Case:
A 43-year-old man with no particular pathological history presented with dysphonia and pulmonary aspiration. The patient complained of pruritus without fever, sweat or weight loss. The physical examination found bilateral fixed cervical lymph node magmas affecting all levels on the right side measuring 10cm and the level II on the left side measuring 5.5 cm . Pan endoscopy revealed a bleeding budding tumor of the epiglottis invading the right aryepiglottic fold, the right side of ​​the three folds, the right pharyngolaryngeal wall, the right piriform sinus and the right vocal cords .The ventricles, the glottic and subglottic plane, the esophageal mouth, the base of the tongue and the valleys were free from tumor invasion.
The biopsy confirmed the diagnosis of classical mixed cellularity Hodgkin Lymphoma. Immunoisthochemical analysis revealed that tumor cells expressed CD30, CD15, fascin, and focal CD20.
The blood count, the biochemical analysis and the serum lactico-deshydrogenase (LDH) were normal. The erythrocyte sedimentation rate was 106 in the first hour,.
The head and neck scan showed a mass measuring 28*31 mm arising from the epiglottis and invading the vallecules, the right aryepiglottic fold, the two vocal cords and the anterior commissure with bilateral cervical lymph nodes :at the levels II III and IV on the right side and at the level II on the left side (Figure 1).
An extension assessment including a bone marrow biopsy and a chest abdomen and pelvic scan was negative, so that the tumor was classified as stage IIEA according to the Ann Arbor classification.
The patient inderwent a chemotherapy, which consisted on ABVD regimen (doxorubicin, bleomycin, vinblastine and dacarbazine). After four cycles of ABVD, we noted a tumor volume reduction and a complete cervical lymph nodes regression with a radiological response of 82% according to cheson. An involved field radiotherapy was delivered at a dose of 30 Gy in 15 fractions with a boost of 6 Gy at the epiglottic residual lesion in 3-Gyfractions. This irradiation was well tolerated.
An epiglottic biopsy was performed six months after the end of treatment, no longer showing tumor infiltration. At a follow-up time of 3,5 years, the patient remains in disease complete remission (clinical,radiological, histological and biological) .