An Unusual Second Malignant Neoplasm following Treatment for Childhood Non-Hodgkin Lymphoma

Purpose: This case study aims to describe a patient with a secondary malignant diagnosis of Ewing sarcoma following initial diagnosis of childhood non-Hodgkin lymphoma, to discuss the clinical features based on this case study, and to highlight the steps in the patient’s medical care that led to discovery of his diagnosis. Methods: Information and records were obtained on a 19 year old man who presented to Cook Children’s Medical Center 3 years following his initial diagnosis of childhood non-Hodgkin lymphoma with progressive back pain. Patient was noncompliant with follow-up childhood cancer survivorship program and discovery of a 4 centimeter spinal mass was delayed over six months due to radiology error by an outside institution. Failure to identify the mass early in the course of the disease led to increasing size of the tumor and impingement of the spinal nerves, causing extreme pain, weakness, and paresthesia of the legs. Results: After review of spinal imaging by a Cook Children’s Medical Center radiologist, a progressively enlarging spinal tumor was discovered. Biopsy of the lesion was not wanted by the family and medically risky due to the tumor’s location within the vertebral canal. Although a diagnosis of recurrent non-Hodgkin lymphoma was assumed, biopsy showed a different malignant, small, round, blue cell tumor. A diagnosis of Ewing sarcoma was made, and patient was started on appropriate chemotherapy protocol. Conclusions: Compliance with cancer survivorship programs is extremely important, especially for patients diagnosed with cancer in childhood. These programs maximize the probability of early discovery of recurrences of the original cancer or of second malignancies. It is also important for physicians to realize the importance of biopsies of new tumors in patients with previous cancer diagnoses so that patients will receive appropriate and effective therapy.