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) .