Classical Hodgkin lymphoma as a second malignancy in a patient with cervical squamous cell carcinoma following...

Concurrent chemoradiotherapy is the established standard treatment for locally advanced cervical cancer. However, it may increase the risk of second primary malignancies in long-term survivors. In our study, we present a case of classical Hodgkin lymphoma (cHL) arising as a secondary neoplasm in a patient with cervical squamous cell carcinoma who was treated with definitive chemoradiotherapy. By presenting this case, we try to find the relation between chemoradiotherpy and cHL and we emphasize the key element to diagnose cHL.

The patient was a 65-year-old woman diagnosed with stage ⅢB cervical squamous cell carcinoma in 2020. She received three cycles of cisplatin-based chemotherapy combined with image-guided radiation therapy (IGRT). In August 2025, she presented with persistent fever, productive cough and systemic lymphadenopathy. Initial investigations confirmed severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2) infection and extensive lymph node enlargement on cross-sectional imaging. Despite clinical resolution of the SARS-CoV-2 infection and empirical antibiotic therapy, she continued to experience recurrent high-grade fever. Excisional biopsy of an intact enlarged right axillary lymph node was performed and pathological examination confirmed cHL. After positron emission tomography/computed tomography (PET/CT) examination, she was diagnosed as stage IVB cHL. After four cycles of tislelizumab combined with the pirarubicin, vinblastine, dacarbazine regimen, the patient achieved complete resolution of symptoms.

Radiotherapy, cisplatin-based chemotherapy, Epstein-Barr virus (EBV) activation, age-related immunosenescence, poorly controlled long-term diabetes mellitus (DM) and SARS-CoV-2 infection-related immunosuppression may have collectively contributed to lymphomagenesis. This case highlights the critical need for sustained long-term follow-up in cervical cancer patients, especially those burdened with concurrent chronic diseases. In the setting of unexplained fever or lymphadenopathy, clinicians must differentiate secondary malignancies from primary tumor recurrence. During the pathological diagnostic process, examination of an intact lymph node is essential for diagnosis.