Hodgkin’s lymphoma in pregnancy

The early peak of Hodgkin's lymphoma (HL) is usually between 20 and 40 years of age and therefore overlaps the child-bearing years. HL is the most common type of lymphoma and the second most common malignancy diagnosed during pregnancy, occurring in 1:1,000 to 1:6,000 pregnancies [1]. Clinically, HL is characterized by painless lymph node enlargement, most commonly in the cervical area and is often detected at an early stage. With current treatment protocols, the disease is associated with long-term survival rates of up to 90%, especially in young patients without significant co-morbidities. Diagnosis and staging The diagnosis of lymphoma requires a lymph node biopsy for pathological examination. Such a biopsy can be safely performed under local anesthesia during pregnancy without harming either the mother or the fetus [2]. When there are no superficial lymph nodes available for excision, biopsy should be performed under general anesthesia. In general, it appears that, with modern surgical and anesthetic techniques, elective surgery is safe throughout pregnancy, without an increase in the risk for spontaneous abortion. Furthermore, there is no significant increase in the risk for maternal death, birth defects, or late neurodevelopmental delays [3]. The histological subtypes of HL in pregnancy are the same as in nonpregnant young women, with nodular sclerosis being the most prevalent [1]. Because the vast majority of lymphoma patients are initially treated with chemotherapy independent of disease stage, staging of a pregnant patient with lymphoma should be limited and include history, physical examination, routine blood tests, and bone marrow biopsies. The routine staging process for all lymphomas requires radiological evaluationusually with chest and abdominal computed tomography (CT). Abdominal and pelvic CT are associated with relatively high fetal radiation exposure of up to 0.02 Gy. This level of radiation exposure is below the threshold dose for severe congenital malformation and should not harm the fetus [4]. However, in many cases other types of examinations such as ultrasonography or magnetic resonance imaging (MRI), may provide the desired diagnostic information without any radiation exposure [5,6]. Concerns have been raised regarding the use of gadolinium-based contrast agents for MRI during pregnancy because their long-term effects on the fetus are unknown [7].