Intestinal Perforation in a Case of Peripheral T Cell Lymphoma after Initiation of Chemotherapy

Non-Hodgkin's lymphoma (NHL) is the most common type of Gastrointestinal (GI) lymphoma with known complications such as bleeding, obstruction and perforation. In this article we present a 59-year-old male patient diagnosed with Peripheral T cell Lymphoma - Not Otherwise Specified (PTCL-NOS) with GI involvement was started on chemotherapy. On day 2 post completion of first cycle of chemotherapy, patient had presented to the emergency department with sudden onset abdominal pain and distension. On evaluation, he was diagnosed with multiple perforations in the small bowel. Patient underwent exploration with primary repair of few perforations and ileal resection with double barrel ileostomy. Chemotherapy plays an important role in the management of NHL. One well-known NHL consequence, intestinal perforation, can happen at the time of initial presentation or after starting chemotherapy. Surgeons should be aware of possibility of such complications and high-risk factors for perforation. At present, there is no role for elective surgery in GI lymphoma and is mainly reserved for complications like uncontrolled bleeding, obstruction or perforation.

Quarter-Century PET/CT Transformation of Oncology: Lymphoma

The clinical landscape of lymphomas has changed dramatically over the last 2 decades, including significant progress made in the understanding and utilization of imaging modalities and the available treatment options for both indolent and aggressive lymphomas. Since the introduction of hybrid PET/CT scanners in 2001, the indications of 18F-fluorodeoxyglucose (FDG) PET/CT in the management of lymphomas have grown rapidly. In today's clinical practice, FDG PET/CT is used in successful management of the vast majority patients with lymphomas.

Autologous hematopoietic stem cell transplantation conditioning regimens and chimeric antigen receptor T cell therapy in various diseases

Conditioning regimens employed in autologous stem cell transplantation have been proven useful in various hematological disorders and underlying malig nancies; however, despite being efficacious in various instances, negative consequences have also been recorded. Multiple conditioning regimens were extracted from various literature searches from databases like PubMed, Google scholar, EMBASE, and Cochrane. Conditioning regimens for each disease were compared by using various end points such as overall survival (OS), progression free survival (PFS), and leukemia free survival (LFS). Variables were presented on graphs and analyzed to conclude a more efficacious conditioning regimen. In multiple myeloma, the most effective regimen was high dose melphalan (MEL) given at a dose of 200/mg/m2. The comparative results of acute myeloid leukemia were presented and the regimens that proved to be at an admirable position were busulfan (BU) + MEL regarding OS and BU + VP16 regarding LFS. In case of acute lymphoblastic leukemia (ALL), BU, fludarabine, and etoposide (BuFluVP) conferred good disease control not only with a paramount improvement in survival rate but also low risk of recurrence. However, for ALL, chimeric antigen receptor (CAR) T cell therapy was preferred in the context of better OS and LFS. With respect to Hodgkin's lymphoma, mitoxantrone (MITO)/MEL overtook carmustine, VP16, cytarabine, and MEL in view of PFS and vice versa regarding OS. Non-Hodgkin's lymphoma patients were administered MITO (60 mg/m2) and MEL (180 mg/m2) which showed promising results. Lastly, amyloidosis was considered, and the regimen that proved to be competent was MEL 200 (200 mg/m2). This review article demonstrates a comparison between various conditioning regimens employed in different diseases.

Children and adolescents with non-Hodgkin lymphoma in Brazil: A national survey identifies the challenges encountered and documents the diversity of care

INTRODUCTION

Brazil has many inequities in the healthcare provided nationwide. Therefore, in order to access challenges in treatment, available resources and current practices, to identify barriers in delivering a good quality of care among Brazilian centers treating children and adolescents with Non-Hodgkin Lymphoma (NHL) and to generate a future prospective guideline, a customized online survey was distributed to pediatric hematologists and oncologists across the country.

RESULTS

A total of 97 surveys were completed (35% response rate), from 47 cities in all Brazilian regions and 79 units of care, with a median of 1 answer by the center (range 1 - 5). Most respondents work at an institution supported exclusively by public/philanthropic resources (58%), with an average of 5 to 9 new cases/year (49%), and 41% have 4 to 6 oncologists/centers. Additionally, 22% have no easy access to the intensive care unit, 26% have no access to Rasburicase, 28% have no access to Rituximabe as front-line therapy and 41% have unreliable methotrexate monitoring levels. Those differences cannot be explained thoroughly by regional wealth variances, nor by the financing model. Regarding the pathology service, 70% consider having reasonable quality assistance, but the timeframe to deliver diagnosis is satisfactory to 46%. There is no uniform management of care, with the current guideline from the Sociedade Brasileira de Oncologia Pediátrica being adopted by 54 to 59%, depending on the NHL subtype.

CONCLUSION

This study provides insights into the heterogeneity of care among Brazilian centers. Recognizing those diversities will support the design of effective strategies and collaboration nationwide.

Anal lymphoma: a tumor with insufficient attention

BACKGROUND

Anal lymphomas are extremely rare. There are no relevant descriptions in professional books, and there are only a few case reports in the literature. Here, we report a new case and review the literature to summarize the clinical and pathological features of anal lymphoma.

METHODS

We described a case of anal lymphoma confirmed by pathological diagnosis, then searched the PubMed database, and finally selected 12 reported cases to be included in the study. We described the clinical and pathological characteristics of the patients.

RESULTS

Thirteen patients with anal lymphoma were confirmed. Seven men and six women with a median age of 50. There were four cases of HIV- and EBV-infected patients. The size of the tumor was 1-13 cm, all of which were diagnosed as B-cell lymphoma, and 61.5% were diffuse large B-cell lymphomas. Among the 13 patients, eight received chemotherapy or immunochemotherapy, two received radiotherapy, one received chemotherapy combined with radiotherapy, one received surgery, and one gave up treatment. Three patients died, and only 2 of 10 surviving patients had complete remission.

CONCLUSION

Anal lymphoma is extremely rare. Patients with persistent abscess complicated with HIV or EBV infection should undergo pathological biopsy to exclude anal lymphoma.

Mediastinal Desmoid Tumor Presents as Lymphadenopathy in Patient with Lymphoma: A Case Report

Desmoid tumors are rare mesenchymal neoplasms that are rapidly growing but do not metastasize. We present a case of a 75-year-old man with a history of non-Hodgkin lymphoma in remission incidentally found to have an enlarging internal mammary lymph node on screening CT, subsequently diagnosed as a desmoid tumor via biopsy. The patient was deemed unfit for surgical resection and instead underwent urgent radiation and immunotherapy. This report highlights a unique case of desmoid tumor presenting as mediastinal lymphadenopathy.

A Rare Occurrence of Primarily Extranodal Spinal Epidural Lymphoma With Spinal Cord Compression and Invasion to the Thoracic Cavity

A 41-year-old man suffered from progressive radiculomyelopathy caused by spinal epidural mass primarily encasing the spinal cord at the cervicothoracic vertebrae that extended into the thoracic cavity through the neural foramen. An urgent decompressive laminectomy and epidural tumor resection were performed to prevent neurological deterioration and effective spinal cord decompression. The histopathologic diagnosis was diffuse large B-cell lymphoma. As first-line treatment for stage II extranodal lymphoma, he received 6 cycles of R-CHOP (rituximab/cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone) chemotherapy. Consequently, follow-up positron-emission tomography CT and MR images demonstrated a complete metabolic response (Deauville score 1). This rare occurrence of primarily extranodal spinal epidural lymphoma with limited disease will be presented in a literature review.

Neurolymphomatosis in Recrudescent Diffuse Large B-cell Lymphoma

Neurolymphomatosis is an uncommon manifestation of lymphoma, often presenting with painful polyneuropathy or polyradiculopathy and concomitant distal extremity weakness. Differentiation from other etiologies resulting in similar neuropathic symptoms such as compressive or inflammatory pathologies can be difficult and often results in delayed diagnosis. Here we describe a case of neurolymphomatosis affecting a 64-year-old man with a history of diffuse large B-cell lymphoma (DLBCL) in remission presenting with a right-sided foot drop following a gunshot wound. MRI at that time demonstrated thickening and enhancement of the cauda equina nerve roots. Over the course of the subsequent eight months, he developed left lower extremity sensory symptoms, left-sided foot drop and signs of upper motor neuron involvement, including left facial weakness, dysphonia, and dysphagia. ¹⁸F-FDG PET/CT revealed intensely avid left lumbosacral nerve roots, bilateral lower extremity and left upper extremity neurovascular bundles. Left sural nerve biopsies showed infiltration of DLBCL and confirmed neurolymphomatosis. We highlight the role of ¹⁸F-FDG PET/CT, with histological verification, for the diagnosis of an extended course of neurolymphomatosis occurring in the absence of typical painful neuropathy but with cranial and peripheral neuropathies.

A phase I pharmacokinetic study of copanlisib in Chinese patients with relapsed indolent non-Hodgkin lymphoma

PURPOSE

Copanlisib, a pan-PI3K inhibitor, has previously shown clinical efficacy and a tolerable safety profile in patients with indolent non-Hodgkin lymphoma. However, the pharmacokinetics, safety, tolerability, and efficacy of copanlisib in Chinese patients have not been reported.

METHODS

This was a single-arm, open-label, phase I study of copanlisib in Chinese patients with relapsed or refractory indolent non-Hodgkin lymphoma (iNHL). Patients received a single intravenous 60 mg infusion of copanlisib over 1 h on days 1, 8, and 15 of a 28-day cycle, with 1 week of rest. Safety was monitored throughout the study, and plasma copanlisib levels were measured for pharmacokinetic analysis. Tumor response was determined by independent central radiologic review.

RESULTS

Sixteen patients were enrolled and 13 were treated with 60 mg of copanlisib for a median of 15.0 weeks. With a C_max of 566 μg/L and a AUC (0-24) of 1880 μg·h/L following single intravenous infusion, the pharmacokinetic parameters of copanlisib were consistent with that in previous studies, and no accumulation in plasma was observed. Treatment-emergent adverse events were reported for all 13 patients, the most common of which were hyperglycemia (100.0%), hypertension (76.9%), decreased neutrophil count (76.9%), and decreased white blood cell count (69.2%). Seven out of 12 evaluated patients achieved partial response, resulting in an overall response rate of 58.3% CONCLUSIONS: Copanlisib was well tolerated in Chinese patients with relapsed or refractory iNHL at the dose of 60 mg and demonstrated encouraging disease control, thus warranting further clinical investigation.

CLINICAL TRIAL REGISTRATION NUMBER

NCT03498430 (April 13, 2018).

Clinical Characteristics, Treatment and Evolution of Splenic and Nodal Marginal Zone Lymphomas-Retrospective and Multicentric Analysis of Portuguese Centers

INTRODUCTION

Treatment of Splenic (SMZL) and Nodal (NMZL) Marginal Zone Lymphoma is not consensual. Histologic transformation (HT) to aggressive lymphoma is a poorly understood event, with an unfavorable outcome.

OBJECTIVES

Describe the clinical characteristics, treatment, outcomes and incidence of HT.

METHODS

Characteristics of patients with SMZL and NMZL consecutively diagnosed in 8 Portuguese centers were retrospectively reviewed. Endpoints were overall survival (OS), time to first systemic treatment (TTFST), frequency of HT and time to transformation (TTT).

RESULTS

This study included 122 SMZL and 68 NMZL, most of them received systemic treatment: 55.4% and 76.5%, respectively. Splenectomy was performed in 58.7% of patients with SMZL. Different treatment protocols were used. OS or TTFST did not differ significantly according to treatments. Given the small sample size, no conclusion can be made concerning the role of Rituximab in the treatment of NMZL and SMZL based in these results. HT was documented in 18 patients, mainly in SMZL, with a cumulative incidence at 5 years of 4.2%. We confirmed that age is a prognostic factor.

CONCLUSION

Randomized prospective trials are needed to standardize treatment in MZL. Patients with HT did appear to have shorter OS in comparison with those who did not experience HT (OS 5 years of 68.4% vs. 80.4%), but the number of HT was too small to reach statistical significance.

Twenty-year Experience with Genitourinary Lymphoma at a Community Hospital

Introduction: Non-Hodgkin lymphoma is the seventh most common cancer in the United States. It may involve any extranodal organ, although involvement of the genitourinary (GU) tract accounts for <5% of all primary extranodal lymphomas. Published GU lymphoma literature is currently limited to small case series and case reports. The last substantial American series was published in 2009. Our objective was to characterize cases of GU lymphoma from our institution based on organ involved and to review relevant literature.Patients and Methods: After institutional review board approval, we retrospectively reviewed medical records of patients diagnosed with lymphoma involving the GU organs from 1995 through 2015. Patients with obstructive uropathy from retroperitoneal adenopathy without parenchymal involvement of a GU organ were excluded. We classified extranodal GU lymphomas as primary or secondary, based on involvement of other organs and distant lymphadenopathy.Results: Thirty-six patients had lymphoid neoplasms involving the kidney, ureters, bladder, testis, penile skin, or prostate in our health system during the study period. Of these, 15 (41.6%) were primary. Most patients initially sought consultation for GU-related symptoms, such as bladder obstruction, hematuria, testicular mass, or abdominal pain. Histological subtypes and flow cytometry findings varied broadly.Conclusion: Our series reports site-specific outcomes data and adds detail to findings from other published series. Although GU lymphomas are rare, our series confirms prior studies demonstrating presentation in urologic organs. They should be considered in the differential diagnosis in all patients, especially those with unusual findings on examination, cystoscopy, or computed tomography scan.

Primary ovarian Burkitt's lymphoma presentation in a young woman: A case report

INTRODUCTION AND IMPORTANCE

Burkitt's lymphoma is one of the fastest growing human cancers and it needs a rapid diagnosis.

CASE PRESENTATION

A young woman presented to our institution with acute abdominal pain, tenderness and constipation. Ultrasound reported a right ovarian mass; at laparoscopy, we discovered ascites, peritoneal carcinomatosis and a voluminous pelvic mass.

CLINICAL DISCUSSION

Diagnosis was confirmed as non-Hodgkin sporadic Burkitt's lymphoma: the careful workup was the key to initiate multiagent chemotherapy.

CONCLUSION

Primary ovarian Burkitt's lymphoma, in a young woman in a non-endemic zone, is a rarity that represents a strong diagnostic challenge, but rapid identification can lead the patient to appropriate therapies and improvement of prognosis.

Soluble programmed cell death protein 1 (sPD-1) and the soluble programmed cell death ligands 1 and 2 (sPD-L1 and sPD-L2) in lymphoid malignancies

BACKGROUND

The programmed cell death protein 1 (PD-1) and its ligand 1 and 2 (PD-L1/PD-L2) regulate the immune system, and the checkpoint pathway can be exploited by malignant cells to evade anti-tumor immune response. Soluble forms (sPD-1/sPD-L1/sPD-L2) exist in the peripheral blood, but their biological and clinical significance is unclear.

METHOD

Time-resolved immunofluorometric assay (TRIFMA) and enzyme-linked immunosorbent assay (ELISA) were used to measure sPD-1, sPD-L1, and sPD-L2 levels in serum from 131 lymphoma patients and 22 healthy individuals.

RESULTS

Patients had higher sPD-1 and sPD-L2 levels than healthy individuals. In diffuse large B-cell lymphoma, patients with high International Prognostic Index score had higher sPD-1 levels and sPD-L2 levels correlated with subtype according to cell of origin. Compared to other lymphoma types, follicular lymphoma displayed higher sPD-1 and lower sPD-L1 levels along with lower ligand/receptor ratios.

CONCLUSION

This is the first study to simultaneously characterize pretherapeutic sPD-1, sPD-L1, and sPD-L2 in a variety of lymphoma subtypes. The relation between higher sPD-1 levels and adverse prognostic factors suggests a possible biological role and potential clinical usefulness of sPD-1. Moreover, the reverse expression pattern in follicular lymphoma and T-cell lymphoma/leukemia may reflect biological information relevant for immunotherapy targeting the PD-1 pathway.

Imaging of primary testicular lymphoma with unusual intraabdominal spread along the spermatic cord and gonadal vein

Primary testicular lymphoma (PTL) is a rare Testicular neoplasm found in elderly patients. Imaging features in PTL presenting with contiguous involvement of spermatic cord and extension along gonadal vein have been rarely detailed before. We describe a case of a 50-year-old male who presented with complaints of scrotal swelling and abdominal discomfort. Imaging, which included Ultrasonography and contrast-enhanced computed tomography of chest-abdomen, showed features of aggressive-looking bilateral testicular mass lesions with the distinctive feature of contiguous spread along the spermatic cord and gonadal vein till retroperitoneum and disseminated chest and abdominal metastases. The distinctive feature of contiguous extension along the spermatic cord and gonadal vein can help suggest a diagnosis of PTL on imaging.

Malignant lymphoma with diffuse cardiac involvement and pulmonary stenosis

Lymphoma is one of the most common tumors with the risk of cardiac metastasis. The pattern of cardiac involvement is usually as focal masses. As early diagnosis of lymphoma plays a crucial role in its response to treatment and patient survival longevity, we report a rare case of cardiac lymphoma with diffuse cardiac involvement and acquired pulmonary stenosis. The patient was referred to our center for further evaluation because of dyspnea and systolic ejection murmur. In pericardial biopsy, T cell lymphoblastic lymphoma was reported. After a full course of chemotherapy and one-year follow up, symptoms had improved and echocardiography was normal except for small pericardial effusion. <Learning objective: Early diagnosis of lymphoma plays a crucial role in its response to treatment and introducing atypical presentation form could be helpful for early diagnosis.>.

The epidemiology of lymphoma in Jordan: A nationwide population study of 4189 cases according to World Health Organization classification system

OBJECTIVE/BACKGROUND

Lymphoma is a common human cancer that shows a variable geographic incidence worldwide. It is the fourth most common cancer in Jordan. Systemic reports of descriptive epidemiology on lymphoma from the Middle East are limited.

METHODS

A nationwide multi-institutional retrospective study was conducted covering all major hospitals and laboratories that provide diagnostic services. We collected data on all cases diagnosed with lymphoma between 2014 and 2019. The included variables were patients' age, gender, anatomic site, and the histologic type according to the World Health Organization classification system.

RESULTS

A total of 4189 cases were diagnosed with lymphoma. There was a statistically significant gender difference (p < .05), as 57.5% of patients were males. The peak incidence occurred at age 25-55 years. There were 1,652 (39%) cases of Hodgkin lymphoma (HL) and 2,537 (61%) of non-Hodgkin lymphoma (NHL), where nodular sclerosis (67%) and diffuse large B-cell lymphoma (53%) were the most common subtypes, respectively. The average age-adjusted incidence rates per 100,000 population were 8.01 for all lymphomas, 4.33 for NHL, and 3.16 for HL and all remained stable over the 6 years.

CONCLUSION

HL is the most common lymphoma in Jordan, with a percentage higher than most of reported studies in Asian and Western countries. It also shows a unimodal distribution of age-specific incidence rates, with a single peak in young adults. The incidence rate of HL is higher than Eastern countries but comparable to the West. In contrast, NHL demonstrates a lower incidence rate than Western countries but a similar distribution of subtypes, as mature T/natural killer-cell lymphomas were rare.

The epidemiology of lymphoma in Jordan: A nationwide population study of 4189 cases according to World Health Organization classification system

OBJECTIVE/BACKGROUND

Lymphoma is a common human cancer that shows a variable geographic incidence worldwide. It is the fourth most common cancer in Jordan. Systemic reports of descriptive epidemiology on lymphoma from the Middle East are limited.

METHODS

A nationwide multi-institutional retrospective study was conducted covering all major hospitals and laboratories that provide diagnostic services. We collected data on all cases diagnosed with lymphoma between 2014 and 2019. The included variables were patients' age, gender, anatomic site, and the histologic type according to the World Health Organization classification system.

RESULTS

A total of 4189 cases were diagnosed with lymphoma. There was a statistically significant gender difference (p < .05), as 57.5% of patients were males. The peak incidence occurred at age 25-55 years. There were 1,652 (39%) cases of Hodgkin lymphoma (HL) and 2,537 (61%) of non-Hodgkin lymphoma (NHL), where nodular sclerosis (67%) and diffuse large B-cell lymphoma (53%) were the most common subtypes, respectively. The average age-adjusted incidence rates per 100,000 population were 8.01 for all lymphomas, 4.33 for NHL, and 3.16 for HL and all remained stable over the 6 years.

CONCLUSION

HL is the most common lymphoma in Jordan, with a percentage higher than most of reported studies in Asian and Western countries. It also shows a unimodal distribution of age-specific incidence rates, with a single peak in young adults. The incidence rate of HL is higher than Eastern countries but comparable to the West. In contrast, NHL demonstrates a lower incidence rate than Western countries but a similar distribution of subtypes, as mature T/natural killer-cell lymphomas were rare.

Primary extra nodal Non-Hodgkin's lymphoma of urinary bladder presenting as a bladder tumor: A case report

Introduction

Primary non-Hodgkin's lymphoma (NHL) of urinary bladder is an exceedingly rare entity accounting for 0.2% of the primary neoplastic lesions. This tumor has female predominance; with most of the cases seen in middle-aged females. It primarily affects urinary bladder without involvement of the surrounding tissues and lymph nodes. The common presentations include hematuria, dysuria, urinary frequency, nocturia, and abdominal or back pain. The clinical, radiological and endoscopic signs are not very specific. It is diagnosed by its characteristic morphology and immunohistochemical characteristics. The various therapeutic options available are chemotherapy; radiotherapy and surgery used either alone or in combination. Presentation of Case: We hereby report a case of 40 years old man who presented with hematuria as the presenting symptom. On radiology, diffuse thickening of bladder wall was noted, which was biopsied. On histopathology, it was NHL, Diffuse large B cell type. He was treated with chemotherapy (6 cycles of CHOP) and radiotherapy for primary NHL of the bladder and now he is in complete remission.

Discussion

Primary lymphoma of the urinary bladder is exceedingly rare. Non-specific presentation and rarity of this disease pose a diagnostic challenge for both the clinician and the histopathologist. Diagnosis is based upon the characteristic morphology and is supported by immunohistochemical analysis.

Conclusion

All patients with extra-nodal lymphoma need thorough diagnostic work up like nodal lymphomas to arrive at exact staging of the disease to outline subsequent management.

•

Primary lymphomas of the urinary bladder are extremely rare.

•

Non-specific presentation and rarity of this disease pose a diagnostic challenge for both the clinician and the histopathologist.

•

Usually, the diagnosis is one of exclusion. It is made on biopsy with immunohistochemical study and after a negative study of disease extension.

[Burkitt’s lymphoma of the skull calotte: a case report]

Introduction

Burkitt’s lymphoma is a non- Hodgkin B-cell lymphoma whose cranial location is extremely rare.

Clinical case

The case of a 35-year-old Peruvian man with a progressive parietal left cranial tumor is described. A biopsy with immunohistochemistry was performed for the diagnostic confirmation of Burkitt’s lymphoma. First-line outpatient treatment with CODOX-M/IVAC was initiated, however, he stopped attending his treatment for 2 months. He returns, he is shown progression of the disease and is treated with rituximab, ifosfamide carboplatin and etoposide. Does not respond satisfactorily and dies.

Conclusions

Burkitt’s lymphoma is a very aggressive tumor that, if not treated in a timely manner, has high mortality, as happened with the patient in the case.

Disparities in Trace Metal Levels in Hodgkin/Non-Hodgkin Lymphoma Patients in Comparison with Controls

Lymphoma arises from cells of the immune system and trace metals augment the immune system and their imbalance may promote immunological disorders including tumorigenesis. The primary aim of the present investigation was to evaluate the levels of essential/toxic trace metals in the nails of non-Hodgkin and Hodgkin lymphomas patients in comparison with controls. The samples collected from patients and controls were digested in the mixture of HNO₃-HClO₄ and selected trace metals were analysed using flame atomic absorption spectrometry. The results showed that mean concentrations of some elements (Pb, Ni, Cd, Cu and Cr) in nails of non-Hodgkin lymphoma patients were significantly elevated (p < 0.05) than that of the controls whereas mean contents of Pb, Cu, Cd and Cr were observed to be significantly higher in the nails of Hodgkin lymphoma patients compared with healthy donors. Additionally, correlation study pointed out significantly diverse mutual associations of the trace metals among the patients and controls. The present results revealed noticeable disparities in the metal concentrations based on gender, food habits, tobacco use and types/stages of the donor's groups. Overall, the pathogenesis of disease significantly affected the trace metal balance in both patients' groups.

Panhypopituitarism and cranial mononeuropathy, manifestation of NK/T lymphoma that imitates meningeal tuberculosis

INTRODUCCIÓN

El linfoma extranodal derivado de células NK/T (LNK/T) es una variedad de linfoma no Hodgkin; el tipo nasal constituye la presentación más común. Nuestro objetivo es presentar un caso de LNK/T con afección del sistema nervioso central (SNC) que simuló una tuberculosis meningea.

CASO CLÍNICO

Varón de 31 años con sensación de obstrucción nasal, cefalea, fiebre, panhipopituitarismo y mononeuropatía craneal múltiple, con lesión hipofisaria por imagen de resonancia magnética y engrosamiento dural, que evolucionó con pancitopenia y úlcera en el paladar blando. El diagnóstico se realizó mediante biopsia de cornete nasal compatible con infiltración por linfoma de estirpe T maduro NK.

CONCLUSIONES

La afección del LNK/T al SNC es una forma rara de presentación. El diagnóstico de LNK/T se puede ver retrasado por la presencia de síntomas heterogéneos. En nuestra población, la infección por Mycobacterium debe ser considerada como diagnóstico diferencial.

BACKGROUND

Lymphoma of NK/T cells (LNK/T) is a variety of non-Hodgkin lymphoma; the nasal type is the most common presentation. The aim of this article is to present a case of LNK/T with affection to central nervous system that imitates meningeal tuberculosis.

CASE REPORT

31 years old man with nasal blockage feeling, headache, fever, panhypopituitarism and multiple cranial mononeuropathy, with a pituitary injury demonstrated by magnetic resonance image and meningeal thickening, that progress with pancytopenia and soft palate ulcer. The diagnosis was made by nasal concha biopsy compatible with lymphoma infiltration, of LNK/T cell linage.

CONCLUSIONS

The affectation of LNK/T cell lymphoma in central nervous system is a rare presentation. the diagnosis could be delayed for the presence of heterogeneous symptoms. Mycobacterium infection must be considered as a differential diagnosis in our population.

Two lymphomas in the same patient: A case report

INTRODUCCIÓN

La asociación de forma sincrónica de un linfoma Hodgkin y un linfoma no Hodgkin en un mismo paciente es muy rara.

CASO CLÍNICO

Varón de 68 años que comienza su padecimiento con adenomegalias cervicales y axilares. Se realiza biopsia escisional y se encuentra linfoma de Hodgkin de tipo celularidad mixta, por lo que se inicia quimioterapia. Durante el transcurso del tratamiento se observa la continuidad de lesiones refractarias en la piel y el músculo, por lo que el servicio de radiooncología decide hacer una nueva biopsia y se demuestra que se trata de una nueva afección, un linfoma no Hodgkin difuso de células B grandes.

CONCLUSIONES

Este caso ejemplifica que ante un paciente con un cuadro clínico típico y con una evolución tórpida hay que replantearse el diagnóstico e incluso repetir los estudios realizados para descartar diagnósticos alternos que puedan alterar el curso de la enfermedad.

BACKGROUND

The synchronous association of Hodgkin lymphoma and non-Hodgkin lymphoma in the same patient is very rare.

CASE REPORT

A 68 years old male patient who began his disease with cervical and axillary adenomegaly, it was performed an excisional biopsy and a mixed cell-type Hodgkin lymphoma was found. Chemotherapy with partial response was initiated. During the course of the treatment, refractory lesions were observed in skin and muscle. Radiation oncology service decided to make a second biopsy which confirms the presence of a large diffuse B cell non-Hodgkin ­lymphoma.

CONCLUSIONS

This case is an example of how when you have a patient with a typical clinical picture of bad prognosis, the diagnosis should be reconsidered and laboratory studies previously done must be repeated to rule out alternative diagnoses that may change the course of the disease.

Plasmablastic lymphoma: case report

INTRODUCCIÓN

El linfoma plasmablástico es un linfoma no Hodgkin de alto grado. Se describe en pacientes con infección por el virus de la inmunodeficiencia humana (VIH), en receptores de trasplantes y en pacientes de edad avanzada. Se presenta en la cuarta década de la vida, siendo la cavidad oral el sitio más común de afección. Sus células neoplásicas expresan marcadores de células plasmáticas como CD138 y CD38. En su patogenia se ha implicado al virus de Epstein-Barr. La consideración más desafiante en el diagnóstico diferencial es el mieloma múltiple, ya que las características morfológicas e inmunofenotípicas de estas dos enfermedades son muy similares. El régimen EPOCH (etopósido, epirubicina, vincristina, ciclofosfamida y prednisona) asociado a tratamiento antirretroviral es la opción más eficaz, mejorando la supervivencia a 17 meses.

CASO CLÍNICO

Varón de 35 años con VIH y síntomas de disfunción orgánica asociada a mieloma. Se realizó electroforesis de proteínas y aspirado de médula ósea, descartándose mieloma múltiple. Continuando con el abordaje diagnóstico y con la sospecha de neoplasia ósea, se realizó una biopsia ósea que reportó linfoma plasmablástico CD138+ y Ki-67 80%, Epstein-Barr positivo. El paciente recibió quimioterapia con EPOCH y tuvo una sobrevida de 6 meses.

CONCLUSIONES

La presencia de disfunción orgánica relacionada con mieloma motivó la búsqueda de dicha patología y se determinó la presencia de linfoma plasmablástico. La correlación clínica, bioquímica, inmunohistoquímica y radiográfica es esencial para el correcto diagnóstico.

BACKGROUND

Plasmablastic lymphoma is a high grade non-Hodgkin lymphoma. It is described in patients with HIV infection, post-transplant and advanced age. It appears in the fourth decade of life and the oral cavity is the most common site of affection. Its neoplastic cells express markers of plasma cells such as CD138, CD38. In its pathogenesis the Epstein-Barr virus has been implicated. The most challenging consideration in the differential diagnosis is with multiple myeloma, since the morphological and immunophenotypic characteristics of these two entities are very similar. Treatment with EPOCH (etoposide, epirubicin, vincristine, cyclophosphamide and prednisone) associated with antiretroviral treatment is the most effective option, improving survival to 17 months.

CASE REPORT

Male of 35 years with HIV and symptoms of organic dysfunction associated with myeloma. Protein electrophoresis and bone marrow aspiration were performed, ruling out multiple myeloma. Continuing with the diagnostic approach and with suspicion of bone neoplasia, a bone biopsy was performed with report of plasmablastic lymphoma CD 138+ and Ki-67 80%, Epstein-Barr positive. He received chemotherapy with EPOCH, with a six-month survival.

CONCLUSIONS

The presence of organic dysfunction related to myeloma motivated the search for said pathology and the presence of plasmablastic lymphoma was determined; clinical, biochemical, immunohistochemical, and radiographic correlation are essential for correct diagnosis.

Burden of lymphoma in China, 2006-2016: an analysis of the Global Burden of Disease Study 2016

Background

The accurate information about lymphoma burden at national and provincial levels remains unknown in China.

Methods

Following the general analytical strategy used in GBD 2016, the age-, sex-, and province-specific incidence, mortality, and prevalence of lymphoma in China were analyzed. Trends in the incidence, mortality, prevalence, and disability-adjusted life years (DALYs) due to Hodgkin’s lymphoma (HL) and non-Hodgkin’s lymphoma (NHL) were assessed from 2006 to 2016.

Results

It was estimated that there were 75,400 new cases and 40,500 deaths of lymphoma in 2016 in China, of which 6900 new cases and 2900 deaths were due to HL, while 68,500 new cases and 37,600 deaths were due to NHL. The age-standardized incidence rate (ASIR), mortality rate (ASMR), and prevalence rate (ASPR) per 100,000 were 0.46, 0.19, and 1.75 for HL, and 4.29, 2.45, and 14.9 for NHL, respectively. An upward trend with age in incidence and mortality was observed. Males had higher incidence and mortality rates than females in all age groups. Sociodemographic index had a correlation with the ASIR (r = 0.75), ASMR (r = − 0.74), ASPR (r = 0.84), and age-standardized DALYs (r = − 0.75) of HL, as well as with the ASIR (r = 0.80), ASPR (r = 0.83), and age-standardized DALYs (r = − 0.33) of NHL. From 2006 to 2016, the age-standardized DALYs of HL decreased significantly, while the age-standardized DALYs of NHL increased from 2006 to 2013 and remained stable from 2013 to 2016.

Conclusions

The burden of lymphoma in China showed unexpected patterns varied by sex, age, and provinces, with an increased trend of NHL and a decreased trend of HL from 2006 to 2016.

Electronic supplementary material

The online version of this article (10.1186/s13045-019-0785-7) contains supplementary material, which is available to authorized users.