Leukemia occurring in treated Hodgkin's disease: two neoplasms or one?

Department of Hematology and Medical Oncology The origin of the malignant cell in Hodgkin's disease and the increased incidence of second malignancies in patients with Hodgkin's disease remain unsolved problems.1"4 The results o f cytochemical, immunomicroscopic, immunologic, and ultrastructural studies of the neoplastic cells5-1 have failed to identify their origin, but suggest either a histiocytic or B-lymphocytic derivation. Similar studies in acute leukemias18,19 arising in patients with Hodgkin's disease have suggested differences between the leukemic cells and the cells of Hodgkin's disease. W e report a case of Hodgkin's disease in which an apparent second neoplasm developed. Sequential studies of the neoplastic cells suggest that radical changes occurred in the cell type during evolution o f the disease. Such changes may reflect treatment-mediated or naturally occurring evolution of the neoplastic cell lines of Hodgkin's disease, rather than a second neoplasm originating from a different cell line.

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