All issues > Volume 33(4); 1990

Original Article

J Korean Pediatr Soc. 1990;33(4):564-572. Published online April 30, 1990.

A case of Second Malignant Neoplasm Complicating Hodgkin's Disease in Remission.

Hong Hoe Koo¹, Jong Woon Choi¹, Sang Oh Na¹, Il Soo Ha¹, Hee Young Shin¹, Hyo Seop Ahn¹, Yeon Lim Suh², Chul Woo Kim², Je Geun Chi²

¹Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
²Department of Pathology, College of Medicine, Seoul National University, Seoul, Korea

Received: September 3, 1989;  Accepted: October 17, 1989.

Abstract

Recent advances in the treatment of cancer have resulted in increased survival and possible cure for many malignant disorders, particularly childhood cancers. There has been a marked improvement in the treatment of childhood Hodgkin’s disease, and five-year survival rates for even advanced stages of Hodgkin’s disease approach or exceed more than 75% with modern treatment policies. However, successful therapy in childhood cancer is frequently associated with second malignant neoplasm and the 20-year cumulative probability percentage of a second cancer was predicted as 12%. The occurrence of sarcoma as a late consequence of ionizing irradiation, although rare, is a well- documented phenomenon. Malignant fibrous histiocytoma is a recently recognized tumor which is composed of bizzare fibroblasts, histiocytes, and giant cells with a storiform fibrous stroma. We have experienced a case of radiation-induced malignant fibrous histiocytoma in treated Hodgkin’s disease. At 13 years of her age she was diagnosed as Hodgkin’s disease and managed by C-MOPP regimen for 6 cycles followed by radiotherapy (4,075 cGy) after remission. Four years and seven months after radiotherapy, a mass was noted on the scapular area which was within the field of radiation. Four months after excisional biopsy which was done at local hospital she received chemotherapy for 5 months. During chemotherapy a mass was found on the same site. At the second excisional biopsy, a 4x3.5x1.2 cm sized pinkish gray soft tissue mass was removed. Immunohisto- chemical study with al -antichymotrypsin staining revealed a strong positivity in the cytoplasm of tumor cells indicating the histiocytic origin. She received chemotherapy for 3 months. Thereafter she was lost to follow-up and expired at home 30 months after diagnosis of second malignant neoplasm. A brief review of the literature was made.

Keywords :Second Malignant Neoplasm, Hodgkin’s disease, Malignant Fibrous Histiocytoma