Complications of Malignancy

Abstract

underwent a laparotomy, ileocolectomy, ileostomy, and transverse colon mucous fistula.Intraoperative findings were consistent with a cecal adenocarcinoma that had perforated into the retroperitoneal soft tissues and into the peritoneal cavity.Pathologic evaluation showed a 9 cm poorly differentiated pT3N2M1 (Stage 4) adenocarcinoma.Despite aggressive support, the patient died from progressive septic shock within 24 hours.Increased risks to develop overwhelming infections or secondary cancers have been well documented for patients with Hodgkin's disease [1][2][3][4].Overwhelming sepsis, however, remains uncommon, and is primarily encountered after previous splenectomy [1,5]; it has been observed after doxorubicin, bleomycin, vinblastine, and dacarbazine therapy in the setting of recurrent disease [6].The infectious hazards after splenic irradiation are less clear, but have been postulated [7,8].An increased incidence of secondary neoplasms, both hematologic and solid, has been observed after all forms of therapy for Hodgkin's disease [9]; combination therapy leads to greater risks than monotherapy [10].Age greater than 40 at the time of the initial Hodgkin's diagnosis appears to be a risk factor [11,12].Secondary solid tumors are predominantly cancers of lung, breast, or colon, with an average latency period of 8 years [13].Our patient presented with metastatic colon cancer, and an infection with gas-forming organisms involving soft tissue at the perforated primary tumor and metastatic sites within the liver.There was no evidence for recurrence of lymphoma.Despite the unusual presentation, this case serves as an important reminder of the significance and possible complexity of neoplastic and infectious hazards that can be encountered in survivors of Hodgkin's disease.