Pericardial Involvement in Newly Diagnosed Children and Adolescents with Pediatric Hodgkin’s Disease at a Single Children’s Cancer Hospital.

Bashir, Hamid; Metzger, Monika; Krasin, Matt; Kaste, Sue; Howard, Scott; Hudson, Melissa M.

doi:10.1182/blood.V106.11.4645.4645

Abstract

Background: Because most cases are clinically silent, incidence, clinical course and outcome of pericardial involvement in Hodgkin disease are unknown.

Methods: Records of all 274 newly diagnosed Hodgkin disease patients treated at our institution between 1991 and 2004 were reviewed. Cases were selected on the basis of pericardial involvement with focal thickening or nodularity at the time of presentation identified by CT and/or pericardial effusion on echocardiogram. Variables noted, in addition to basic demographic data, were stage, histologic subtype, clinical presentation, treatment, serial EKG, echocardiography and CT findings, and resolution versus progression of disease. Statistical analysis was performed using SAS version 9.1.

Results: The incidence of pericardial involvement in our cohort was 5% (13 of 274 patients). Patient characteristics (age, sex, and race), stage of disease and presence of B-symptoms were equally distributed among affected and unaffected individuals. All 13 cases were nodular sclerosing histology (p=0.02) and 9 (67%) had a bulky mediastinal mass (p=0.002). Of the 13 patients, five had extension into the pericardium by CT, two of which also had pericardial effusion (one large and one massive). Eight patients had only pericardial effusions (trace to large) without other CT findings. Two patients required pericardiocentesis for symptomatic effusions and one underwent pericardial drainage procedure for impending tamponade. Two of the 13 patients relapsed but were successfully salvaged and all remain alive and free of disease at a median follow up of 8.7 years (range, 1.1–11.9 years) and 6.3 years (range 0.4–12.7 years) for patients without pericardial involvement.

Conclusions: In our experience, secondary pericardial involvement due to lymphoma is largely asymptomatic unless accompanied by significant effusion. Most of these resolve with treatment of underlying malignancy but require watchful observation for hemodynamic complications. Once treated for symptomatic effusion, there is no difference in mortality amongst various groups.