosis (TB) may be missed in cases of HL because of similarity in clinical and radiological features. Here, we present our data of association of HL with histopathologically proven TB lymph node, their clinical presentation, treatment details, and outcome. Materials and Methods A retrospective review of all the cases of HL diagnosed between January 2007 and December 2016 was done. The cases which had an association of TB, based on the histopathology, were reviewed separately. Results A total of 262 children with HL were treated at our institute from January 2007 to December 2016. Of these cases, 42 children had received empirical antitubercular therapy (ATT) (due to suspicion of TB) before presenting to us, and only five cases had histopathologically proven TB lymph node. Ziehl–Neelsen (ZN) stain for acid-fast bacilli (AFB) was positive in the biopsy specimen of all the five cases, proving TB lymph node coexistence with HL. They were treated with six-drug ATT as per the Revised National Tuberculosis Control Program (RNTCP) guidelines along with chemotherapy with adriamycin, bleomycin, vinblastine, and dacarbazine regimen. All the five patients are healthy and disease free until their last follow-up. Conclusion A high-end suspicion for concomitant TB and HL is needed, especially in our country where TB is still rampant. Biopsy with immunohistochemistry and demonstration of AFB can enable a definite diagnosis of both the entities.

Optimized computed tomography protocol in pediatric Hodgkin’s Lymphoma

Background Children with HL are forced to undergo repetitive studies accompanied by radiation, which increases radiation doses. High radiation during studies in children is a huge problem, since the risk of developing complications for patients of this age is much higher than for adults. Purpose To optimize the computed tomography protocol in pediatric Hodgkin lymphoma for radiation dose reduction by reducing the scanning phases. Material and methods CT scan analysis of 75 children with newly diagnosed, verified Hodgkin’s lymphoma was performed at the primary staging and after treatment. All studies were performed with contrast enhancement, scanning on a 16-slice computed tomography in the precontrast, arterial, venous and delayed phases. The radiation dose and the diagnostic value of each phase were assessed. Results Using the reduced CT protocol for primary patients allows significantly reduce the cumulative ED by 3.8 times and by 3.6 times for dynamic scanning. Using the abbreviated protocol does not reduce the diagnostic value of CT. Conclusion The proposed low-dose CT protocol with the reduction of contrast enhancement phases allows to obtain CT images with good diagnostic quality and reliably reduces the radiation dose to the child.