Concurrent Esophageal Squamous Cell Carcinoma and Recurrent Hodgkin Lymphoma in an HIV Positive Patient: A Case Report

Case Report

Ann Hematol Oncol. 2016; 3(7): 1104.

Concurrent Esophageal Squamous Cell Carcinoma and Recurrent Hodgkin Lymphoma in an HIV Positive Patient: A Case Report

Bonder B¹, Karapetyan L², Turakhia S³, Sandhaus LM³ and Gibson MK4*

¹Department of Internal Medicine, Case Western Reserve University, USA

²Department of Internal Medicine, Michigan State University, USA

³Department of Pathology, Case Western Reserve University, USA

4Department of Hematology/Oncology, Case Western Reserve University, USA

*Corresponding author: Michael K. Gibson, Department of Hematology/Oncology, UH Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Lakeside 1242, Cleveland, OH, 44106, USA

Received: July 06, 2016; Accepted: August 27, 2016; Published: August 29, 2016

Abstract

Patients with human immunodeficiency virus (HIV) infection have an increased risk of developing certain malignancies compared with the general population. HIV-specific risk factors such as viral co-infections, immunosuppression, and chronic inflammation contribute to development of cancer in HIV patients.

We present the case of an HIV-infected patient with concurrent recurrent stage IVB Hodgkin Lymphoma and newly diagnosed stage III esophageal squamous cell carcinoma. Metastases from both cancers were found in a single supraclavicular lymph node.

Keywords: Esophageal cancer; Hodgkin’s lymphoma; HIV; Metastases

Introduction

Individuals infected with HIV have a higher prevalence of certain malignancies compared with the general population. HIV-related immune suppression and decreased immune surveillance result in an increased risk of these cancers. The high prevalence of smoking and alcohol use along with viral infections in HIV patients further contribute to development of cancer. Initiation of highly active antiretroviral therapy (HAART) resulted in durable control of viral replication and increased life expectancy of HIV patients. As a result, the rates of AIDS defining malignancies, such as Kaposi sarcoma, cervical cancer and non-Hodgkin lymphomas, declined. However, the rates of non-AIDS defined cancers remained relatively constant despite improvement in ART. Anal cancer, Hodgkin’s lymphoma (HL), lung and liver cancers are the most common non- AIDS defined cancers in HIV patients [1,2]. The incidence of HL is eleven times higher in HIV-infected patients than in general population and in most cases is associated with the presence of oncogenic Epstein- Barr virus (EBV). Mixed cellularity (MC) is the most common histological subtype. HIV-HL patients often present in advanced stages of disease (stage III or IV) with extranodal involvement. High international prognostic score (IPS), stage III-IV disease, and CD4 cell count less than 200 cell/μl are associated with poor prognosis in HL-HIV patients [3,4].

Esophageal cancer (EC) comprises a small percentage (1.5%) of total cancer cases in the United States. Compared with the general population, the risk of EC is increased ([standardized incidence ratios] SIR, 1.69; 95% CI, 1.37-2.07) in people with acquired immunodeficiency syndrome (AIDS). The incidence is equally elevated for both adenocarcinoma and squamous cell cancer (SCC) of esophagus. The high prevalence of smoking and alcohol use in HIV patients contribute to the increased risk of EC in this population as well [5].

We present a case of HIV-infected patient who presented with recurrent stage IVB HL and advanced/stage III EC with both cancers present as metastases in a single supraclavicular lymph node.

Case Presentation

A 55-year-old Hispanic male presented with dysphagia, chronic sore throat, hoarseness and 20 pound weight loss over two months. He had HIV infection and was on HAART therapy. The CD4 count on presentation was 111 cells/μl, and the viral load was 20 copies/ ml. He had a history of stage IVB EBV positive HL for which he underwent six cycles of doxorubicin, bleomycin, vinblastine and dacarbazine (ABVD) two years prior to presentation-resulting in a complete response by imaging and bone morrow biopsy. Other comorbidities included: type II diabetes mellitus, gastro esophageal reflux disease (GERD), hypothyroidism, dyslipidemia, hypertension, diverticulosis and a trial fibrillation.

Initial work-up led to a vocal cord biopsy which was negative for cancer. Despite treatment with supportive care and antibiotics, his symptoms acutely worsened, and he underwent a CT of the neck and chest. This revealed a right supraclavicular lymph node/mass that measured 3.2×3.5 cm as well as asymmetrical thickening of the proximal esophagus. Subsequent esophagogastroduodenoscopy (EGD) showed esophageal stricture and a mass that started below the cricopharyngeus and extended inferiorly for approximately 4 cm in length. The stricture was dilated and a percutaneous endoscopic gastrostomy tube was placed. Biopsy of the mass was positive for invasive squamous cell carcinoma of esophageal origin. He was transferred to our facility for further cancer care.

Further staging by positron emission tomography (PET) scan showed hyper-metabolic thickening of the proximal esophagus with adjacent hyper-metabolic para-esophageal and supraclavicular adenopathy as well as extensive bulky retroperitoneal adenopathy (Figure 1). Biopsies of both nodal regions were performed. The periarotic lymph node showed classic EBV positive Hodgkin’s Lymphoma (HL). The supraclavicular lymph node contained both HL and metastatic squamous cell carcinoma (Figure 2). A bone marrow biopsy was done and also showed HL.

Citation: Bonder B, Karapetyan L, Turakhia S, Sandhaus LM and Gibson MK. Concurrent Esophageal Squamous Cell Carcinoma and Recurrent Hodgkin Lymphoma in an HIV Positive Patient: A Case Report. Ann Hematol Oncol. 2016; 3(7): 1104.