CNS non-Hodgkin lymphoma in a patient previously treated for systemic Hodgkin disease.

Current therapy for Hodgkin disease has resulted in a 5year survival rate of approximately 90% for individuals with asymptomatic stage I and II disease and nearly a 60% survival rate for those with symptomatic stage IV disease (1 ]. This improvement in survival has created an increase in the number of second malignancies occurring after successful treatment of the original disease, a complication that is of particular concern in children because of their longer life expectancy. The development of a non-Hodgkin lymphoma after treatment for Hodgkin disease is one such described complication, with an estimated risk of 1.6% at 15 years (2]. Non-Hodgkin lymphoma occurring as a second malignancy usually exhibits aggressive histology, frequent abdominal involvement, and an apparent relation to immunosuppression , augmented by therapy for Hodgkin disease (1, 3, 4]. Six cases of primary CNS non-Hodgkin lymphoma arising as a second malignancy in patients initially treated for Hodgkin disease have been described (3, 5-7]. CT findings are described in three of these cases (5 , 6]. We present a case of intracranial non-Hodgkin lymphoma, complete with CT and MR imaging findings, that arose 5 years after successful treatment of non-CNS Hodgkin disease to reemphasize that this rare sequence of events can occur.