1985 Volume 31 Issue 4 Pages 850-857
A 24-year-old male consulted our out-patient clinic on October, 1983 because of a round mass in the left upper neck. History of patient illness revealed that he noticed the round mass about the size of a thumb tip, with low grade fever and sweating about a month prior to consultation.
He had taken medication for one week but without benefit. He was thin, fairy nourished and no weight loss for the last 6 months. Past medical history and familly history were unremarkable.
On clinical examination, the round mass in the upper neck was 6.5 cm in diameter and another round mass, the size of a pea was noticed in the posterior cervical triangle. The mass was elastic, movable and not tender to palpation. There was no lymphoadenopathy in the contra-lateral neck, both sides of the supraclavicle fossa, axilla and inguinal region and no hepato-lienomegaly was observed.
Laboratory findings revealed slight anemia, leucocytosis, decreased number of lymphocyte, CRP 1+ and fairy high level of ESR. Although the tuberculin test gave a positive result, chest X-ray was normal. Many physical examinations were performed and didn't allay the suspicion of the malignant lymphoma, so a biopsy was done. Histopathological results showed Hodgkin cells (H cell), Reed-Sternberg cells (R-S cell), diffusely developed lymphocytes, eosinophils and large monocytes. A part of specimen showed a few of necrosis and fibrosis. The diagnosis was Hodgkin's disease of the mixed cellularity type. Clinical stage was IVb because of the presence of H cells and R-S cells in cytologic examination from the aspirated bone marrow and B-symptom because of fever and sweating prior to consultation.
Therapy was performed as follows: combination chemotherapy (COPP) and irradiation (mantle field) and in addition another combination chemotherapy (ABVD). He was discharged July, 1984 and is being followed up in the out-patient clinic.
