276
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Higuchi K, Komatsu K, Wakamatsu H, Kawasaki H, Murata M, Miyazaki K, Oikawa K, Ohwada M, Nanjo H, Otaka M, Watanabe S, Komatsu K. Small intestinal follicular lymphoma with multiple tumor formations diagnosed by double-balloon enteroscopy. Intern Med 2007; 46:705-9. [PMID: 17541220 DOI: 10.2169/internalmedicine.46.6087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Follicular lymphoma of the small intestine remains relatively rare, especially in its early stage. Recently, double-balloon endoscopy has enabled observation of the entire small intestine. We describe a case of follicular lymphoma with multiple lesions in the small intestine detected by double-balloon endoscopy. The patient showed multiple whitish granules in descending portion of the duodenum on screening esophagogastroduodenoscopy, which were subsequently diagnosed as follicular lymphoma by immunohistochemistry. Endoscopic examination of the entire small intestine revealed multiple follicular lymphoma tumors in inferior portion of the duodenum and in the proximal jejunum. Double-balloon endoscopy is useful for evaluating tumor distribution of follicular lymphoma.
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277
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Zinzani PL, Musuraca G, Alinari L, Fanti S, Tani M, Stefoni V, Marchi E, Fina M, Pellegrini C, Castellucci P, Farsad M, Baccarani M. Predictive Role of Positron Emission Tomography in the Outcome of Patients with Follicular Lymphoma. ACTA ACUST UNITED AC 2007; 7:291-5. [PMID: 17324337 DOI: 10.3816/clm.2007.n.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the reliability of positron emission tomography (PET) in patients with follicular lymphoma (FL) after induction treatment. PATIENTS AND METHODS In all, 45 previously untreated patients with FL were studied with PET and computed tomography (CT) scans after chemotherapy induction treatment (fludarabine-containing regimens and CHOP [cyclophosphamide/doxorubicin/vincristine/prednisone] chemotherapy). Histopathologic analysis was performed when considered necessary. RESULTS After treatment, 4 of 5 patients (80%) who had CT-negative/PET-positive findings experienced relapse/progression, compared with only 1 of 22 patients (4.5%) in the CT-negative/PET-negative subset. Among the 18 patients with CT-positive findings, all 6 patients (100%) who had PET-positive findings experienced relapse or progression, compared with 1 of 12 patients (8.3%) who had PET-negative findings. The 2-year progression-free survival rates were 20% and 90% in the CT-negative/PET-positive and CT-positive/PET-negative subsets, respectively (P = 0.0031). During the follow-up, 2 patients, who presented a PET positivity with a negative CT scan, underwent a lymph node biopsy, which confirmed the presence of FL infiltration. CONCLUSION In patients with FL, persisting PET positivity is predictive of early disease progression, because it is still highly likely that patients with PET-negative findings will ultimately progress, but this has not yet been manifested during the period of observation.
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278
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Lotto AA, Kendall SW, Hartley R, Walker P. A case of a periaortic lymphoma presenting with the features of descending thoracic aorta dissection. Br J Radiol 2007; 80:e30-2. [PMID: 17267468 DOI: 10.1259/bjr/77258375] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the case of a 68-year-old male in whom an intrathoracic non-Hodgkin's lymphoma was diagnosed late after he presented with the clinical and radiological features of a descending aortic dissection due to penetrating ulcer. An endovascular stent was implanted in the descending aorta. At follow up, a CT scan showed the presence of a mediastinal mass thought to be a periaortic haematoma as a consequence of the endovascular stent implantation. A further CT scan showed an increase in size of the mediastinal mass encasing the whole descending aorta. A biopsy of the mass was performed which was shown to be non-Hodgkin's lymphoma. This is the first report of a penetrating ulcer of the descending aorta due to lymphoma, which probably caused the dissection.
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279
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Mossafa H, Damotte D, Jenabian A, Delarue R, Vincenneau A, Amouroux I, Jeandel R, Khoury E, Martelli JM, Samson T, Tapia S, Flandrin G, Troussard X. Non-Hodgkin's lymphomas with Burkitt-like cells are associated with c-Myc amplification and poor prognosis. Leuk Lymphoma 2006; 47:1885-93. [PMID: 17065002 DOI: 10.1080/10428190600687547] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Out of 344 patients with newly diagnosed non-Hodgkin's lymphoma (NHL), this study identified 16 patients presenting Burkitt-like cells (BLCs) after cytological and/or histological review. Conventional cytogenetic analysis showed at diagnosis complex chromosomal abnormalities in 13 cases and a normal karyotype in three cases. However, neither t(8;14)(q24;q32) nor the variants t(2;8)(p12;q24) or t(8;22)(q24;q11) was detected. FISH studies showed c-MYC amplification in all cases with four to more than seven copies in 10 - 77% metaphase or inter-phase cells. This study did not observe any gene fusion signal for c-MYC/IgH excluding a t(8;14) translocation and partial tri or polysomy of chromosome 8. It also excluded in that cases a break apart for the c-MYC locus. This study also never detected IgL/c-MYC, IgK/c-MYC or X-c-MYC. The BLCs were present whatever the lymphoma sub-type: follicular lymphoma (FL) was diagnosed in six out of 16 patients, mantle cell lymphoma (MCL) in four out of 16 patients, marginal zone lymphoma (MZL) in two out of 16 patients and diffuse large B-cell lymphomas (DLBCL) in three out of 16 patients. One additional patient presented a T-cell lymphoma. The clinical course was aggressive with a poor prognosis, as death occurred in nine patients, within 6 months after diagnosis for eight of them. These data could suggest a sub-group of NHL patients (15 B-NHL, 1 T-NHL) have been identified with a poor prognosis characterized by the association of Burkitt-like cells and c-MYC amplification without t(8;14)(q24;q32) or its variants. The possibility that this profile may represent a distinct morphologic NHL sub-set remains to be determined on a large cohort of patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Burkitt Lymphoma/diagnosis
- Burkitt Lymphoma/genetics
- Chromosomes, Human/genetics
- Cytogenetic Analysis
- Female
- Gene Amplification
- Humans
- Immunoglobulin Heavy Chains/genetics
- In Situ Hybridization, Fluorescence
- Karyotyping
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/genetics
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, T-Cell/diagnosis
- Lymphoma, T-Cell/genetics
- Male
- Middle Aged
- Prognosis
- Proto-Oncogene Proteins c-myc/genetics
- Translocation, Genetic
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280
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Cole AS, Trotter MI, O'Connell J. Follicular lymphoma presenting as mumps, with persistent cervical lymphadenopathy. The Journal of Laryngology & Otology 2006; 121:501-2. [PMID: 17166323 DOI: 10.1017/s0022215106003549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2006] [Indexed: 11/07/2022]
Abstract
We report a case of follicular lymphoma in a healthy individual, which presented as saliva- and serum-proven mumps. The patient presented with a sore throat and parotid and submandibular lymphadenopathy. Fine needle aspiration, undertaken three weeks following presentation, revealed no malignant cells. An excision biopsy of a level two node was performed due to persistent lymphadenopathy, five weeks following presentation. As far as we are aware, this is the first reported case of follicular lymphoma presenting as mumps. This case highlights the importance of follow up in patients in whom lymphadenopathy is persistent despite the proven diagnosis of mumps.
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281
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Charfi S, Bahri Zouari I, Khabir A, Toumi N, Gouiaa N, Daoud J, Sellami Boudawara T. Compression médullaire révélatrice d'un lymphome folliculaire : à propos d'un cas. Cancer Radiother 2006; 10:586-9. [PMID: 16843028 DOI: 10.1016/j.canrad.2006.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 05/18/2006] [Accepted: 05/19/2006] [Indexed: 11/23/2022]
Abstract
Epidural localization is a rare presenting sign of non-Hodgkin's lymphoma. These tumours are classified in the majority of cases as large B cell lymphomas. Low grade lymphomas are rarely reported. We report a 43-year-old woman admitted for a total functional disability of the two lower limbs. Magnetic resonance imaging revealed a spinal epidural mass extending from D7 to D9. A laminectomy was performed. The histopathological study revealed a follicular lymphoma. The patient underwent a spinal irradiation and chemotherapy. Follow up evaluation at 16 months demonstrated no evidence of relapse. Our purpose is to describe the clinical features, the pathologic findings, the treatment and the prognosis of non-Hodgkin's lymphoma revealed by an epidural involvement.
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282
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Belaud-Rotureau MA, Parrens M, Carrere N, Turmo M, Ferrer J, de Mascarel A, Dubus P, Merlio JP. Interphase fluorescence in situ hybridization is more sensitive than BIOMED-2 polymerase chain reaction protocol in detecting IGH-BCL2 rearrangement in both fixed and frozen lymph node with follicular lymphoma. Hum Pathol 2006; 38:365-72. [PMID: 17134735 DOI: 10.1016/j.humpath.2006.08.022] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 08/22/2006] [Accepted: 08/23/2006] [Indexed: 11/18/2022]
Abstract
The detection of t(14;18)(q32;q21) is advisable for the diagnosis of follicular lymphoma (FL). In 51 patients with FL, we evaluated the applicability and sensitivity of interphase fluorescence in situ hybridization (FISH) and polymerase chain reaction (PCR) using commercially available reagents. In 23 patients, only a formalin-fixed lymph node was available. In 28 patients, both frozen and formalin-fixed lymph nodes were evaluated. Fluorescence in situ hybridization was found to be 100% applicable whatever the material type. With the use of IGH-BCL2 dual-fusion, dual-color probes, t(14;18) translocation was detected in 47 (92%) of 51 FL cases with concordant results between isolated nuclei (n = 41) and frozen cytologic imprints (n = 28). Twenty-two IGH-BCL2-positive cases were also studied on fixed sections with BCL2 split signal probes showing a BCL2 split in all. Conversely, no BCL2 split was observed in IGH-BCL2-negative cases (n = 4). Owing to DNA degradation as assessed by the failure of control genes amplification, the applicability of PCR was found to be 76% in fixed lymph nodes (n = 51). After exclusion of the 12 noninformative cases, the BIOMED-2 protocol allowed the detection of an IGH-BCL2 fusion in 25 (64%) of 39 fixed specimens with 11 PCR-negative (31%) of 36 FISH-positive cases. Even on frozen material with 100% applicability, the amplification of a BCL2-JH breakpoint was achieved in only 20 (71%) of 28 cases with 5 PCR-negative (20%) out of 25 FISH-positive cases. Therefore, FISH was found superior to PCR (using BIOMED-2 protocol) in detecting IGH-BCL2 fusion. Finally, FISH individualized 4 IGH-BCL2-negative FL cases without specific histopathologic features. With the use of split signal DNA probes, 1 case showed a trisomy of the BCL2 locus and another displayed BCL6 and IGH breakpoints that would suggest a t(3;14). Whether such IGH-BCL2-negative cases are characterized by alternative oncogenetic pathways remains to be determined.
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283
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Palma S, Cavazzini L, Bovo R, Padovani D, Bugli AM, Borrelli M, Martini A. Merkel cell tumour of the external ear. Report of a case. Auris Nasus Larynx 2006; 34:229-32. [PMID: 17064866 DOI: 10.1016/j.anl.2006.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2006] [Revised: 07/13/2006] [Accepted: 07/21/2006] [Indexed: 11/26/2022]
Abstract
Merkel cells carcinoma (MCC) is an uncommon skin lesion, considered a malignancy of the neuroendocrine system, which is found mainly in elderly people. Its incidence is highly correlated with sun exposure or immunodeficiency syndromes. MCC is often an aggressive tumour with high tendency for local recurrence, lymph node involvement and distant metastasis. To our best knowledge 20 cases originated from the auricle have been described, 2 of them arising from external ear canal. The authors report a case of the ear canal characterized by two others synchronous tumours and the occurrence of a malignant high grade lymphoma, in which contribute of the pathologist was essential for a critical review. MCC diagnosis is not always easy for its pathological and clinical features and it should always be considered in presence of lymphoma. A multidisciplinary approach is basic.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Biopsy, Fine-Needle
- Carcinoma, Merkel Cell/diagnosis
- Carcinoma, Merkel Cell/drug therapy
- Carcinoma, Merkel Cell/pathology
- Ear Neoplasms/diagnosis
- Ear Neoplasms/drug therapy
- Ear Neoplasms/pathology
- Ear, External/pathology
- Fatal Outcome
- Head and Neck Neoplasms/diagnosis
- Head and Neck Neoplasms/therapy
- Humans
- Keratins/analysis
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/therapy
- Magnetic Resonance Imaging
- Male
- Neoplasms, Second Primary/diagnosis
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/pathology
- Parotid Gland/pathology
- Skin Neoplasms/diagnosis
- Skin Neoplasms/therapy
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284
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Fehring A, Schmulewitz N. EUS-guided FNA diagnosis of recurrent follicular lymphoma in the transverse colon. Gastrointest Endosc 2006; 64:652-3. [PMID: 16996367 DOI: 10.1016/j.gie.2006.02.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 02/21/2006] [Indexed: 02/08/2023]
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285
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Abstract
The observed variability in the clinical course of follicular lymphoma (FL), along with the diverse range of therapeutic options available, necessitates accurate prognostic stratification of the individual patient. A number of clinical, laboratory, and pathologic parameters have been associated with both good and poor risk disease; in some instances these have been incorporated into readily calculable prognostic indices. With new insights into disease biology and the resulting identification of biomarkers that have arisen from the analysis of both the genome and the transcriptome, more accurate individualization of prognosis will be realized. At present the clinical application of such biomarkers, however, remains largely in its infancy. This review examines the clinical and molecular prognostic features that have been identified as of value in FL.
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286
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Pantanowitz L, Thompson LDR. Follicular lymphoma. EAR, NOSE & THROAT JOURNAL 2006; 85:636-7. [PMID: 17124929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
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287
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Estrera AL, Porat EE, Aboul-Nasr R, Sin KY, Buja LM, Safi HJ. Primary lymphoma of the aorta presenting as a descending thoracic aortic aneurysm. Ann Thorac Surg 2006; 80:1502-4. [PMID: 16181902 DOI: 10.1016/j.athoracsur.2004.03.091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2003] [Revised: 03/14/2004] [Accepted: 03/30/2004] [Indexed: 10/25/2022]
Abstract
We describe a case of primary lymphoma of the thoracic aorta that presented as an aneurysm of the descending thoracic aorta. The aortic tumor was successfully resected with 2-year disease-free survival.
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288
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Voso MT, Gumiero D, D'Alo' F, Guidi F, Mansueto G, Di Febo AL, Massini G, Martini M, Larocca LM, Hohaus S, Leone G. DAP-kinase hypermethylation in the bone marrow of patients with follicular lymphoma. Haematologica 2006; 91:1252-6. [PMID: 16956827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
We studied whether DAP-kinase hypermethylation plays a role as a prognostic marker in patients with follicular lymphoma (FL). We found that DAP-kinase was frequently hypermethylated in bone marrow (BM) samples of 52 FL patients at diagnosis (71%) and identified patients with worse progression-free survival (p=0.06). In particular, patients with histologically proven BM infiltration and DAP-kinase hypermethylation had a poorer outcome (p=0.037). In a total of 170 BM samples obtained at diagnosis or during follow-up, DAP-kinase hypermethylation and the bcl2/IgH rearrangement gave concordant results in 67% of samples (48% both positive, 19% both negative). Both mrakers were independent predictors of the disease status (p<0.001).
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289
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Giné E, Montoto S, Bosch F, Arenillas L, Mercadal S, Villamor N, Martínez A, Colomo L, Campo E, Montserrat E, López-Guillermo A. The Follicular Lymphoma International Prognostic Index (FLIPI) and the histological subtype are the most important factors to predict histological transformation in follicular lymphoma. Ann Oncol 2006; 17:1539-45. [PMID: 16940035 DOI: 10.1093/annonc/mdl162] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Histological transformation (HT) is a well-known event in patients with follicular lymphoma (FL) conferring an unfavorable prognosis. The aim of the study was to analyze incidence and risk factors for HT in a large series of FL patients. PATIENTS AND METHODS 276 patients (median age: 54 years; M139/F137) diagnosed with FL (42% grade 1, 51% 2, 7% 3) in a single institution were studied. Initial treatment consisted of combined chemotherapy in most cases. Median survival was 11.3 years. Main clinic and biological variables were assessed for HT and survival. RESULTS 30 of 276 patients (11%) presented HT after a median follow-up of 6.5 years, with a risk of 15% and 22% at 10 and at 15 years, respectively. All HT corresponded to diffuse large B-cell lymphoma (DLBCL). Grade 3 histology, nodal areas >4, increased LDH and beta(2)-microglobulin, and high-risk IPI and FLIPI were associated with HT. In multivariate analysis, grade 3 histology and FLIPI retained prognostic significance. Only FLIPI predicted HT in grade 1-2 patients. 28 patients received salvage treatment for HT, with a CR rate of 52%. Median survival from transformation was 1.2 years, with 6/13 CR patients being alive >5 years after HT. CONCLUSION FLIPI and histology were the most important variables predicting HT. Upon HT, only patients achieving CR reached prolonged survival, thus emphasizing the need for effective therapies once this event occurs.
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290
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Brandao GDA, Rose R, McKenzie S, Maslak P, Lin O. Grading follicular lymphomas in fine-needle aspiration biopsies. Cancer 2006; 108:319-23. [PMID: 16937377 DOI: 10.1002/cncr.22173] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends a 3-tier grading system (Grades 1-3) for follicular lymphomas (FLs) based on the absolute number of centroblasts per high-power microscopic field (HPF) in 10 neoplastic follicles. Grades 1 and 2 FL are still managed as indolent FLs, whereas Grade 3 FL is thought to behave more aggressively. In this study, the feasibility of grading FL using ThinPrep (TP) slides and flow cytometry (FC) was evaluated. METHODS Fifty-three cases of lymph node fine-needle aspiration (FNA) from patients with histologically confirmed FL (20 Grade 1, 17 Grade 2, and 16 Grade 3) were included. The number of centroblasts present in 300 lymphoid cells and in 10 HPF in TP Papanicolaou-stained slides was evaluated. The percentage of CD10-positive small cells was calculated with FC results. Statistical analysis was performed with the Jonckheer-Terpstra nonparametric trend test and the Wilcoxon rank sum test. RESULTS The statistical analysis demonstrated a significant upward trend in the number of centroblasts as the grades increased. Also, all 3 methods had statistically significant results to distinguish different grades of FL, except when FC was used to distinguish Grade 2 from Grade 3 FL. CONCLUSIONS Counting centroblasts, either in 300 lymphoid cells or per 10 HPF in TP slides, represented a statistically significant method to separate different grades of FL in FNA samples. Analysis of cell size by FC was not as reliable to distinguish different grades of FL, especially Grade 2 from 3.
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291
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Kojima M, Murayama K, Higuchi K, Matsumoto M, Tamaki Y, Masawa N. Reactive lymphoid hyperplasia with giant follicles associated with post-therapeutic state of hematological malignancies: a report of six cases. Leuk Lymphoma 2006; 47:1404-6. [PMID: 16923578 DOI: 10.1080/10428190500527835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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292
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Torlakovic EE, Bilalovic N, Golouh R, Zidar A, Angel S. Prognostic significance of PU.1 in follicular lymphoma. J Pathol 2006; 209:352-9. [PMID: 16639693 DOI: 10.1002/path.1986] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Very few prognostic factors are known in follicular lymphoma (FL), a common malignancy of germinal centre (GC) B-cells. The Follicular Lymphoma International Prognostic Index (FLIPI) thus far appears to be the most important predictor of clinical outcome. This study explores the predictive power of the degree of GC differentiation for outcome in FL. Samples from 73 patients with FL were evaluated by immunohistochemistry for expression of GC markers. Strong PU.1, CD20, and CD75 expression were significantly associated with longer progression-free survival (PFS) and overall survival (OS). Results for PFS were independent of the International Prognostic Index or the Italian Lymphoma Intergroup prognostic index for CD75 and PU.1, but only PU.1 expression was independent of FLIPI for PFS and OS. Oct-2 was weakly expressed overall, but more strongly in higher grades of FL; it had a trend for negative linear association with PU.1 and strong positive linear association with CD27, which possibly reflects its role in terminal B-cell differentiation. We show that the level of GC differentiation, as determined by the levels of PU.1, CD75, CD20, Bcl-6, and CD10 expression, has an association with outcome in patients with FL. While this is determined qualitatively in most studies of diffuse large B-cell lymphoma, in FL there is a quantitative positive association between a high level of expression of GC antigens and longer OS and PFS even when data are stratified by the FLIPI score.
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293
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Lu MT, Millstine J, Menard MT, Rybicki FJ, Viscomi S. Periaortic lymphoma as a mimic of posttraumatic intramural hematoma. Emerg Radiol 2006; 13:35-8. [PMID: 16897055 DOI: 10.1007/s10140-006-0502-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2006] [Accepted: 04/06/2006] [Indexed: 10/24/2022]
Abstract
Computed tomography (CT) of an 87-year-old man who presented to the emergency department with chest pain after a motor vehicle collision demonstrated multiple broken ribs and a thoracic periaortic soft tissue mass which was high density on precontrast images and enhanced postcontrast. The scan also demonstrated a mass encircling the left ureter and masses in the axilla and pelvis. The enhancement of the periaortic lesion and the presence of the additional soft tissue masses suggested lymphoma as opposed to intramural hematoma (IMH). The diagnosis of follicular B-cell lymphoma was rapidly confirmed with fluorodeoxyglucose-positron emission tomography/CT and excisional biopsy of the axillary lymph node. While this is an atypical presentation, lymphoma and other extravascular pathology must be considered in the evaluation of a periaortic high attenuation mass seen on CT.
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MESH Headings
- Accidents, Traffic
- Aged, 80 and over
- Aorta, Thoracic/diagnostic imaging
- Aorta, Thoracic/injuries
- Axilla
- Contrast Media/administration & dosage
- Diagnosis, Differential
- Fluorodeoxyglucose F18
- Hematoma/diagnosis
- Hematoma/diagnostic imaging
- Humans
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/diagnostic imaging
- Male
- Positron-Emission Tomography
- Radiographic Image Enhancement
- Radiopharmaceuticals
- Tomography, X-Ray Computed
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294
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Dickinson M, Wotherspoon A, Cunningham D. Sub-clinical dissemination of follicular lymphoma in normal sized lymph nodes may not be detected by radiologic staging: a case of disseminated follicular lymphoma detected in nodal clearance as part of therapy for cutaneous melanoma. Leuk Lymphoma 2006; 47:553-6. [PMID: 16396780 DOI: 10.1080/10428190500305596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients with localized follicular lymphoma are potentially curable; however, the failure rate for local treatment suggests that a proportion of apparently localized disease is being under-staged. We report a case of incidentally diagnosed follicular lymphoma found in association with a stage II malignant melanoma, with immunohistochemical evidence of disseminated lymphoma in radiologically and clinically benign regional lymph nodes. This case provides some evidence to the cause of treatment failure in patients with clinically localized follicular lymphoma, and is a histologically proven example of the association between melanoma and lymphoma.
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295
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Richmond J, Bryant R, Trotman W, Beatty B, Lunde J. FISH detection of t(14;18) in follicular lymphoma on Papanicolaou-stained archival cytology slides. Cancer 2006; 108:198-204. [PMID: 16671111 DOI: 10.1002/cncr.21917] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The t(14;18)(q32;q21) translocation is present in about 85% of follicular lymphomas (FL) and can be identified using fluorescence in situ hybridization (FISH). In the diagnostic laboratory setting, the cytologic archival material consists of stained slides, and only rarely is material saved for molecular testing. The authors proposed FISH for FL using Papanicolaou-stained archival cytology material as a practical ancillary technique for diagnosing FL. METHODS Cases included 35 FL, 6 small lymphocytic lymphomas/chronic lymphocytic leukemias (SLL/CLL), 4 mantle cell lymphomas (MCL), 4 marginal zone lymphomas (MZL), 1 lymphoplasmacytic lymphoma (LPL), and 10 reactive lymphoid tissues (RLT). FISH was performed on Papanicolaou-stained archival cytology slides using probes for immunoglobulin heavy chain (IGH) on chromosome 14 and BCL2 on chromosome 18. RESULTS In all, 25 of 32 (81%) FL cases exhibited the t(14;18) translocation, whereas 7 of 32 (19%) lacked the translocation. No cases of non-FL were positive for t(14;18). This series shows a sensitivity of 81% and specificity of 100% for detecting the t(14;18) translocation as a diagnostic tool in FL. CONCLUSIONS When performed on Papanicolaou-stained cytology slides, FISH for t(14;18) is relatively sensitive and quite specific for FL. These findings are similar to those reported on other specimens, such as paraffin-embedded tissue and unstained cytology slides. The authors proposed that their technique would allow the pathologist and clinician the flexibility to utilize previously stained fine-needle aspiration slides for FISH evaluation.
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MESH Headings
- Biopsy, Fine-Needle
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoid Tissue/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/genetics
- Lymphoma, Mantle-Cell/pathology
- Staining and Labeling
- Translocation, Genetic
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296
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Rodriguez J, Tirabosco R, Pizzolitto S, Rocco M, Falconieri G. Hodgkin lymphoma presenting with exclusive or preponderant pulmonary involvement: a clinicopathologic study of 5 new cases. Ann Diagn Pathol 2006; 10:83-8. [PMID: 16546042 DOI: 10.1016/j.anndiagpath.2005.07.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A review of the pathological features of Hodgkin lymphoma manifesting with exclusive or preponderant lung involvement is given for 5 patients. Three patients were men and 2 were women, with an age range 17 to 48 years (median, 42 years). They presented with nonspecific symptoms including dry cough, fever, or chest pain. Initial clinical assessment suggested a lung tumor. Pathological evaluation was carried out on lung biopsy, wedge resection, lobectomy, or pneumonectomy specimens. All the cases showed diagnostic Reed Sternberg cells within the proper background. Immunopositivity for CD15 and CD30 was documented as well. Nodular sclerosing and mixed cellularity were the documented subtypes. Additional histologic features were a pronounced nodular growth pattern with or without necrosis, a diffuse hypersensitivity pneumonia-like picture, or acute pneumonia-like changes. Our study confirms that the recognition of Hodgkin lymphoma in lung, although based on well-established morphologic criteria, may represent a source of interpretative problems because of the unusual clinical presentation as well as the peculiar histologic changes induced within the pulmonary microenvironment.
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297
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Pennell N, Woods A, Reis M, Buckstein R, Spaner D, Imrie K, Hewitt K, Boudreau A, Seth A, Berinstein NL. Association of clinical status of follicular lymphoma patients after autologous stem cell transplant and quantitative assessment of lymphoma in blood and bone marrow as measured by SYBR Green I polymerase chain reaction. J Mol Diagn 2006; 8:40-50. [PMID: 16436633 PMCID: PMC1867565 DOI: 10.2353/jmoldx.2006.050050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Molecular remission in the autograft and bone marrow after transplant are predictive of durable clinical remission in relapsed follicular lymphoma. Thus, a simple reliable method to quantify minimal residual disease (MRD) would improve prognostication in these patients. Fluorescent hybridization probes have been used in real-time quantitative polymerase chain reaction (RQ-PCR) to monitor MRD with a reproducible sensitivity of 0.01%; however, these techniques are expensive and require additional experiments to examine clonality. We describe a SYBR Green I detection method that is more universal, checks clonal identity, yields the same sensitivity for monitoring MRD, and is more economically attractive. Using this method to follow 14 follicular lymphoma patients treated with autologous stem cell transplantation, molecular markers were successfully defined for 12 patients. Median contamination of stem-cell grafts was 0.1% (range, 0 to 13%). Six patients with measurable graft contamination became PCR-negative in blood and bone marrow within 12 months after autologous stem cell transplantation. Three patients free of disease progression (median follow-up of 75 months) are in molecular remission. Increasing fractions of RQ-PCR-positive blood and bone marrow cells reliably predicted morphological and clinical relapse. In one case, both clinical relapse and spontaneous regression were reflected by changes in MRD levels. Thus, our RQ-PCR method reproducibly distinguishes different levels of MRD.
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298
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Tumuluri K, Bonshek RE, Leatherbarrow B. Eyelid lymphoma in a patient with multiple lipomatosis. Eye (Lond) 2006; 21:135-7. [PMID: 16778824 DOI: 10.1038/sj.eye.6702466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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299
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Bryant RJ, Banks PM, O'Malley DP. Ki67 staining pattern as a diagnostic tool in the evaluation of lymphoproliferative disorders. Histopathology 2006; 48:505-15. [PMID: 16623776 DOI: 10.1111/j.1365-2559.2006.02378.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate a group of lymphoid proliferations using only Ki67-stained slides to determine the value of the pattern of proliferating cells in diagnosis. Ki67 immunohistochemistry allows evaluation of the distribution of proliferating cells in addition to simply determining the proliferation rate of cells. METHODS AND RESULTS Three observers, using a Ki67-stained slide only, studied 149 cases from five diagnostic groupings: follicular hyperplasia, mixed pattern hyperplasia, localized Castleman's disease, follicular lymphoma and marginal zone lymphoma. The sensitivity for benign lesions varied from 94% to 97% among the three observers. Follicular lymphomas were recognized as neoplastic with a sensitivity of 96% and 100% by two of the observers. Marginal zone lymphoma was recognized as neoplastic in 67-73% of cases. CONCLUSIONS The Ki67 stain alone is a powerful tool for distinguishing benign from malignant proliferations within the selected groups. Nuances and pitfalls in the interpretation of Ki67 staining pattern are discussed.
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300
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Regazzi MB, Iacona I, Avanzini MA, Arcaini L, Merlini G, Perfetti V, Zaja F, Montagna M, Morra E, Lazzarino M. Pharmacokinetic behavior of rituximab: a study of different schedules of administration for heterogeneous clinical settings. Ther Drug Monit 2006; 27:785-92. [PMID: 16306856 DOI: 10.1097/01.ftd.0000184162.60197.c1] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study was designed to report the pharmacokinetic behavior of Rituximab in patients affected with different diseases and treated with different schedules of administration. A low tumor burden was a common feature of all patients (N=48) included in our study, whereas the timing of Rituximab administration varied from weekly (groups 1, 2, 3) to monthly (group 4). Group 1 included patients with follicular lymphoma treated with 4 weekly doses of Rituximab after first-line chemotherapy with CHOP. At the start of Rituximab, patients were in partial or complete clinical response but showed persistence of disease at molecular level (bcl-2-positive) in bone marrow and/or peripheral blood. Patients in group 2 had autoimmune disorders and Rituximab was given to act on B-cells, interfering with their production of autoantibodies. In patients with amyloidosis (group 3), Rituximab was given to kill progenitor B-cells of the small clone terminating in amyloid-producing plasma cells. In groups 2 and 3, the target of monoclonal antibody was a population of small B cells, which make an intrinsic feature of the diseases. Group 4 included patients with relapsed or refractory follicular and mantle cell lymphoma who underwent a salvage program of immunochemotherapy, purging in vivo and autotransplant: the first of the six planned doses of Rituximab was administered after a debulking phase with a third-generation regimen, such as VACOP-B. An enzyme-linked immunoassay (ELISA) developed and validated in our laboratory was used for the pharmacokinetic study. Rituximab disposition was characterized by a 2-exponential decay, with a long elimination half-life of approximately 3 weeks (range, 248-859 hours). The total systemic clearance ranged between 3.1 and 11.9 mL/hr/m. After 4 weekly infusions, Rituximab concentration was approximately 2.5 microg/mL, which is approximately 85% of the steady-state level. Steady-state plasma concentrations of Rituximab were reached after 6 to 8 weekly infusions. The adopted pharmacokinetic model (2-compartment open model) seems to provide the best fit of Rituximab disposition both during and after treatment, even when different schedules of drug administration are used. Because several studies reported an association between response and serum Rituximab concentrations, a treatment based on a pharmacokinetic model may be useful for predicting the desired drug concentration.
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