201
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MacQueen IT, Shannon EM, Dawes AJ, Ostrzega N, Russell MM, Maggard-Gibbons M. The Role of Surgery in the Clinical Management of Primary Gastrointestinal Non-Hodgkin's Lymphoma. Am Surg 2015. [DOI: 10.1177/000313481508101016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) is a heterogeneous family of tumors, with treatment modalities including chemotherapy, surgery, and radiotherapy. Because the role of surgery in PGINHL remains disputed, this study aims to assess the impact of operative resection on survival. We used a pathology database to identify all cases of PGINHL diagnosed at a single academic-affiliated medical center from 1988 to 2013. Demographic and clinical data were abstracted from the medical record. We summarized the clinical courses of patients with PGINHL and then performed a survival analysis to compare overall and disease-free survival, stratified by demographic and clinical variables. We identified 33 patients diagnosed with PGINHL during the study period. Of 29 who subsequently received treatment at the institution, 15 initially underwent chemotherapy, 10 underwent surgical resection, and 4 underwent surgery for other reasons such as diagnosis without resection or management of disease complications. Three patients suffered surgical complications and two of these patients died. We found no difference in overall survival between patients receiving surgical resection and patients managed initially with chemotherapy. This case series supports a continued role for surgical resection in the management of patients with PGINHL, though anticipated benefits should be weighed against the risk of complications.
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Affiliation(s)
- Ian T. MacQueen
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Evan M. Shannon
- University of California San Francisco, San Francisco, California
| | - Aaron J. Dawes
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
- VA/Robert Wood Johnson Foundation Clinical Scholars Program, Los Angeles, California
| | - Nora Ostrzega
- Department of Pathology, Olive View-UCLA Medical Center, Sylmar, California; and
| | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Melinda Maggard-Gibbons
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Department of Surgery, Olive View-UCLA Medical Center, Sylmar, California
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202
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Zhang S, Wang L, Yu D, Shen Y, Cheng S, Zhang L, Qian Y, Shen Z, Li Q, Zhao W. Localized primary gastrointestinal diffuse large B cell lymphoma received a surgical approach: an analysis of prognostic factors and comparison of staging systems in 101 patients from a single institution. World J Surg Oncol 2015; 13:246. [PMID: 26271948 PMCID: PMC4536702 DOI: 10.1186/s12957-015-0668-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/29/2015] [Indexed: 12/11/2022] Open
Abstract
Background Diffuse large B cell lymphoma (DLBCL) represents the most common histological subtype of primary gastrointestinal lymphoma and is a heterogeneous group of disease. Prognostic characterization of individual patients is an essential prerequisite for a proper risk-based therapeutic choice. Methods Clinical and pathological prognostic factors were identified, and predictive value of four previously described prognostic systems were assessed in 101 primary gastrointestinal DLBCL (PG-DLBCL) patients with localized disease, including Ann Arbor staging with Musshoff modification, International Prognostic Index (IPI), Lugano classification, and Paris staging system. Results Univariate factors correlated with inferior survival time were clinical parameters [age >60 years old, multiple extranodal/gastrointestinal involvement, elevated serum lactate dehydrogenase and β2-microglobulin, and decreased serum albumin], as well as pathological parameters (invasion depth beyond serosa, involvement of regional lymph node or adjacent tissue, Ki-67 index, and Bcl-2 expression). Major independent variables of adverse outcome indicated by multivariate analysis were multiple gastrointestinal involvement. In patients unfit for Rituximab but received surgery, radical surgery significantly prolonged the survival time, comparing with alleviative surgery. Addition of Rituximab could overcome the negative prognostic effect of alleviative surgery. Among the four prognostic systems, IPI and Lugano classification clearly separated patients into different risk groups. IPI was able to further stratify the early-stage patients of Lugano classification into groups with distinct prognosis. Conclusions Radical surgery might be proposed for the patients unfit for Rituximab treatment, and a combination of clinical and pathological staging systems was more helpful to predict the disease outcome of PG-DLBCL patients. Electronic supplementary material The online version of this article (doi:10.1186/s12957-015-0668-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shengting Zhang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li Wang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Dong Yu
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yang Shen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shu Cheng
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Li Zhang
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ying Qian
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Zhixiang Shen
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Qinyu Li
- Department of Surgery, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Rui Jin Er Road, Shanghai, 200025, China.
| | - Weili Zhao
- State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Shanghai Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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203
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Vetro C, Bonanno G, Giulietti G, Romano A, Conticello C, Chiarenza A, Spina P, Coppolino F, Cunsolo R, Raimondo FD. Rare gastrointestinal lymphomas: The endoscopic investigation. World J Gastrointest Endosc 2015; 7:928-949. [PMID: 26265987 PMCID: PMC4530327 DOI: 10.4253/wjge.v7.i10.928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/01/2015] [Accepted: 07/09/2015] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal lymphomas represent up to 10% of gastrointestinal malignancies and about one third of non-Hodgkin lymphomas. The most prominent histologies are mucosa-associated lymphoid tissue lymphoma and diffuse large B-cell lymphoma. However, the gastrointestinal tract can be the site of rarer lymphoma subtypes as a primary or secondary localization. Due to their rarity and the multifaceted histology, an endoscopic classification has not been validated yet. This review aims to analyze the endoscopic presentation of rare gastrointestinal lymphomas from disease diagnosis to follow-up, according to the involved site and lymphoma subtype. Existing, new and emerging endoscopic technologies have been examined. In particular, we investigated the diagnostic, prognostic and follow-up endoscopic features of T-cell and natural killer lymphomas, lymphomatous polyposis and mantle cell lymphoma, follicular lymphoma, plasma cell related disease, gastrointestinal lymphomas in immunodeficiency and Hodgkin’s lymphoma of the gastrointestinal tract. Contrarily to more frequent gastrointestinal lymphomas, data about rare lymphomas are mostly extracted from case series and case reports. Due to the data paucity, a synergism between gastroenterologists and hematologists is required in order to better manage the disease. Indeed, clinical and prognostic features are different from nodal and extranodal or the bone marrow (in case of plasma cell disease) counterpart. Therefore, the approach should be based on the knowledge of the peculiar behavior and natural history of disease.
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204
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Dasappa L, Suresh Babu MC, Sirsath NT, Suresh TM, Govind Babu K, Sathyanarayna V, Lokesh KN, Lakshmaiah KC. Primary gastrointestinal mantle cell lymphoma: a retrospective study. J Gastrointest Cancer 2015; 45:481-6. [PMID: 25316096 DOI: 10.1007/s12029-014-9655-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Primary gastrointestinal tract mantle cell lymphoma is very rare. There is paucity of literature regarding natural history and outcome of this unusual entity. AIMS AND OBJECTIVES The aim of the present study was to analyze clinical profile, epidemiological parameters, and outcome of primary gastrointestinal mantle cell lymphoma patients treated at our institute. MATERIALS AND METHODS This was a retrospective observational study of consecutive patients diagnosed with primary gastrointestinal mantle cell lymphoma at our institute between 2001 and 2012. RESULTS A total of seven patients, all males with a median age of 67.7 years, were diagnosed with primary gastrointestinal mantle cell lymphoma. Sites involved were the stomach, colon, and rectum. Blastoid and diffuse variants were observed in three patients each, and one patient had nodular pattern. Five patients received cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP) chemotherapy. Only one patient achieved complete remission and remained disease free for 21 months before being lost to follow up. The remaining four patients had inadequate response to CHOP chemotherapy with a median survival of 6 months. Cyclophosphamide, vincristine, prednisolone (CVP) was given to one patient in view of poor performance status. He had progressive disease and died after first cycle of chemotherapy. One patient is currently undergoing treatment and receiving rituximab with chemotherapy. CONCLUSIONS Primary gastrointestinal mantle cell lymphoma is highly aggressive with the Mantle Cell Lymphoma International Prognostic Index (MIPI) scores in high-risk group; survival is poor compared to nodal mantle cell lymphoma involving the gastrointestinal tract; patients respond poorly to CHOP chemotherapy. As majority of patients are elderly and not eligible for transplant, the use of rituximab in remission induction and maintenance should be considered to improve outcome of these patients.
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Affiliation(s)
- Lokanatha Dasappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, M.H. Mari Gowda Road, Banglore, Karnataka, 560029, India
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205
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Primary small-bowel malignancy: update in tumor biology, markers, and management strategies. J Gastrointest Cancer 2015; 45:421-30. [PMID: 25339426 DOI: 10.1007/s12029-014-9658-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Primary small-bowel malignancies (SBM) are rare tumors but their incidence is rising. An estimated 9160 new cases and 1210 deaths due to SBM may occur in the USA in 2014. We review advances made in tumor biology, immunohistochemistry, and discuss treatment strategies for these malignancies. METHODS Relevant articles from PubMed/Medline and Embase searches were collected using the phrases "small-bowel adenocarcinoma, gastrointestinal carcinoids, gastrointestinal stromal tumors, small-bowel leiomyosarcoma, and small-bowel lymphoma". RESULTS Advances in imaging techniques such as wireless capsule endoscopy, CT and MRI enterography, and endoscopy (balloon enteroscopy) along with discovery of molecular markers such as c-kit and PDGFRA for GIST tumors have improved our ability to diagnose, localize, and treat these patients. Early detection and surgical resection offers the best chance for long-term survival in all tumors except bowel lymphoma where chemotherapy plays the main role. Adjuvant therapy with imatinib has improved overall survival for GIST tumors, somatostatin analogs have improved symptoms and also inhibited tumor growth and stabilized metastatic disease in carcinoid disease, but chemotherapy has not improved survival for adenocarcinoma. CONCLUSIONS Recent advances in molecular characterization holds promise in novel targeted therapies. Currently ongoing trials are exploring efficacy of targeted therapies and role of adjuvant therapy for adenocarcinoma and results are awaited. Early detection and aggressive surgical therapy for all localized tumors and lymph node sampling particularly for adenocarcinoma remains the main treatment modality.
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206
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Abstract
Primary gastrointestinal T-cell lymphoma is an uncommon entity and primary colon T-cell lymphoma is even rarer. The majority of enteropathy-associated T-cell lymphomas present predominantly as ulcers or strictures in the endoscopic examinations, while primary B-cell lymphomas commonly present as exophytic lesions. Ulcerative colon T-cell lymphoma may mimic Crohn's disease (CD), which is a chronic inflammatory disease of the intestines with ulcer and fistula formations difficult for clinicians to diagnose based on endoscopic observations alone. Like CD, T-cell lymphoma may be characterized by the presence of multiple skipped ulcers distributed from the terminal ileum to the descending colon. Furthermore, it is difficult to diagnose this unusual lymphoma by a single endoscopic biopsy. Typically, the histological composition of T-cell lymphoma is made of medium to large atypical cells located in the base of the ulcer with extension to the muscle layer and the adjacent mucosa. However, it is common that biopsy specimens show only mixed inflammatory changes where the lymphoma cells are hard to be identified. The differential diagnosis of malignant lymphoma must be considered when clinically diagnosed CD is refractory to the medical treatment or when its clinical behavior becomes aggressive. The current study presents a rare case of primary colon T-cell lymphoma in a 56-year-old male with marked recent weight loss, watery diarrhea and bilateral neck lymphadenopathy, who received a laboratory checkup and endoscopic workup for colon biopsy. The initial pathological report was consistent with mucosal inflammation and benign colon ulcers. Interestingly, the blood test showed a prominent eosinophilia. A biopsy of the enlarged neck lymph nodes done approximately 1 month after the colon biopsy unexpectedly showed T-cell lymphoma, which led to a review of the initial colonic biopsy specimens. Additional immunohistochemical stains were used accordingly, which showed positive results for CD3, CD45RO and LCA antibodies confirming the diagnosis of lymphoma. The endoscopic diagnosis of ulcerative colon T-cell lymphoma is frequently confused with inflammatory conditions of the large bowel such as CD, and tuberculosis colitis. Our study aims to emphasize the difficulty in differentiating this ulcerative form of colon T-cell lymphoma from the inflammatory bowel diseases and the importance of its differential diagnosis due to the much more aggressive clinical behavior of the T-cell lymphoma.
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Affiliation(s)
- Ping-Hsiu Wu
- Department of Internal Medicine, Division of Hepatology and Gastroenterology, Taipei, Taiwan, ROC
| | - Kuang-En Chu
- Department of Internal Medicine, Division of Hepatology and Gastroenterology, Taipei, Taiwan, ROC
| | - Yu-Min Lin
- Department of Internal Medicine, Division of Hepatology and Gastroenterology, Taipei, Taiwan, ROC
| | - Shu-Han Huang
- Department of Pathology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
| | - Chin-Chu Wu
- Radiology and Images Studies, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, ROC
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207
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Primary Gastric Diffuse Large B Cell Lymphoma Presenting as Gastric Outlet Obstruction: a Call for High Clinical Suspicion. J Gastrointest Cancer 2015; 47:324-7. [PMID: 26116259 DOI: 10.1007/s12029-015-9743-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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208
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Igwe E, Diaz J, Ferriss J. Diffuse large B cell lymphoma of the cervix with rectal involvement. Gynecol Oncol Rep 2015; 10:1-4. [PMID: 26075990 PMCID: PMC4434152 DOI: 10.1016/j.gore.2014.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/23/2014] [Indexed: 12/22/2022] Open
Abstract
Diffuse large B cell lymphoma of the cervix is a very rare gynecologic malignancy and difficult to diagnose. This case is the youngest reported occurrence of cervical DLBCL with interesting considerations of GI involvement and fertility.
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Affiliation(s)
- Elena Igwe
- Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, PA, USA
| | - Juan Diaz
- Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, PA, USA
| | - James Ferriss
- Department of Obstetrics and Gynecology, Temple University Hospital, Philadelphia, PA, USA
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209
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Adekolujo OS, Agu C, Shamar I, Trauber D. Advanced Gastrointestinal Diffuse Large B-Cell Lymphoma Presenting with Obstructive Jaundice and Very High CA 19-9 Level Mimicking Pancreatic Adenocarcinoma. J Gastrointest Cancer 2015; 47:100-3. [PMID: 25963397 DOI: 10.1007/s12029-015-9728-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
MESH Headings
- Adenocarcinoma/complications
- Adenocarcinoma/diagnosis
- Adenocarcinoma/metabolism
- Aged
- Biomarkers, Tumor/metabolism
- CA-19-9 Antigen/metabolism
- Diagnosis, Differential
- Female
- Gastrointestinal Neoplasms/complications
- Gastrointestinal Neoplasms/diagnosis
- Gastrointestinal Neoplasms/metabolism
- Humans
- Immunoenzyme Techniques
- Jaundice, Obstructive/diagnosis
- Jaundice, Obstructive/etiology
- Jaundice, Obstructive/metabolism
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/metabolism
- Prognosis
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Affiliation(s)
- Orimisan Samuel Adekolujo
- Department of Medicine, McLaren Regional Medical Center, 401 S Ballenger Hwy, Flint, MI, 48532, USA.
- Department of Medicine, College of Human Medicine, Michigan State University, East Lansing, MI, 48824, USA.
| | - Chidozie Agu
- Department of Medicine, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, 11213, USA
| | - Iqbal Shamar
- Department of Pathology, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, 11213, USA
| | - David Trauber
- Department of Medicine, Interfaith Medical Center, 1545 Atlantic Avenue, Brooklyn, NY, 11213, USA
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210
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Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
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Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
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211
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Srinivasan AP, Parijatham BO, Ganapathy H. A case of intestinal MALToma with co-existent tuberculosis and Peutz-Jeghers polyp. J Postgrad Med 2015; 61:134-6. [PMID: 25766352 PMCID: PMC4943450 DOI: 10.4103/0022-3859.150900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 22-year-old male patient underwent a segmental resection of the ileum due to clinical symptoms of bowel obstruction and radiological evidence of ileal wall thickening and enlarged mesenteric nodes. Histopathological examination of the resected specimen revealed an extranodal marginal zone B-cell lymphoma(MALToma) of the intestine and tuberculous lesions along with a solitary Peutz-Jeghers polyp. The case is presented for its rarity and to stress upon the clinical and radiological challenges that arise when lymphomas and tuberculous lesions co-exist at the same site.
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Affiliation(s)
- A P Srinivasan
- Department of Pathology, Sree Balaji Medical College and Hospital, Bharath University' Chennai, Tamil Nadu, India
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212
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Lin PY, Tsai JR, Chang CC. A rare cause of intermittent epigastric pain and melena in a 38-year-old man. Gastroenterology 2015; 148:e10-1. [PMID: 25637837 DOI: 10.1053/j.gastro.2014.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 09/29/2014] [Indexed: 12/02/2022]
Affiliation(s)
- Pao-Ying Lin
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jia-Ruey Tsai
- Division of Hematology & Oncology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chao Chang
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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213
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A unique case of colorectal lymphoma in a 39-week intrauterine pregnant female. Int J Colorectal Dis 2015; 30:271-3. [PMID: 25081384 DOI: 10.1007/s00384-014-1966-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2014] [Indexed: 02/04/2023]
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214
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Zamanian–Azodi M, Rezaei–Tavirani M, Hasanzadeh H, Rahmati Rad S, Dalilan S. Introducing biomarker panel in esophageal, gastric, and colon cancers; a proteomic approach. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2015; 8:6-18. [PMID: 25584171 PMCID: PMC4285927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/18/2014] [Indexed: 10/26/2022]
Abstract
Cancer research is an attractive field in molecular biology and medicine. By applying large-scale tools such as advanced genomics and proteomics, cancer diagnosis and treatment have been improved greatly. Cancers of esophagus, gastric, and colon accounted for major health problem globally. Biomarker panel could bring out the accuracy for cancer evaluation tests as it can suggest a group of candidate molecules specified to particular malignancy in a way that distinguishing malignant tumors from benign, differentiating from other diseases, and identifying each stages with high specificity and sensitivity. In this review, a systematic search of unique protein markers reported by several proteomic literatures are classified in their specific cancer type group as novel panels for feasible accurate malignancy diagnosis and treatment. About thousands of introduced proteins were studied; however, a small number of them belonged to a specific kind of malignancy. In conclusion, despite the fact that combinatorial biomarkers appear to be hopeful, more evaluation of them is crucial to achieve the suitable biomarker panel for clinical application. This effort needs more investigations and researches for finding a specific and sensitive panel.
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Affiliation(s)
- Mona Zamanian–Azodi
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Rezaei–Tavirani
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hadi Hasanzadeh
- Department of Medical Physics, Semnan University of Medical Sciences, Semnan, Iran
| | - Sara Rahmati Rad
- Department of Cell and Molecular Biology, Faculty of Science, University of Tehran, Tehran, Iran
| | - Sona Dalilan
- Proteomics Research Center, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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215
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Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, Chiarenza A, Raimondo CD, Giulietti G, Bonanno G, Palumbo GA, Raimondo FD. Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up. World J Gastroenterol 2014; 20:12993-13005. [PMID: 25278693 PMCID: PMC4177478 DOI: 10.3748/wjg.v20.i36.12993] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.
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MESH Headings
- Animals
- Endoscopy, Gastrointestinal
- Endosonography
- Helicobacter Infections/complications
- Helicobacter Infections/microbiology
- Helicobacter pylori/pathogenicity
- Humans
- Intestinal Neoplasms/diagnostic imaging
- Intestinal Neoplasms/microbiology
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm Grading
- Predictive Value of Tests
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
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216
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Liu B, Ramalho M, AlObaidy M, Busireddy KK, Altun E, Kalubowila J, Semelka RC. Gastrointestinal imaging-practical magnetic resonance imaging approach. World J Radiol 2014; 6:544-566. [PMID: 25170393 PMCID: PMC4147436 DOI: 10.4329/wjr.v6.i8.544] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/15/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
Over the past two decades, advances in cross-sectional imaging such as computed tomography and magnetic resonance imaging (MRI) have dramatically changed the concept of gastrointestinal imaging. MR is playing an increasing role in the evaluation of gastrointestinal disorders. MRI combines the advantages of excellent soft-tissue contrast, noninvasiveness, functional information and lack of ionizing radiation. Furthermore, recent developments of MRI have led to improved spatial and temporal resolution as well as decreased motion artifacts. In this article we describe the technical aspects of gastrointestinal MRI and present a practical approach for a well-known spectrum of gastrointestinal disease processes.
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217
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Abstract
Primary gastrointestinal (GI) lymphoma most often arises from stomach, small bowel, or colon. The 2 most common subtypes of primary GI lymphoma include low-grade mucosa-associated lymphoid tissue lymphoma, strongly associated with Helicobacter pylori infection, and high-grade diffuse, large B-cell lymphoma. Primary GI lymphoma demonstrates a myriad of imaging manifestations that can commonly mimic other pathologies. Timely and accurate diagnosis remains important because treatment and prognosis of primary GI lymphoma differ significantly from other GI malignancies and even lymphoma of other primary sites.
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Affiliation(s)
- Stephanie T Chang
- Department of Radiology, Stanford University School of Medicine, Stanford, CA; Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO
| | - Christine O Menias
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, MO; Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO.
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Extranodal Marginal Zone Lymphoma Presenting within the Meckel Diverticulum as Diverticulitis: A Case Report. Case Rep Pathol 2014; 2014:374814. [PMID: 24868477 PMCID: PMC4020529 DOI: 10.1155/2014/374814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Abstract
Meckel diverticulum is the most common congenital defect of the gastrointestinal tract. It can be asymptomatic or mimic appendicitis and may be complicated by bleeding, diverticulitis, obstruction, and, rarely, neoplasia. We report the first case of extranodal marginal zone lymphoma occupying a Meckel diverticulum. A 44-year-old man with history of colonic diverticulitis presented to the emergency department for evaluation of acute abdominal pain. Radiography showed enteric obstruction, prompting diagnostic laparoscopy. Above the level of mid-ileum an intact Meckel diverticulum was identified. Microscopy showed extensive infiltration of sheets of small lymphocytes with abundant cytoplasm (monocytoid B-cells) prominently in submucosa and focally transmural involving serosal adipose tissue with multiple reactive germinal centers. The immunostains showed positivity for CD20, BCL-2, and CD43 (weak) and negativity for CD3, CD5, BCL-1, CD10, and BCL-6 in monocytoid B-cells. Fluorescence in situ hybridization studies revealed API2-MALT1 fusion signals consistent with t(11;18)(q21;q21), which confirmed the diagnosis of extranodal marginal zone lymphoma, also known as mucosa associated lymphoid tissue lymphoma.
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219
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Bismar MM, Alasadi M, Hendawy BS, Waness A. A case of successful remission of extensive primary gastric diffuse large B cell lymphoma: radiologic, endoscopic and pathologic evidence. Case Rep Gastroenterol 2014; 8:134-40. [PMID: 24847196 PMCID: PMC4025053 DOI: 10.1159/000362537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Though rare amongst stomach neoplasms, primary gastric diffuse large B cell lymphoma is one of the commonest extranodal non-Hodgkin lymphomas. If left untreated, it can have a devastating progression and life-threatening consequences. We present the case of a successfully treated large antral ulcer confirmed to be large B cell lymphoma as evidenced by radiologic, endoscopic and histopathologic findings. A brief discussion about the types of gastric lymphoma, their Helicobacter pylori relation and therapeutic modalities follows.
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Affiliation(s)
- Mike M Bismar
- Department of Gastroenterology and Hepatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Mazen Alasadi
- Department of Gastroenterology and Hepatology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Bassem S Hendawy
- Department of Pathology and Laboratory Medicine, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Abdelkarim Waness
- Department of Medicine, Mafraq Hospital, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
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220
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Li M, Zhang S, Gu F, Xiao W, Yao J, Chao K, Chen M, Li J, Zhong B. Clinicopathological characteristics and prognostic factors of primary gastrointestinal lymphoma: a 22-year experience from South China. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:2718-2728. [PMID: 24966993 PMCID: PMC4069930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/28/2014] [Indexed: 06/03/2023]
Abstract
Primary gastrointestinal lymphoma (PGIL) is a kind of relatively rare cancer and easily misdiagnosed due to its unspecific signs in digestive tract. Data including 216 patients histologically diagnosed as PGIL between January 1991 and October 2012 from The First Affiliated Hospital of Sun Yat-sen University were reviewed. This study was to investigate the clinicopathological features and prognosis, and make the comparison between the different sites of PGIL. Abdominal pain (75.9%) was the most frequent symptom and intermediate-grade lymphoma (53.7%) presented as the most common histological type. Intestine (55.1%) was the most common site involved, followed by stomach (38.5%), both intestine and stomach (6.4%). PGIL of different original site showed distinguished clinicopathological characteristics that patients in Stomach and GI group were older than Intestine group (Mean age: 54 and 53 vs. 43 years, p<0.001); diarrhea, B symptom, abdominal mass and complication occurred more in intestine group. Histologically, high-grade lymphoma (especially T-cell type) almost located in Intestine group (82.5%). Five-year overall survival (OS) and event-free survival (EFS) for all PGIL patients were 56.4% and 49.3%, respectively. Stomach group had better OS (72.3%) and EFS (48.4%) than Intestine group (43.1% and 23.6% respectively), but it lost the significance in the multivariate analysis. Univariate and multivariate analysis revealed that performance status, lactate dehydrogenase (LDH) level and histological type were independent prognostic factors for PGIL.
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Affiliation(s)
- Minrui Li
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Shenghong Zhang
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Fang Gu
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Weiwei Xiao
- Division of Radiation Oncology, Cancer Center of Sun Yat-sen UniversityGuangzhou 510080, P.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhou 510080, P.R. China
| | - Jiayan Yao
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Kang Chao
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Minhu Chen
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Juan Li
- Division of Hematology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Bihui Zhong
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
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221
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NonHodgkin's Lymphoma with Peritoneal Localization. Case Rep Gastrointest Med 2014; 2014:723473. [PMID: 24711934 PMCID: PMC3970443 DOI: 10.1155/2014/723473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/23/2014] [Indexed: 12/15/2022] Open
Abstract
The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5–20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.
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222
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Jayabackthan L, Murgi SB, Graham S, Kini RG. A rare case of primary lymphoma of the caecum presenting as intussusception. J Lab Physicians 2014; 5:118-20. [PMID: 24701105 PMCID: PMC3968621 DOI: 10.4103/0974-2727.119864] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Mucosa associated lymphoid tissue (MALT) lymphomas are rare neoplasms. They are most common in the stomach followed by small intestine and colon. The symptoms are nonspecific and generally do not present with intussusception. Here we report a rare clinical entity in which a 35-year-old female presented to the emergency with severe abdominal pain which was sudden in onset. History revealed that she had been having vague mild abdominal pain for 2 years. Ultrasonography showed ileocolic intussusception with hypoechoic lesion of 54 × 46 mm seen at the lead point. Emergency laparotomy with the right hemi-colectomy was done. The specimen was sent for histopathological examination which revealed a diagnosis of MALT lymphoma. Awareness of the varied clinical presentation helps in formulating the appropriate therapeutic strategy.
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Affiliation(s)
- Leena Jayabackthan
- Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India
| | | | - Shane Graham
- Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India
| | - Reshma G Kini
- Department of Pathology, Father Muller Medical College, Mangalore, Karnataka, India
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223
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Palakodeti S, Hoda K, Munroe CA. Perirectal Burkitt lymphoma presenting as an uncommon cause of lower gastrointestinal bleeding. Clin Gastroenterol Hepatol 2014; 12:A23-4. [PMID: 24135467 DOI: 10.1016/j.cgh.2013.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 02/07/2023]
Affiliation(s)
- Sandeep Palakodeti
- Department of Internal Medicine, Kaiser Permanente Medical Center, San Francisco, California
| | - Kaveh Hoda
- Department of Gastroenterology, Kaiser Permanente Medical Center, San Francisco, California
| | - Craig A Munroe
- Department of Gastroenterology, Kaiser Permanente Medical Center, San Francisco, California
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225
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Khan AM, Khan S, Dave V, Bhurgri H. Small cell lung carcinoma presenting as a caecal polyp on surveillance colonoscopy. BMJ Case Rep 2014; 2014:bcr-2013-202624. [PMID: 24667947 DOI: 10.1136/bcr-2013-202624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A 60-year-old man underwent surveillance colonoscopy that demonstrated five subcentimetre polyps, all of which were biopsied. One of the five polyps had histopathology consistent with small cell lung carcinoma (SCLC) metastasis from primary lung cancer. Subsequent imaging demonstrated a spiculated mass in the right upper lung lobe with metastasis to the brain, liver and spleen. He was immediately treated with palliative whole-brain irradiation followed by eight cycles of carboplatin and etoposide. Despite aggressive management, he had disease progression characterised by worsening performance status and development of transfusion-dependent anaemia, new blastic bone lesions and epidural disease. Given his liver failure, he was not considered a candidate for second-line topotecan. After discussion with the patient, family and palliative services, he was discharged with home hospice. This report describes a rare case of advanced SCLC presenting as a metastatic caecal polyp on surveillance colonoscopy.
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226
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Genovese F, Becchina G, Nagar C, Ottoveggio G, Giacalone B, Scaglione G, Varriale E, Tralongo V. Primary diffuse large B-cell lymphoma developing within a rectal tubular adenoma with low-grade dysplasia: a case report. J Med Case Rep 2014; 8:103. [PMID: 24661491 PMCID: PMC3978092 DOI: 10.1186/1752-1947-8-103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 01/22/2014] [Indexed: 02/06/2023] Open
Abstract
Introduction Colorectal lymphomas represent only 5% to 10% of gastrointestinal lymphomas, after the stomach and small intestine. Primary lymphoma of the colon and rectum is an unusual observation, constituting only 0.2% to 0.5% of all malignant tumors arising from the colorectal region. Very little is known about the correlation between adenoma and lymphoma in the colorectal tract. We report here a rare case of diffuse large B-cell lymphoma developing within a solitary tubular adenoma with low-grade dysplasia of the rectum. Case presentation An 83-year-old Caucasian man was referred to our hospital intermittent anal bleeding and irregular bowel. Colonoscopy revealed a 1cm solitary rectal polyp, which was completely removed by endoscopic resection. Histologic studies revealed low-grade intraepithelial dysplasia; the stroma of adenoma showed focal localization by highly proliferative lymphoid cells. Immunohistochemical analyses demonstrated that lymphoid cells were positive for CD20 and bcl2, whereas they were negative for CD3, CD5, CD10, CD23, CD30, CD138 and cyclin D1. Approximately 90% of the neoplastic cells reacted positively when stained with an antibody to Ki-67. Molecular studies showed the presence of a monoclonal immunoglobulin heavy chain gene rearrangement. To determine primary or secondary lymphoma localization, Dawson’s criteria were applied to the case. A diagnosis of primary diffuse large B- lymphoma Ann Arbor stage 1A was established. Subsequently, the patient was referred to oncology to establish the stage and to select appropriate treatment. Conclusions The case of diffuse large B-cell lymphoma developing within a tubular adenoma, as reported here, is considered a rare event. Little about the prognosis of primary colorectal lymphomas is available and therapeutic treatment protocol is unclear. This case report provides more information on the history and macroscopic appearance of lymphomas presenting in an unusual location. To report additional cases in the future would be helpful in redefining the diagnostic, prognostic and therapeutic approach.
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Affiliation(s)
- Francesco Genovese
- Department of Diagnostic Laboratory, U,O,C, of Pathological Anatomy, "G,F, Ingrassia" Hospital, ASP Palermo, Italy.
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227
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Rare tumors of the rectum. Narrative review. Cir Esp 2014; 92:579-88. [PMID: 24629769 DOI: 10.1016/j.ciresp.2013.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/23/2013] [Accepted: 06/02/2013] [Indexed: 02/06/2023]
Abstract
Most rectal neoplasms are adenocarcinomas, but there is a small percentage of tumors which are of other histological cell lines such as neuroendocrine tumors, sarcomas, lymphomas and squamous cell carcinomas, which have special characteristics and different treatments. We have reviewed these rare tumors of the rectum from a clinical and surgical point of view.
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228
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Ambrosio MR, Rocca BJ, Barone A, Mastrogiulio MG, Costa A, Bellan C, Lazzi S. Primary anorectal Hodgkin lymphoma: report of a case and review of the literature. Hum Pathol 2014; 45:648-52. [DOI: 10.1016/j.humpath.2013.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 09/12/2013] [Accepted: 09/16/2013] [Indexed: 12/20/2022]
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Abstract
INTRODUCTION Intestinal lymphomas can present as surgical complications such as perforation. There is little data regarding the risk factors, clinical features, management, and prognosis of bowel perforation in patients with intestinal lymphoma. The aims of this study were to analyze the risk factors for this complication and to describe the clinical picture. PATIENTS AND METHODS All patients undergoing surgery for lymphoma-related perforation between 2002 and 2012 in the University Hospital of Dijon were retrospectively analyzed. The clinical, histological, and imaging features were recorded. RESULTS Six patients underwent emergent laparotomy for this cause: in three patients, the perforation revealed the underlying disease, and in the other three patients, it occurred during chemotherapy treatment for known lymphoma. The clinical picture was a typical acute peritonitis in the first group, but was nonspecific and insidious in the chemotherapy-induced group. In all cases, aggressive lymphomas were present, and three patients had coexisting infection with the human immunodeficiency virus. CONCLUSION Lymphoma-related perforation presents as an acute peritonitis in previously untreated patients in which it reveals the disease. However, it may be induced by chemotherapy and present with nonspecific insidious symptoms. The prognosis is also different according to these characteristics. The particularities of this disease warrant its knowledge to ensure an optimal management.
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230
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Hwang HS, Yoon DH, Suh C, Park CS, Huh J. Intestinal diffuse large B-cell lymphoma: an evaluation of different staging systems. J Korean Med Sci 2014; 29:53-60. [PMID: 24431906 PMCID: PMC3890477 DOI: 10.3346/jkms.2014.29.1.53] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 11/06/2013] [Indexed: 12/15/2022] Open
Abstract
The gastrointestinal tract is the most common primary extranodal site for diffuse large B-cell lymphoma (DLBCL). However, there is no consensus on the most appropriate staging system for intestinal DLBCL. We evaluated the utility of the modified Ann Arbor system, the Lugano system, and the Paris staging system (a modification of the Tumor, Node, Metastases [TNM] staging for epithelial tumors) in 66 cases of resected intestinal DLBCL. The cases were treated with surgery, plus either cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy alone (n=26) or with the addition of rituximab immunotherapy (n=40). Median follow-up time was 40.4 months (range, 2.1-171.6 months). Fifty-six patients (84.8%) achieved complete remission. The overall 5-yr survival rate was 86.4% (57/66). Of the stage categories defined for each staging system, only the T stage of the Paris classification showed prognostic significance for overall survival by univariate analysis. However, none of the stage parameters was significantly correlated with patient survival on multivariate analysis. In conclusion, the results suggest that the T stage of the Paris classification system may be a prognostic indicator in intestinal DLBCL. The results also imply that in surgically resected intestinal DLBCL, the addition of rituximab to the CHOP regimen does not confer significant survival advantage.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Immunologic Factors/therapeutic use
- Intestinal Neoplasms/classification
- Intestinal Neoplasms/drug therapy
- Intestinal Neoplasms/mortality
- Intestinal Neoplasms/surgery
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/surgery
- Male
- Middle Aged
- Neoplasm Staging/methods
- Prednisone/therapeutic use
- Retrospective Studies
- Rituximab
- Survival
- Survival Rate
- Treatment Outcome
- Vincristine/therapeutic use
- Young Adult
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Affiliation(s)
- Hee Sang Hwang
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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231
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Liu YY, Chen MK, Cao Z, Liu SZ, Ding BJ. Differential diagnosis of intestinal tuberculosis from Crohn's disease and primary intestinal lymphoma in China. Saudi J Gastroenterol 2014; 20:241-7. [PMID: 25038210 PMCID: PMC4131307 DOI: 10.4103/1319-3767.136979] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS There are many similarities and overlaps in clinical, radiological, endoscopic, and histological features among intestinal tuberculosis (ITB), Crohn's disease (CD), and primary intestinal lymphoma (PIL), and the differential diagnosis of ITB can be very challenging for clinicians. PATIENTS AND METHODS The clinical, radiologic, endoscopic, and pathological data of 213 patients were analyzed retrospectively. According to the diagnostic criteria and exclusive criteria of ITB, CD, and PIL, 83 patients were recruited and divided into three groups, including 30 cases in the ITB group, 38 cases in the CD group, and 15 cases in the PIL group, and the medical data and statistical analysis were recorded. RESULTS Rural patients with abdominal pain as the first symptom and with transverse ulcer and caseating granulomas were more common in the ITB group than the CD group, whereas urban patients with stool change as the first symptom, moderate or severe anemia, thickening of intestinal wall, rectal involvement, skipping distribution, prominent lymphoid aggregates, and irregular glands were more common in CD group than ITB group (P < 0.05). Young patients (age < 30 years) with fever, weakness, fatigue, abdominal mass, intestinal perforation, and emergent operation were more common in ITB group than PIL group, whereas thickening of intestinal wall, malignant lymphocytes, limited distribution, and involvement of small intestine occurred more in PIL group than ITB group (P < 0.05). CONCLUSION The differential diagnosis of ITB from CD and PIL can be made by a combination of clinical manifestation, endoscopy, and pathological examinations.
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Affiliation(s)
- Yun-Yan Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Hubei Province, China
| | - Ming-Kai Chen
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Hubei Province, China,Address for correspondence: Dr. Ming-Kai Chen, Department of Gastroenterology, Renmin Hospital of Wuhan University, 99 Ziyang Road, Wuhan 430060, Hubei Province, China. E-mail:
| | - Zhuo Cao
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Hubei Province, China
| | - Shu-Zhong Liu
- Department of Gastroenterology, Renmin Hospital of Wuhan University, Hubei Province, China
| | - Bai-Jing Ding
- Department of Gastroenterology, The Second People's Hospital of Wuhu, Anhhui Province, China
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Primary non-hodgkin lymphoma of the stomach: clinicopathological characteristics and prognostic factors in Iranian patients. IRANIAN JOURNAL OF CANCER PREVENTION 2014; 7:219-24. [PMID: 25628842 PMCID: PMC4307104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 09/03/2014] [Indexed: 10/31/2022]
Abstract
BACKGROUND Primary Gastric Lymphoma (PGL) is an uncommon malignancy with various histological subtypes and treatment outcomes. The aim of this study was to investigate the potential prognostic factors and clinicopathological characteristics of Iranian patients with PGL. METHODS The clinicopathological characteristics of 60 patients with PGL were retrospectively reviewed from 2001 to 2012. The patients underwent various combinations of chemotherapy, radiotherapy, and surgery. We evaluated multiple potential prognostic factors and their associations with patient survival rate. RESULTS According to the results, Diffuse Large B-cell Lymphoma (DLBCL) and Mucosa-Associated Lymphoid Tissue (MALT) were two predominant histological subtypes. The majority of cases were diagnosed with stage I tumor in the distal part of the stomach. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 60% and 70%, respectively. It was revealed that poor World Health Organization (WHO) performance status, presence of B symptoms, and International Prognostic Index (IPI) score≥3 were significantly associated with decreased patient survival. CONCLUSION Most of the patients with PGL in early stage have a favorable prognosis.
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233
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Isomoto H, Matsushima K, Hayashi T, Imaizumi Y, Shiota J, Ishii H, Minami H, Ohnita K, Takeshima F, Shikuwa S, Miyazaki Y, Nakao K. Endocytoscopic findings of lymphomas of the stomach. BMC Gastroenterol 2013; 13:174. [PMID: 24369830 PMCID: PMC3877966 DOI: 10.1186/1471-230x-13-174] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 12/17/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The gastric lesions of various lymphomas were observed at the cellular level using endocytoscopy. METHODS Endocytoscopy and magnifying endoscopy with narrow band imaging (NBI) were performed in 17 patients with lymphomas of the stomach. The lesions consisted of 7 with low-grade mucosa-associated lymphoid tissue (MALT), 5 with gastric involvement by adult T-cell leukemia/lymphoma (ATLL), 4 with diffuse large B-cell lymphoma (DLBCL), and 1 with peripheral T-cell lymphoma. RESULTS On conventional endoscopy, 9 were classified as having superficial spreading type, 7 were mass-forming type, and 1 was diffuse infiltrating type. Anti-H. pylori treatment was given in the 7 MALT lymphoma cases. NBI magnification endoscopy invariably showed dilatation or ballooning and destruction of gastric pits and elongation and distortion in microvessels. Endocytoscopy showed mucosal aggregation of interstitial cellular elements in almost all gastric lymphoma cases. The nuclear diversity in size and configuration was exclusively seen in gastric lymphomas other than MALT lymphoma, whereas the nuclei of MALT lymphoma cells were regular and small to moderate in size. Inter-glandular infiltration by lymphomatous cell elements was frequently observed in MALT lymphoma and DLBCL, but it was uncommon in peripheral gastric T-cell malignancies. Endocytoscopy could identify the disease-specific histology, the lymphoepithelial origin, as inter-glandular infiltration of cellular components in MALT lymphoma and the possibly related DLBCL cases. Complete regression (CR) was observed in 2 of the 7 MALT lymphoma patients. In the 2 patients with CR who underwent repeat endocytoscopy, the ultra-high magnification abnormalities returned to normal, while they were unchanged in those without tumor regression. CONCLUSIONS On endocytoscopy, intra-glandular aggregation of cellular components was invariably identified in lymphomas of the stomach. Nuclear regularity in size and configuration may indicate the cytological grade, differentiating the indolent low-grade from aggressive lymphoproliferative diseases. The inter-glandular infiltration seen on endocytoscopy can indicate the lymphoepithelial lesions seen in MALT lymphoma and related DLBCL. Endocytoscopy would be applicable for virtual histopathological diagnosis of different lymphoproliferative disorders and their clinical assessment during ongoing endoscopy.
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Affiliation(s)
- Hajime Isomoto
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Kayoko Matsushima
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Tomayoshi Hayashi
- Department of Pathology, Nagasaki University Hospital, Nagasaki, Japan
| | | | - Junya Shiota
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Hiroyuki Ishii
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Hitomi Minami
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Ken Ohnita
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Saburo Shikuwa
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
| | - Yasushi Miyazaki
- Department of Hematology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan
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Vetro C, Chiarenza A, Romano A, Amico I, Calafiore V, Di Raimondo C, Coppolino F, Di Raimondo F. Prognostic assessment and treatment of primary gastric lymphomas: how endoscopic ultrasonography can help in tailoring patient management. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 14:179-85. [PMID: 24369919 DOI: 10.1016/j.clml.2013.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/03/2013] [Accepted: 10/21/2013] [Indexed: 12/18/2022]
Abstract
Endoscopic ultrasonography (EUS) has recently gained a pivotal role in the management of gastric lymphomas, especially in the diagnostic workup. Its accuracy and reliability have overcome those of other imaging techniques, such that it represents an invaluable tool for the management of gastric lymphomas. Although this technique is operator dependent, its application in large series has proved its reliability. Thus, it has generally been considered a useful tool for providing information crucial in deciding the treatment program, especially for mucosa-associated lymphoid tissue (MALT) lymphomas, for which EUS can provide an accurate evaluation of disease extension and treatment response probability. Limited-stage disease, confined to the submucosa, has a greater probability to respond to sole Helicobacter pylori eradication. In contrast, the value of EUS in response assessment and follow-up monitoring is still debated, with discordant opinions about its reliability and clinical advantages, because normalization of the EUS findings occurs with a considerable delay compared to the histologic evaluation. In the follow-up setting, preliminary data have indicated that persistently positive EUS findings in low-grade gastric lymphoma could represent a warning for a possible relapse. However, in high-grade gastric lymphoma, such findings do not have any clinical implications.
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Affiliation(s)
- Calogero Vetro
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Annalisa Chiarenza
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Alessandra Romano
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Irene Amico
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
| | - Valeria Calafiore
- Division of Hematology, AOU Policlinico-OVE, University of Catania, Catania, Italy
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235
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Wang HW, Yang W, Wang L, Lu YL, Lu JY. Composite diffuse large B-cell lymphoma and classical Hodgkin’s lymphoma of the stomach: Case report and literature review. World J Gastroenterol 2013; 19:6304-6309. [PMID: 24115832 PMCID: PMC3787365 DOI: 10.3748/wjg.v19.i37.6304] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 07/22/2013] [Accepted: 08/20/2013] [Indexed: 02/06/2023] Open
Abstract
The combination of classical Hodgkin’s lymphoma (cHL) and non-Hodgkin lymphoma coexisting in the same patient is not common, especially in one extranodal location. Here we present a rare case of composite diffuse large B-cell lymphoma (DLBCL) and cHL occurring simultaneously in the stomach of a 53-year-old female who presented with upper abdominal discomfort and gas pain. Surgery was performed and the disease was diagnosed pathologically as composite lymphoma of DLBCL and cHL using hematoxylin-eosin and immunohistochemical staining. Epstein-Barr virus (EBV) infection was not detected by in situ hybridization for EBV-encoded RNA or immunohistochemistry for EBV latent membrane protein-1. Polymerase chain reaction analysis from the two distinct components of the tumor demonstrated clonal immunoglobulin κ light chain gene rearrangements. The patient died approximately 11 mo after diagnosis in spite of receiving eight courses of the CHOP and two courses of the rituximab-CHOP (RCHOP) chemotherapy regimen. This case report showed that the two distinct components, DLBCL and cHL, appeared to originate from the same clonal progenitor cell, and that EBV infection was not essential for transformation during the course of tumorigenesis.
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MESH Headings
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Biopsy
- Chemotherapy, Adjuvant
- Composite Lymphoma/chemistry
- Composite Lymphoma/genetics
- Composite Lymphoma/pathology
- Composite Lymphoma/therapy
- Fatal Outcome
- Female
- Gastrectomy
- Hodgkin Disease/genetics
- Hodgkin Disease/metabolism
- Hodgkin Disease/pathology
- Hodgkin Disease/therapy
- Humans
- Immunohistochemistry
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Stomach Neoplasms/chemistry
- Stomach Neoplasms/genetics
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
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236
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El Hage Chehade HH, Abtar HK, Seblini MI. Simultaneous double ileoileal intussusception due to Burkitt's lymphoma in a young male. J Surg Case Rep 2013; 2013:rjt031. [PMID: 24964440 PMCID: PMC3813728 DOI: 10.1093/jscr/rjt031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Burkitt's lymphoma is an uncommon cause of intussusception in adults. Double intussusceptions due to Burkitt's lymphoma are extremely rare. We present a case of a 26-year-old man who presented with symptoms of intestinal obstruction and was diagnosed with double ileoileal intussusception at laparotomy. The pathology of the lead points turned out to be Burkitt's lymphoma. This could be the first reported case in the literature.
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237
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Saber MM, Zeeneldin AA, Samra MA, Farag SA. Primary gastrointestinal lymphoma in an Egyptian district: a study using a population-based cancer registry. J Egypt Natl Canc Inst 2013; 25:95-101. [PMID: 23719408 DOI: 10.1016/j.jnci.2013.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/16/2013] [Accepted: 03/17/2013] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Gastrointestinal lymphoma (GIL) is the most common extranodal form of non-Hodgkin's lymphoma (NHL) with geographical and age variation of its various subtypes. AIM To study GIL in Gharbiah, Egypt and to recognize the treatments employed and their outcomes including survival. METHODS This is a retrospective study. Between 2000 and 2002, 40 adult patients with GIL were identified in the Gharbiah population based cancer registry (GPBCR); 26 cases of whom were treated at Tanta Cancer Center (TCC). RESULTS GIL in Gharbiah, Egypt represented 6.2% of all GIT cancers. The median age was 47 years with slight male predominance. The commonest primary site was the stomach followed by the colon/rectum then the small intestine (67.5%, 25% and 7.5%, respectively). The commonest histological subtypes were the diffuse large B-cell (41.5%) followed by marginal zone B-cell (39%). The commonest symptoms were abdominal pains followed by vomiting. Only 18% of GILs were surgically resected. Most patients (77%) received chemotherapy with a 60% complete response (CR) rate. Once in CR, relapses are occasional. The median overall survival (OS) and progression free survival (PFS) were 31 and 14 months (95% CI, 13.2-48.7 and 6.4-21.6 months, respectively). Gastric primary site and diffuse large B cell subtype carry a non-significant worse OS and PFS than those of other sites and subtypes. CONCLUSIONS GILs in Gharbiah, Egypt are characterized by predominance of male gender, gastric site and marginal zone histology. Survival is worse for gastric and diffuse large B-cell GILs compared to other sites and histologies.
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Affiliation(s)
- Magdy M Saber
- Department of Medical Oncology, National Cancer Institute, Cairo University, Egypt
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238
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Zheng W, Song Y, Lin N, Tu M, Liu W, Zhu J. Primary gastrointestinal mantle lymphoma with massive bleeding: a case report and literature review. Chin J Cancer Res 2013; 25:250-3. [PMID: 23592907 DOI: 10.3978/j.issn.1000-9604.2012.12.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 12/10/2012] [Indexed: 12/17/2022] Open
Abstract
The incidence of primary gastrointestinal lymphomas (PGILs) has been increasing. The clinical presentation and treatment of PGIL are distinct from those of nodular lymphomas. Symptoms include abdominal pain, abdominal mass, changes in bowel habits, obstruction, and bleeding. Less life-threatening gastrointestinal bleeding occurs after chemotherapy and few reports have focused on the bleeding of PGILs. We report a case of severe gastrointestinal bleeding caused by low-dose chemotherapy, which was dramatically improved by rituximab monotherapy treatment. The prevention and treatment of gastrointestinal bleeding in PGIL should be given much attention.
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Affiliation(s)
- Wen Zheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Beijing 100142, China
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239
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Abstract
The barium meal with plain X-ray films of the small intestine has for decades been the undisputed gold standard in imaging of the small intestine. More recently, X-rays and fluoroscopy with an overall accuracy of 73% have been replaced by multislice computed tomography (MSCT) or modern magnetic resonance imaging (MRI). Ultrasound is suitable for the orienting investigation of the small intestine in the context of general abdominal sonography as well as for dedicated examinations with a sensitivity of 67-96% and a specificity up to 97%. The endoscopic examinations of the small bowel, such as video capsule endoscopy and double-balloon enteroscopy are expensive and time-consuming techniques, which provide valuable information in special indications. Other than with the stomach or colon, the diagnostics of primary small intestine tumors plays a relatively subordinate role due to the low incidence of 3-5% of all gastrointestinal (GI) neoplasms but with a high sensitivity of 84% and a specificity of up to 97% for computed tomography (CT) and MRI. Predominant questions are those concerning ileus or the diagnostics of passage disturbances after preceding operations, to depict bowel obstructions, adhesions or the involvement of the small bowel in peritoneal carcinomatosis. The sensitivity per lesion in the initial evaluation of Crohn's disease (CD) is 47-68% for capsule endoscopy, 43% for MRI and 21% for CT enterography. In cases of known CD, the sensitivity is 70% for capsule endoscopy and 79% for MRI. A further indication is the evaluation of acute or occult gastrointestinal bleeding.
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Affiliation(s)
- J Hansmann
- Diagnostische und Interventionelle Radiologie, Theresienkrankenhaus Mannheim, Deutschland.
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240
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A retrospective analysis of primary gastric diffuse large B-cell lymphoma with or without concomitant mucosa-associated lymphoid tissue (MALT) lymphoma components. Ann Hematol 2013; 92:807-15. [PMID: 23417758 DOI: 10.1007/s00277-013-1701-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/05/2013] [Indexed: 02/07/2023]
Abstract
Primary gastric diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease entity that includes patients with (DLBCL/MALT) and without detectable mucosa-associated lymphoid tissue (MALT) lymphoma components (de novo DLBCL). We sought to evaluate the clinical characteristics and outcome of this disease in a large number of cases. Patients with primary gastric DLBCL (n=162) seen on 2001-2011 at the Tianjin Medical University Cancer Institute and Hospital and the First affiliated Hospital of Chinese PLA General Hospital were retrospectively reviewed. The distribution of sex, age, Lugano staging, and other main clinical characteristics was similar between the de novo DLBCL and DLBCL/MALT groups (p>0.05). However, the proportion of patients with a stage-modified international prognostic index (m-IPI) ≥ 2 was higher in the de novo DLBCL (34 %) than the DLBCL/MALT group (17 %) (p=0.026). In addition, the Helicobacter pylori infection rates were higher in the DLBCL/MALT (75 %) than the de novo DLBCL group (36 %) (p<0.001). Five-year progression-free survival (PFS) and overall survival (OS) estimates were similar for patients in the de novo DLBCL (p=0.705) and DLBCL/MALT groups (p=0.846). Surgical treatment did not offer survival benefits when compared with chemotherapy for 5-year PFS (p=0.607) and OS estimates (p=0.554). There were no significant differences in 5-year PFS and OS estimates for patients treated with rituximab-chemotherapy (p=0.261) or conventional chemotherapy (p=0.227). Non-GCB subtype and m-IPI ≥ 2 were independently associated with shorter OS, and advanced stages of lymphoma were independently associated with shorter PFS.
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241
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Mneimneh WS, Ashraf MA, Li L, El-Kadi O, Qian J, Nazeer T, Hayner-Buchan A. Primary dural lymphoma: a novel concept of heterogeneous disease. Pathol Int 2013; 63:68-72. [PMID: 23356228 DOI: 10.1111/pin.12025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 12/07/2012] [Indexed: 12/15/2022]
Abstract
Spinal primary dural lymphoma (PDL) is uncommon with a total of 37 previous well-documented cases reported, including one diagnosed in the authors' institution. More recently we encountered an additional case of spinal PDL that, similarly to our previous case, was grade 1-2 follicular B-cell PDL. Our two cases were diagnosed over a 3-year interval in a 72-year-old female and a 74-year-old male, respectively. An exhaustive literature review on PDL was performed consequently to reveal that: (i) spinal and cerebral sites of involvement by PDL are constantly mutually exclusive; and (ii) unlike cerebral PDL, which is usually of marginal zone B-cell type, only two of the 38 cases of spinal PDL were diagnosed as such, diffuse large B-cell lymphoma being the most commonly encountered type in the spine. This divergence infers that, in contrast to the prevailing concept that PDL is a unique disease group, PDL appears to be rather heterogeneous with a difference in predilection of lymphoma type for the anatomical site of dural involvement. Such a site-specific lymphoma-type predilection phenomenon, well-recognized in other organ systems, has not been acknowledged in PDL. This report brings new insights into PDL, and may contribute to a better understanding of nervous system pathophysiology and lymphoma classification.
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242
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Li JZ, Tao J, Ruan DY, Yang YD, Zhan YS, Wang X, Chen Y, Kuang SC, Shao CK, Wu B. Primary duodenal NK/T-cell lymphoma with massive bleeding: A case report. World J Clin Oncol 2012; 3:92-7. [PMID: 22724088 PMCID: PMC3380103 DOI: 10.5306/wjco.v3.i6.92] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 05/12/2012] [Accepted: 06/05/2012] [Indexed: 02/06/2023] Open
Abstract
Primary natural killer/T-cell (NK/T-cell) lymphoma of the gastrointestinal tract is a very rare disease with a poor prognosis, and the duodenum is quite extraordinary as a primary lesion site. Here, we describe a unique case of a primary duodenal NK/T-cell lymphoma in a 26-year-old man who presented with abdominal pain and weight loss. Abdominal computed tomography scan demonstrated a hypodense tumor in the duodenum. Because of massive upper gastrointestinal tract bleeding during hospitalization, the patient was examined by emergency upper gastrointestinal endoscopy. Under endoscopy, an irregular ulcer with mucosal edema, destruction, necrosis, a hyperplastic nodule and active bleeding was observed on the duodenal posterior wall. Following endoscopic hemostasis, a biopsy was obtained for pathological evaluation. The lesion was subsequently confirmed to be a duodenal NK/T-cell lymphoma. The presenting symptoms of primary duodenal NK-/T-cell lymphoma in this patient were abdominal pain and gastrointestinal bleeding, and endoscopy was important for diagnosis. Despite aggressive treatments, the prognosis was very poor.
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Affiliation(s)
- Jian-Zhong Li
- Jian-Zhong Li, Jin Tao, Yi-Dong Yang, Ya-Shi Zhan, Xing Wang, Yu Chen, Bin Wu, Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong Province, China
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243
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Kohisa J, Kamimura K, Iwanaga A, Shioji K, Kawai H, Suda T, Suzuki K, Sakurada J, Naito M, Aoyagi Y. Efficient palliative involved-field radiotherapy on highly progressive diffuse large B-cell primary gastric lymphoma with liver cirrhosis. Clin J Gastroenterol 2012; 5:164-9. [PMID: 26182162 DOI: 10.1007/s12328-012-0292-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 02/20/2012] [Indexed: 02/07/2023]
Abstract
We report the case of a 73-year-old woman having diffuse large B-cell primary gastric lymphoma with a cirrhotic liver caused by hepatitis C virus infection. She visited our hospital with symptoms of nausea and vomiting, which appeared to be caused by stenosis due to the tumor. Metastatic tumors were seen in the gastric and jugular lymph nodes. The clinical stage was IVB with a high risk of poor prognosis according to the international index. Because of poor hepatic reserve function, standard chemotherapy could not be administered. To maintain her quality of life, palliative involved-field radiotherapy was performed. The symptoms and tumor markers significantly improved, and computed tomography and endoscopy indicated the disappearance of the primary gastric tumor. Two months after radiotherapy and her return home, she died of pneumonia. Autopsy showed neither lymphoma cells nor stenosis of gastric lesion. The significant anti-tumor effect on primary tumor in our case suggests that the involved-field radiotherapy, although palliative, can be a therapeutic option for primary gastric lymphoma patients with various complications.
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Affiliation(s)
- Junji Kohisa
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Kenya Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan.
| | - Akito Iwanaga
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Kazuhiko Shioji
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Hirokazu Kawai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Takeshi Suda
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Kenji Suzuki
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Junko Sakurada
- Division of Cellular and Molecular Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Makoto Naito
- Division of Cellular and Molecular Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
| | - Yutaka Aoyagi
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, Asahimachi 1-757, Niigata, 951-8122, Japan
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244
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Lee YJ, Lee JH. Gastrointestinal Lymphoma. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2012. [DOI: 10.7704/kjhugr.2012.12.3.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Yoon Jung Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Haeng Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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245
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Rodríguez-Lago I, Carretero C, Munoz-Navas M. Gastrointestinal bleeding caused by primary small bowel lymphoma in a patient who received a renal transplant. Clin Gastroenterol Hepatol 2012; 10:e2. [PMID: 21888884 DOI: 10.1016/j.cgh.2011.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/07/2011] [Accepted: 08/14/2011] [Indexed: 02/07/2023]
Affiliation(s)
- Iago Rodríguez-Lago
- Department of Gastroenterology, University of Navarra Clinic, Pamplona, Spain
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246
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Correlational study of vascular endothelial growth factor expression and microvessel density in primary malignant gastric lymphoma. Med Oncol 2011; 29:1711-5. [DOI: 10.1007/s12032-011-0008-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 06/14/2011] [Indexed: 12/15/2022]
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