Hodgkin's lymphoma presenting in two siblings with atypical pseudocholinesterase

A 21-year-old white man was admitted with a diagnosis of mixed cellularity Hodgkin's lymphoma for staging laparotomy. His family history was positive for a brother who had both Hodgkin's lymphoma and atypical pseudocholinesterase. Serum pseudocholinesterase activity, dibucaine number and fluoride number were obtained, revealing markedly decreased pseudocholinesterase activity and dibucaine number, with an only slightly decreased fluoride number, consistent with homozygous type E1a atypical pseudocholinesterase. After induction of anesthesia using vecuronium, a staging laparotomy was performed without complication. Through a discussion of what is known of the genetics of Hodgkin's disease and atypical pseudocholinesterase, we conclude that the association between the two conditions is very rare but more likely due to chance than to genetic linkage.