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Hodgkin's disease in children: a review of 21 cases
Insights
This study analyzed 21 boys with Hodgkin's disease, finding delayed diagnoses and advanced stages common. Most patients achieved remission, with many discontinuing therapy without tumor recurrence.
Area of Science:
- Pediatric Oncology
- Hematology
- Clinical Pathology
Background:
- Hodgkin's disease in children presents unique diagnostic and clinical challenges.
- Early diagnosis is often delayed, impacting treatment strategies and outcomes.
Purpose of the Study:
- To retrospectively analyze the clinical characteristics of pediatric Hodgkin's disease.
- To identify diagnostic delays, presenting symptoms, disease stages, and treatment outcomes.
Main Methods:
- Retrospective analysis of clinical data from 21 pediatric patients diagnosed with Hodgkin's disease.
- Review of diagnostic procedures, initial symptoms, histopathology, disease staging, and treatment regimens.
Main Results:
- Exclusively male patients, median age 7 years 10 months; diagnosis delayed in 9 patients (median 5 months).
- Common manifestations included nodal enlargement, cholestasis, and hemolytic anemia; 61% presented with advanced disease (Stage III/IV).
- Most patients received radiotherapy, chemotherapy, or combined modalities; long-term follow-up showed sustained remission in many, with no recurrence after therapy discontinuation.
Conclusions:
- Pediatric Hodgkin's disease requires a high index of suspicion due to potential diagnostic delays and varied initial presentations.
- Advanced disease at diagnosis is frequent, necessitating prompt and effective therapeutic interventions.
- Long-term follow-up indicates favorable outcomes for many patients, even after therapy cessation.
Abstract:
The clinical data of 21 children with Hodgkin's disease were retrospectively analyzed to identify their characteristics. Our patients were exclusively boys, ranging in age from 2 years and 9 months to 13 years and 9 months (median 7 years and 10 months). A diagnosis could not be made until after the 2nd to 4th biopsy attempt in 9 patients, with a median time lapse of 5 months from initial biopsy. The primary manifestation was generally nodal enlargement, but also included idiopathic cholestasis and Coombs' positive hemolytic anemia. The disease stages of the patients at diagnosis were 2 stage I; 5 stage II; 10 stage III; 1 stage IV; and 3 not determined. The histologic subtypes were 12 nodular sclerosis, 5 mixed cellularity and 4 lymphocyte predominance. Nine patients had "B" symptoms. Seventy-one percent were associated with anemia and the majority were microcytic. There was a high prevalence of advanced disease (61%). The therapy plan was affected by treatment philosophy at the time, availability of anticancer drugs and the family's attitude toward primary treatment. The patients were initially treated with either radiotherapy alone, chemotherapy alone or combined modality regimens. Five patients were lost within 3 months of diagnosis. The remaining 16 patients were followed, with the longest duration being 9.5 years. Two patients died: 4 were lost after 5-12 months of follow-up, (2 with disease, 2 with no evidence of disease); and the remaining 10 were still being followed (from 2 months to 9 1/2 years). Among those still being followed, 6 of them had discontinued their therapy 8 months to 4 years 5 months earlier and none of them had evidence of tumor recurrence.
