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Kim T, Jung G, Buckner-Wolfson E, Fatemi R, Liriano G, Tal A, Wang Y, Tepper O, Kobets A. Case Report: Treatment of the rare B-cell lymphoblastic lymphoma with scalp lesion using rotation flap. Front Oncol 2023; 13:1252512. [PMID: 37927459 PMCID: PMC10623147 DOI: 10.3389/fonc.2023.1252512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/30/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Leukemia is the most frequently occurring cancer in children, and lymphoblastic lymphoma (LBL) is a rare subtype. LBL are lymphoid neoplasms of B or T cell origin and are primarily treated with chemotherapy. Although cure rates among children are excellent, these patients must be monitored for relapse. Cutaneous lesions involving B-cell LBL (B-LBL) are extremely rare and here we present a patient with a worsening B-LBL scalp mass who required radical surgical excision. Case report A 6-year-old female patient with a history of a nontender scalp mass discovered at approximately 2-3 years of age was evaluated for resection of the nodule due to its size and treatment history. The patient was originally diagnosed with follicular lymphoma by punch biopsy; excision was successfully performed on this 4 cm lesion and upon examination of the skin biopsy did we get a diagnosis of B-LBL. Reconstruction of the scalp was done through the rotation flap method. The patient's scalp healed well, and adjuvant chemotherapy was continued. There has been no reoccurrence. Discussion Here we report the rarity of B-LBL cases involving extranodal involvement in the scalp. The most common reconstruction of scalp lesions has been using free flap from the anterolateral thigh (ALT) and latissimus dorsi (LD). Our case used the rotation flap, which has its functional and cosmetic benefits. The importance of monitoring this patient is emphasized due to the dangerous consequences of B-LBL relapse. Ultimately, our successful treatment and care of this rare case can be used as guidance for similar patients in the future.
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Affiliation(s)
- Timothy Kim
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Geena Jung
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Emery Buckner-Wolfson
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Ryan Fatemi
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Genesis Liriano
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
| | - Adit Tal
- Department of Pediatric Hematology/Oncology, Montefiore Medical Center, Bronx, NY, United States
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, Bronx, NY, United States
| | - Oren Tepper
- Department of Surgery (Plastic and Reconstructive Surgery), Montefiore Medical Center, Bronx, NY, United States
| | - Andrew Kobets
- Departments of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, United States
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2
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Anderson BP, Metz CM. B-cell Lymphoblastic Lymphoma of the Paranasal Sinuses: A Case Study of a Rare Clinical Entity. Cureus 2022; 14:e31565. [DOI: 10.7759/cureus.31565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
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3
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Montazer F, Motlagh AS, Dastgir R. Primary cutaneous B-Cell lymphoblastic lymphoma presenting with solitary scalp mass in a female child: A case report and review of the literature. Clin Case Rep 2022; 10:e6553. [PMID: 36381035 PMCID: PMC9638076 DOI: 10.1002/ccr3.6553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 11/09/2022] Open
Abstract
Lymphoblastic lymphoma is a group of non-Hodgkin lymphomas that account for approximately 2% of all lymphomas. This is a report of a case of a young girl presenting with a solitary scalp mass which was resected. Histopathological examination of the mass along with bone marrow analysis revealed primary cutaneous B-cell lymphoblastic lymphoma. A nine-year-old girl presenting with an asymptomatic erythematous, non-tender scalp mass present for 12 months was admitted. Skull and brain were intact and devoid of any pathological findings on computed tomography imaging. Systemic examination also showed no evidence of mass lesion in other parts of the body. The lesion was resected and referred for pathological analysis. Microscopic study revealed heavy diffuse dermal and subcutaneous infiltration of monomorphous medium-sized mononuclear cells, with fine chromatin, scant cytoplasm, and variable nucleoli along with intact epidermis and presence of grenz zone. Tumor cells dissect through the collagen fibers. Extensive mitotic figures and focal infiltration of the skin adnexa are seen. IHC study revealed that TdT, CD79a, CD99, CD45, CD20, and Ki67 markers were positive. According to these findings, a definitive diagnosis of primary cutaneous lymphoblastic lymphoma of B cell type was concluded. The 1-year follow up after necessary treatment revealed normal findings without traces of recurrence. Lymphoblastic lymphomas (LBL) are a neoplasm of immature B cells belonging to the B-(B-LBL) or T-cell lineage (T-LBL) that accounts for approximately 2% of all lymphomas. Lymphoblastic lymphoma (LBL) is similar to acute lymphoblastic leukemia (ALL) and the differentiation between these neoplasms is based upon proportion of involvement of lymphoblasts in bone marrow. It has a higher male to female predominance, higher incidence in older children and younger adults, and a relatively higher frequency of CNS and gonadal involvement. The differential diagnosis is based on immunohistochemistry study of B-cell linage tumor markers. Cutaneous involvement is present in about one third of patients with B-LBL but rarely in patients with ALL.
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Affiliation(s)
| | | | - Ramtin Dastgir
- Faculty of Dentistry, Tehran Medical SciencesIslamic Azad UniversityTehranIran
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4
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Vijayasekharan K, Kc A, Prasad M, Dhamne C, Roy Moulik N, Shet T, Sridhar E, Laskar S, Kembhavi S, Shah S, Gujral S, Narula G, Banavali SD. Clinical outcomes and prognostic factors in children with B-cell lymphoblastic lymphoma (LBL) treated according to on modified BFM-90 protocol: Experience from a Tertiary cancer care center in India. Pediatr Hematol Oncol 2022; 39:427-440. [PMID: 35179438 DOI: 10.1080/08880018.2021.2005725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatric B-cell lymphoblastic lymphoma (LBL) is a rare entity, and appropriate treatment for pediatric B-cell LBL is not well defined. While intensive ALL type regimens achieve long term survival of 90% across Western co-operative group trials, published data from Asian studies on long term outcomes are scarce. We retrospectively analyzed the data of pediatric B-cell LBL patients treated between January 2010 and December 2017 on a uniform protocol (modified BFM 90). Kaplan-Meier method was used to estimate the survival and Cox regression models to identify prognostic factors. Of 21 patients who received treatment on the modified BFM-90 protocol, 17(81%) were alive in remission, 3(14%) had relapse, and 1(4%) had treatment-related mortality (TRM) while in remission. Two of 3 relapsed patients subsequently expired. With a median follow-up of 66 months (range 6-114), 5-year event free survival (EFS) and overall survival (OS) were 80% (95% CI:71-89%) and 91% (95% CI:85-97%), respectively. While delayed presentation from symptom onset (p=0.030), and partial response at early (D35) interim assessment (p=0.025) had inferior EFS, patients with elevated baseline LDH had a worse OS (p=0.037). Outcomes of pediatric B-cell LBL patients treated on a modified BFM-90 protocol at a single center in India were excellent. In our study, higher disease burden manifested by elevated baseline LDH and delayed presentation (≥3months) and partial interim response portend poorer survival.Supplemental data for this article is available online at https://doi.org/10.1080/08880018.2021.2005725.
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Affiliation(s)
- Kalasekhar Vijayasekharan
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India.,Department of Pediatric Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Anand Kc
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Maya Prasad
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Chetan Dhamne
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nirmalya Roy Moulik
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tanuja Shet
- Department of Pathology, Tata Memorial Center, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Epari Sridhar
- Department of Pathology, Tata Memorial Center, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Center, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Seema Kembhavi
- Department of Radiodiagnosis, Tata Memorial Center, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine, Tata Memorial Center, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Center, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gaurav Narula
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shripad D Banavali
- Department of Medical Oncology, Tata Memorial Center, Pediatric Hematolymphoid Disease Management Group, Mumbai, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
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5
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Mehta M, Shah I, Parikh A, Suryanarayan U, Panchal H, Singh J, T. A. Assessment of Cranial Radiotherapy Treatment in T-cell Lymphoblastic Lymphoma: Retrospective Study from Tertiary Care Center. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1743507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract
Introduction Leukemia-like regimens given for acute lymphoblastic leukemia (ALL) are the cornerstone of treatment for T-cell lymphoblastic lymphoma (LBL) and can produce complete remission rates exceeding 90%. For central nervous system (CNS) prophylaxis, intrathecal chemotherapy and cranial irradiation are used to prevent future CNS recurrence.
Objective The purpose of this study was to assess CNS relapse rate after cranial prophylaxis treatment given at our institute.
Materials and Methods In this retrospective analysis, between July 2013 and June 2019, 149 files of lymphoblastic lymphoma were reviewed. Out of these, 53 patients received cranial irradiation. All patients were given CNS-directed therapy in the form of intrathecal methotrexate and patients with CNS-negative disease and primary tumor complete response or more than partial response after chemotherapy were given prophylactic cranial irradiation (18 Gy/10#), and in patients with upfront CNS involvement, therapeutic cranial irradiation (24 Gy/12#) was delivered. Radiotherapy was delivered as per the standard conventional protocol on a linear accelerator.
Results Out of 53 patients (age range: 2–50 years, mean–16.79 years, 26 [49.1%] pediatric [<14 years], 27 [50.9%] adults [>14 years]), 13/53 (24.5%), and 40/53 (75.5%) patients were on MCP 841 and BFM 90 protocols, respectively. Also, 48 (90.56%) patients received prophylactic cranial irradiation (25 [52.1%] pediatric, 23 [47.9%] adults). Moreover, 3/48 (6.25%) (2 [4.16%] pediatric, 1 [2.08%] adult) patients had CNS failure after receiving prophylactic cranial irradiation. For 48 target patients, with the median follow-up of 27.27 months (26.1 months–pediatric, 28.2 months– adults), EFS (event-free survival) in the brain was 93.8% (92%: pediatric, 95.7%: adults). Also, the difference between pediatric and adult groups was not statistically significant (p-value = 0.662). Five (9.43%) patients had CNS-positive disease upfront and received therapeutic cranial irradiation.
Conclusion In BFM 90/MCP 841 protocol in lymphoblastic lymphoma, prophylactic cranial irradiation and intrathecal methotrexate have been the standard of care as the CNS-directed therapy to prevent cranial infiltration. Though our results are not at par with the published world literature, further research and efforts are required to prevent CNS relapse in a selected sub-set of patients with lymphoblastic lymphoma.
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Affiliation(s)
- Maitrik Mehta
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
| | - Isha Shah
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
| | - Ankita Parikh
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
| | - U. Suryanarayan
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
| | - Harsha Panchal
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
| | - Jayesh Singh
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
| | - Arun T.
- The Gujarat Cancer and Research Institute, M. P. Shah Cancer Hospital, Ahmedabad, Gujarat, India
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6
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A case of conjunctival precursor T cell lymphoblastic lymphoma presenting with salmon colored conjunctival mass. Am J Ophthalmol Case Rep 2022; 25:101382. [PMID: 35243143 PMCID: PMC8859792 DOI: 10.1016/j.ajoc.2022.101382] [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: 12/18/2020] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Observations Conclusions and importance
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7
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Dabaja BS, Specht L, Yahalom J. Lymphoblastic Lymphoma: Guidelines From the International Lymphoma Radiation Oncology Group (ILROG). Int J Radiat Oncol Biol Phys 2018; 102:508-514. [PMID: 30238900 DOI: 10.1016/j.ijrobp.2018.05.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/19/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
Presentation with a large mediastinal mass is a hallmark of acute lymphoblastic lymphoma, a disease that is treated in the same way as acute lymphoblastic leukemia even in the absence of marrow involvement. The role of mediastinal radiation for patients who achieve complete remission after chemotherapy has been overlooked and controversial. This document presents current knowledge on the role of radiation for lymphoblastic lymphoma and best practices for addressing how to deliver mediastinal radiation with modern technology.
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Affiliation(s)
- Bouthaina Shbib Dabaja
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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8
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Li X, Gao Y, Zhang Q, Hu N, Han D, Ning S, Ao Z. Dihydroartemisinin-regulated mRNAs and lncRNAs in chronic myeloid leukemia. Oncotarget 2017; 9:2543-2552. [PMID: 29416790 PMCID: PMC5788658 DOI: 10.18632/oncotarget.23274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 12/04/2017] [Indexed: 02/02/2023] Open
Abstract
Chronic myelocytic leukemia (CML) is characterized by increased and unregulated growth of predominantly myeloid cells in the bone marrow, and accumulation of these cells in blood. We investigated the effects of an anti-malarial drug, dihydroartemisinin (DHA), on K562 CML cells. We identified 34 mRNAs and eight lncRNAs dysregulated following DHA treatment in pure and hemin-induced K562 cells. Up- or downregulation of these potential DHA targets increased with increasing DHA concentration. We also constructed and analyzed a DHA-related mRNA-lncRNA regulation network in K562 cells, and found that four DHA-modulated mRNAs regulated by four lncRNAs participated in the steroid biosynthesis pathway. Some estrogen-related drugs, such as tamoxifen, shared common targets with DHA. We inferred that DHA exerted anti-cancer effects on K562 cells by influencing estrogen levels. Our findings indicate that DHA has potential not only as an anti-malarial drug, but also as an anti-CML chemotherapeutic.
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Affiliation(s)
- Xiang Li
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Yue Gao
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Qiang Zhang
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Nan Hu
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China.,Department of Traditional Chinese Medicine, Chengde Medical University, Chengde 066000, China
| | - Dong Han
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
| | - Shangwei Ning
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin 150081, China
| | - Zhuo Ao
- CAS Center for Excellence in Nanoscience, National Center for Nanoscience and Technology, Beijing 100190, China
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9
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Sabatino R, Aquino G, Pinto A, Piris MA, Marra L, Napolitano M, De Chiara A, Franco R. B-cell lymphoblastic lymphoma presenting as solitary temporal mass with amplification of AML1/RUNX1: case report. Hematol Oncol 2017; 35:380-384. [PMID: 28933515 DOI: 10.1002/hon.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 09/18/2015] [Accepted: 09/27/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Rocco Sabatino
- Pathology Unit, Istituto Nazionale Tumori " Fondazione 'G. Pascale", Napoli, Italy
| | - Gabriella Aquino
- Pathology Unit, Istituto Nazionale Tumori " Fondazione 'G. Pascale", Napoli, Italy
| | - Antonio Pinto
- Haematology- Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori Fondazione " G. Pascale", Napoli, Italy
| | - Miguel Angel Piris
- Pathology Unit, Hospital Universitario Marques de Valdecilla IDIVAL, Santander, Spain
| | - Laura Marra
- Pathology Unit, Istituto Nazionale Tumori " Fondazione 'G. Pascale", Napoli, Italy
| | - Maria Napolitano
- Immunology- Oncology Unit, Istituto Nazionale Tumori Fondazione " G. Pascale", Napoli, Italy
| | | | - Renato Franco
- Pathology Unit, Istituto Nazionale Tumori " Fondazione 'G. Pascale", Napoli, Italy
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10
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Unnikrishnan P, Narayanan G, Kumar BS, Devi N. B-lymphoblastic lymphoma of the rectum. Proc (Bayl Univ Med Cent) 2017; 30:336-337. [PMID: 28670078 DOI: 10.1080/08998280.2017.11929639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Lymphoblastic lymphoma is a neoplasm of immature cells committed to the B-cell or T-cell lineage. B-lymphoblastic lymphoma usually involves lymph nodes and extranodal sites, such as the skin, bone, and soft tissue. The rectum is a very rare site of involvement in B-lymphoblastic lymphoma. We describe a 26-year-old man who presented with bleeding per rectum and fecal incontinence. Endoscopy showed a large nodular friable lesion narrowing the entire rectal lumen. Biopsy was diagnostic of B-lymphoblastic lymphoma. He was started on chemotherapy with the Berlin-Frankfurt-Münster protocol and achieved complete remission after induction chemotherapy. This is the first report of B-lymphoblastic lymphoma presenting as a rectal lesion in the world literature.
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Affiliation(s)
| | - Geetha Narayanan
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, India
| | - Bhavya S Kumar
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, India
| | - Nandini Devi
- Department of Medical Oncology, Regional Cancer Center, Trivandrum 695011, India
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11
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Prognostic Factors and Outcomes of Adult Lymphoblastic Lymphoma in the United States. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2017. [PMID: 28647403 DOI: 10.1016/j.clml.2017.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND T-lymphoblastic lymphoma (T-LL) and B-lymphoblastic lymphoma (B-LL) are aggressive lymphoid neoplasms accounting for 2% to 4% of adult non-Hodgkin lymphoma. The aim of the present analysis was to characterize the clinical features and histologic subtypes and to assess the clinical prognostic factors for 696 adult patients with LL, the largest epidemiologic sample to date. PATIENTS AND METHODS The present retrospective cohort study used the Surveillance, Epidemiology, and End Results database to identify adult patients (age, > 18 years) with LL with data recorded from 2001 to 2012. We used multivariate Cox regression models to test the clinical prognostic factors, stratified by the histologic subtype. RESULTS Of 696 patients with LL (median age, 39 years), 367 (53%) had T-LL and 131 (19%) had B-LL. Patients with T-LL tended to be younger (33 years vs. 48 years), male (66% vs. 50.4%), and less likely to have extranodal involvement (6% vs. 32%) compared with those with B-LL. The 5-year survival rate for those with B-LL versus those with T-LL was not significantly different (45% vs. 48%; P = .58), even in a model adjusted for clinical features, disease stage, primary site, radiotherapy, and year of diagnosis (adjusted hazard ratio, 0.93; 95% confidence interval, 0.69-1.25; P = .63). Multivariate analysis identified age, race, and radiotherapy as independent prognostic factors for outcome in T-LL. Limited tumor stage and the most recent year of diagnosis were favorable prognostic factors for B-LL. CONCLUSION Adult patients with LL have poor long-term outcomes and novel therapies are needed. Radiotherapy had a positive effect on T-LL outcomes.
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12
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Dayton VD, Williams SJ, McKenna RW, Linden MA. Unusual extramedullary hematopoietic neoplasms in lymph nodes. Hum Pathol 2017; 62:13-22. [DOI: 10.1016/j.humpath.2016.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 12/19/2022]
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13
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O’Dwyer KM, Advani AS. When to Treat Adults Like Children: Optimizing Therapy for Lymphoblastic Lymphoma in Young Adults. J Clin Oncol 2016; 34:533-8. [DOI: 10.1200/jco.2015.64.7156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors’ suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 23-year-old man was urgently referred for evaluation of rapidly enlarging cervical lymphadenopathy, progressive dyspnea, fatigue, night sweats, and an unintentional weight loss of 25 pounds. A computed tomography scan of the neck performed 30 days before referral revealed bilateral cervical and supraclavicular lymphadenopathy (6 × 5 cm). A fine-needle aspirate of nasopharyngeal tissue demonstrated fibroadipose tissue. Tissue collected by core needle biopsy of a left internal jugular lymph node demonstrated a reactive lymph node but no malignancy. The patient was admitted to an academic medical center hospital. His physical examination was remarkable for bulky cervical and supraclavicular lymphadenopathy. A testicular examination was normal. The patient’s lactate dehydrogenase concentration was 327 U/L (normal range, 118-225 U/L). A positron emission tomography scan revealed bilateral cervical and supraclavicular lymphadenopathy (6 × 5 cm with a standardized uptake value [SUV] of 14), a 1.3-cm subcutaneous nodule in the left thigh (SUV 16), and two 2.7-cm liver lesions (SUV 14). He underwent an excisional lymph node biopsy. The lymph node revealed effacement of the architecture by an interfollicular infiltrate of lymphoid cells ( Fig 1 ). Mitotic figures were abundant (Ki-67 stain 80% to 90% positive) and there were multiple foci of tissue necrosis. The lymphoblasts were examined by flow cytometry and immunohistochemistry and expressed the T-cell markers CD2, CD3, CD4, and terminal deoxynucleotidyl transferase. A subpopulation of T cells was positive for both CD4 and CD8. Polymerase chain reaction studies revealed a clonal rearrangement of the T-cell receptor γ gene. A marrow aspirate and biopsy revealed normal trilineage hematopoiesis with no evidence of lymphoma and a normal male karyotype (46, XY). A lumbar puncture sample did not contain lymphoma cells. The patient’s diagnosis was T-lymphoblastic lymphoma.
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Affiliation(s)
- Kristen M. O’Dwyer
- University of Rochester Medical Center, Wilmot Cancer Institute, Rochester, NY
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14
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Cai Q, Medeiros LJ, Xu X, Young KH. MYC-driven aggressive B-cell lymphomas: biology, entity, differential diagnosis and clinical management. Oncotarget 2015; 6:38591-616. [PMID: 26416427 PMCID: PMC4770723 DOI: 10.18632/oncotarget.5774] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 09/04/2015] [Indexed: 01/09/2023] Open
Abstract
MYC, a potent oncogene located at chromosome locus 8q24.21, was identified initially by its involvement in Burkitt lymphoma with t(8;14)(q24;q32). MYC encodes a helix-loop-helix transcription factor that accentuates many cellular functions including proliferation, growth and apoptosis. MYC alterations also have been identified in other mature B-cell neoplasms and are associated with aggressive clinical behavior. There are several regulatory factors and dysregulated signaling that lead to MYC up-regulation in B-cell lymphomas. One typical example is the failure of physiological repressors such as Bcl6 or BLIMP1 to suppress MYC over-expression. In addition, MYC alterations are often developed concurrently with other genetic alterations that counteract the proapoptotic function of MYC. In this review, we discuss the physiologic function of MYC and the role that MYC likely plays in the pathogenesis of B-cell lymphomas. We also summarize the role MYC plays in the diagnosis, prognostication and various strategies to detect MYC rearrangement and expression.
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Affiliation(s)
- Qingqing Cai
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - L. Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xiaolu Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Ken H. Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- The University of Texas School of Medicine, Graduate School of Biomedical Sciences, Houston, Texas, USA
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Campuzano-García AE, Torres-Álvarez B, Castanedo-Cázares JP. Leukemia cutis in a patient with pre-B-cell acute lymphoblastic leukemia. JAAD Case Rep 2015; 1:364-7. [PMID: 27051782 PMCID: PMC4809375 DOI: 10.1016/j.jdcr.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Juan Pablo Castanedo-Cázares
- Correspondence to: Juan Pablo Castanedo-Cázares, MD, Dermatology Department, Hospital Central Dr. Ignacio Morones Prieto, Venustiano Carranza No. 2395, Zona Universitaria, 78210, San Luis Potosí, S.L.P. México.
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Anti-thymocyte globulin could improve the outcome of allogeneic hematopoietic stem cell transplantation in patients with highly aggressive T-cell tumors. Blood Cancer J 2015; 5:e332. [PMID: 26230956 PMCID: PMC4526780 DOI: 10.1038/bcj.2015.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 06/12/2015] [Indexed: 12/05/2022] Open
Abstract
The early experiment result in our hospital showed that anti-thymocyte globulin (ATG) inhibited the proliferation of lymphoid tumor cells in the T-cell tumors. We used the ATG as the part of the conditioning regimen and to evaluate the long-term anti-leukemia effect, the safety and complication in the patients with highly aggressive T-cell lymphomas. Twenty-three patients were enrolled into this study. At the time of transplant, six patients reached first or subsequent complete response, three patients had a partial remission and 14 patients had relapsed or primary refractory disease. The conditioning regimen consisted of ATG, total body irradiation, toposide and cyclophosphamide. The complete remission rate after transplant was 95.7%. At a median follow-up time of 25 months, 16 (69.6%) patients are alive and free from diseases, including nine patients in refractory and progressive disease. Seven patients died after transplant, five from relapse and two from treatment-related complications. The incidence of grades II–IV acute graft-vs-host disease (GvHD) was 39.1%. The maximum cumulative incidence of chronic GvHD was 30%. The most frequent and severe conditioning-related toxicities observed in 8 out of 23 patients were grades III/IV infections during cytopenia. Thus, ATG-based conditioning is a feasible and effective alternative for patients with highly aggressive T-cell tumors.
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Kim JY, Om SY, Shin SJ, Kim JE, Yoon DH, Suh C. Case series of precursor B-cell lymphoblastic lymphoma. Blood Res 2014; 49:270-4. [PMID: 25548762 PMCID: PMC4278010 DOI: 10.5045/br.2014.49.4.270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 10/20/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022] Open
Abstract
Precursor B-cell lymphoblastic lymphoma (B-LBL) is an uncommon subtype of Non-Hodgkin lymphoma (NHL), accounting for only 0.3% of NHL in adults and less than 10% of all LBL cases. Unlike T-cell LBL, it usually presents with extranodal involvement while sparing the bone marrow (BM). Among the 27 patients with LBL treated in the Asan Medical Center between January 2007 and March 2012, 3 had B-LBL. All had a good performance status and low International Prognostic Index. However, unlike most previously reported cases, the patients had lymphoma in their bone marrow and extranodal sites such as bone and lung. After intensive combination chemotherapy, one patient achieved a complete response and the other 2 patients, a partial response. Our experience suggests that multiple extranodal sites may be involved in B-LBL and BM involvement may not be as infrequent as previously thought. Furthermore, intensive chemotherapy seems to be effective.
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Affiliation(s)
- Jin Yong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yong Om
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Su-Jin Shin
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Gao YJ, Pan C, Tang JY, Lu FJ, Chen J, Xue HL, Zhai XW, Li J, Ye QD, Zhou M, Wang HS, Miao H, Qian XW, Xu Z, Meng JH. Clinical outcome of childhood lymphoblastic lymphoma in Shanghai China 2001-2010. Pediatr Blood Cancer 2014; 61:659-63. [PMID: 24243691 DOI: 10.1002/pbc.24848] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/14/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND This retrospective cohort study analysed the clinical characteristics and outcomes of patients with childhood lymphoblastic lymphoma (LBL) treated in Shanghai, China. PROCEDURE From 2001 to 2010, 108 evaluable patients ≤16 years of age who were newly diagnosed with biopsy-proven LBL were treated with one of three treatment protocols: CCCG-99, SCMC-T-NHL-2002, or LBL-CHOF-2006. RESULTS Two patients had Stage I disease, 5 had Stage II, 55 had Stage III, and 46 had Stage IV. The immunophenotype was T-cell LBL in 92 patients (85.2%) and precursor B-cell LBL in 16 (14.8%). The abandonment rate was 11.5%. Twenty-five patients (23.2%) suffered from resistant disease, including 1 with isolated central nervous system (CNS) relapse. At a median follow-up of 40.4 months (range, 0-114 months), the 5-year probability of event-free survival (pEFS) was 63.9 ± 4.6% in all patients. The 5-year pEFS for patients with pB-LBL was better than for patients with T-LBL (100% vs. 61.3 ± 5.1%, P = 0.007). Patients who had achieved complete remission on day 33 of induction had significantly better pEFS than those who had not (78.8 ± 4.6% vs. 28.2 ± 9.0%, P = 0.000). Three of 25 patients who experienced resistant disease were alive at the end of the study period. CONCLUSIONS The abandonment rate was lower for patients with LBL than for patients with acute lymphoblastic leukemia. Prophylactic cranial radiation can be omitted for patients with LBL even when advanced-stage disease is present, as intensive systemic chemotherapy with intrathecal therapy is sufficient to prevent CNS relapse. The survival of patients with resistant disease was very poor.
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Affiliation(s)
- Yi-Jin Gao
- Children's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Geethakumari PR, Hoffmann MS, Pemmaraju N, Hu S, Jorgensen JL, O'Brien S, Daver N. Extramedullary B lymphoblastic leukemia/lymphoma (B-ALL/B-LBL): a diagnostic challenge. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2014; 14:e115-8. [PMID: 24589157 DOI: 10.1016/j.clml.2014.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Marc S Hoffmann
- Department of Leukemia, M.D. Anderson Cancer Center, University of Texas, Houston, TX
| | - Naveen Pemmaraju
- Department of Leukemia, M.D. Anderson Cancer Center, University of Texas, Houston, TX
| | - Shimin Hu
- Department of Hematopathology, M.D. Anderson Cancer Center, University of Texas, Houston, TX
| | - Jeffrey L Jorgensen
- Department of Hematopathology, M.D. Anderson Cancer Center, University of Texas, Houston, TX
| | - Susan O'Brien
- Department of Leukemia, M.D. Anderson Cancer Center, University of Texas, Houston, TX
| | - Naval Daver
- Department of Leukemia, M.D. Anderson Cancer Center, University of Texas, Houston, TX.
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20
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Lee WJ, Moon HR, Won CH, Chang SE, Choi JH, Moon KC, Lee MW. Precursor B- or T-lymphoblastic lymphoma presenting with cutaneous involvement: a series of 13 cases including 7 cases of cutaneous T-lymphoblastic lymphoma. J Am Acad Dermatol 2013; 70:318-25. [PMID: 24314877 DOI: 10.1016/j.jaad.2013.10.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 10/05/2013] [Accepted: 10/10/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lymphoblastic lymphoma (LBL) is a rare neoplasm of precursor lymphocytes, and cutaneous involvement is present in less than 20% of cases. OBJECTIVE We sought to describe the clinical and histopathological features of cutaneous LBL. METHODS We retrospectively examined the clinical and histologic features of 13 patients with cutaneous LBL, 6 with B-LBL and 7 with T-LBL. RESULTS Five of 6 patients with B-LBL had lesions in the head and neck area, whereas 4 of 7 patients with T-LBL developed skin lesions on sites other than the head and neck. Seven patients (1 case of B-LBL, and 6 of 7 cases of T-LBL) developed multiple skin lesions, and the T-LBL cases frequently developed multiple skin lesions in the head, neck, and throughout the torso. Complete remission was achieved in 9 patients (3 patients with T-LBL and all patients with B-LBL). LIMITATIONS This study used a retrospective design and included a small sample size. CONCLUSION This study compared the clinical features of T-LBL and B-LBL, in particular the affected sites and number of skin lesions. Cutaneous T-LBL is likely to be accompanied by disseminated disease and has a relatively poor prognosis compared with B-LBL.
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Affiliation(s)
- Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Rim Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Ho Choi
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kee Chan Moon
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Abstract
Adult lymphoblastic lymphoma (LBL) is an aggressive form of non-Hodgkin lymphoma occurring in predominantly adolescent and young adult men. Lymphoblastic lymphoma is rare, accounting for 1% to 2% of all non-Hodgkin lymphomas and is of T-cell phenotype in 90% of cases. Lymphoblastic lymphoma is morphologically indistinct from acute lymphoblastic leukemia (ALL). Both express their lineage-specific markers as well as terminal deoxynucleotidyl transferase. The differences are often made on clinical grounds. Lymphoblastic lymphoma is characterized by a predominantly nodal distribution of disease, often with a large mediastinal mass. Patients with less than 25% bone marrow involvement have typically been categorized as LBL rather than ALL, although this has not been applied consistently in the literature. Gene expression studies have identified differences in gene expression, with LBL expressing higher levels of genes associated with cytoskeleton, adhesion, angiogenesis, and chemotaxis than ALL. Although LBL and ALL can be distinct clinically, chemotherapy strategies are often very similar. Acute lymphoblastic leukemia regimens, which incorporate intensive multidrug induction, consolidation, delayed intensification, and maintenance, have been shown to be superior to standard lymphoma regimens. As central nervous system (CNS) relapse is common, CNS prophylaxis with high-dose chemotherapy and intrathecal therapy is also standard. The prophylactic use of CNS irradiation has declined with the introduction of chemotherapy regimens incorporating high doses of CNS-penetrating drugs such as cytarabine and methotrexate. The use of consolidative radiation to the mediastinum remains uncertain. High-dose chemotherapy followed by autologous or allogeneic transplantation as consolidation for patients in CR1 is controversial with modern intensive chemotherapy regimens, although transplantation has a proven role in the relapse setting.
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Sadrzadeh H, Huck AE, Chen YB, Hasserjian RP, Fathi AT. Philadelphia chromosome positive B-cell lymphoblastic lymphoma isolated to bone. Leuk Lymphoma 2013; 54:2052-4. [DOI: 10.3109/10428194.2012.760735] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Siah TW, Windebank KP, Menon G, Leech S. A scalp nodule in a 4-year-old boy. Precursor B-cell lymphoblastic lymphoma. Pediatr Dermatol 2013; 30:135-6. [PMID: 23316720 DOI: 10.1111/j.1525-1470.2012.01732.x] [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] [Indexed: 11/30/2022]
Affiliation(s)
- Tee W Siah
- Department of Dermatology and Oncology, Royal Victoria Infirmary, Newcastle Upon Tyne, UK.
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Shi SF, Zhou FD, Zou WZ, Wang HY. Acute kidney injury and bilateral symmetrical enlargement of the kidneys as first presentation of B-cell lymphoblastic lymphoma. Am J Kidney Dis 2012; 60:1044-8. [PMID: 22835902 DOI: 10.1053/j.ajkd.2012.05.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 05/23/2012] [Indexed: 11/11/2022]
Abstract
Lymphoblastic lymphoma is an uncommon subtype of lymphoid neoplasm in adults. Acute kidney injury at initial presentation due to lymphoblastic lymphoma infiltration of the kidneys has rarely been described. We report a 19-year-old woman who presented with acute kidney injury due to massive lymphomatous infiltration of the kidneys. The diagnosis of B-cell lymphoblastic lymphoma was established by immunohistochemical study of the biopsied kidney. The patient had an excellent response to the VDCLP protocol (vincristine, daunomycin, cyclophosphamide, asparaginase, and dexamethasone) with sustained remission. We recommend that lymphomatous infiltration be considered in patients presenting with unexplained acute kidney injury and enlarged kidneys.
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Affiliation(s)
- Su-fang Shi
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, Peoples Republic of China
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25
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Cho SY, Lee SS, Back DH, Lim KA, Lee YR, Kang HJ. Primary cutaneous B-cell lymphoblastic lymphoma in an elderly man. THE KOREAN JOURNAL OF HEMATOLOGY 2012; 46:283-6. [PMID: 22259636 PMCID: PMC3259522 DOI: 10.5045/kjh.2011.46.4.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/31/2011] [Accepted: 11/14/2011] [Indexed: 11/17/2022]
Abstract
Precursor B-cell lymphoblastic lymphoma (B-LBL) is an uncommon high-grade neoplasm of immature B cells. It occurs predominantly in childhood with extranodal involvement such as skin and bone. Therefore, primary cutaneous involvement in elderly adults is a very rare manifestation of B-LBL. Here, we report a 78-year-old man with B-LBL presenting as a single cutaneous lesion which was immunohistochemically positive for leukocyte common antigen (LCA), CD79a, paired box 5 (PAX5), B cell lymphoma-2 (bcl-2), and terminal deoxynucleotidyl transferase (TdT) staining, but was without systemic involvement. The patient was treated using cyclophosphamide, adriamycin, vincristine, and prednisolone (CHOP), and achieved complete response (CR) at the first response assessment conducted after 3 CHOP cycles. After an additional cycle of CHOP treatment, radiotherapy was administered at a total dose of 3,600 cGy over 4 weeks. At the 21-month follow-up, he had maintained CR.
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Affiliation(s)
- Su-Yeon Cho
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
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26
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Lee SP, Choi EK, Kim TM, Park EA, Kim HK, Cho HJ, Oh S. Multimodality imaging can help to doubt, diagnose and follow-up cardiac mass. Korean Circ J 2011; 41:555-8. [PMID: 22022334 PMCID: PMC3193050 DOI: 10.4070/kcj.2011.41.9.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Accepted: 01/03/2011] [Indexed: 11/18/2022] Open
Abstract
Primary cardiac lymphoma is a very rare form of lymphoma primarily or mainly involving the heart, as in the two cases presented in this report. Various imaging modalities, including coronary computed tomography angiography, cardiac magnetic resonance imaging and positron emission tomography were useful for the characterization and diagnosis of cardiac mass. Pathologic confirmation was successful with endomyocardial biopsy under echocardiographic guidance, intra- and extracardiacally. In primary cardiac lymphoma, diagnosis using multiple modalities may be useful for mass characterization, and for response monitoring after chemotherapy.
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Affiliation(s)
- Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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27
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Vezzoli P, Novara F, Fanoni D, Gambini D, Balice Y, Venegoni L, Paulli M, Crosti C, Berti E. Three cases of primary cutaneous lymphoblastic lymphoma: microarray-based comparative genomic hybridization and gene expression profiling studies with review of literature. Leuk Lymphoma 2011; 53:1978-87. [PMID: 21879810 DOI: 10.3109/10428194.2011.618233] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Lymphoblastic lymphoma (LBL) is a neoplasm of precursor B- or T-lymphocytes, and primary skin involvement is uncommon. The aim of the study was to review all reported primary cutaneous (PC)-LBLs and to examine three new cases to better characterize this neoplasm. Two of our patients showed a pre-B phenotype (PC-B-LBL) and one a never-reported pre-T phenotype (PC-T-LBL). The patient with PC-T-LBL showed an aggressive course, while those with PC-B-LBL showed a complete remission (CR) after polychemotherapy. Cytogenetic analysis and gene expression profiling (GEP) were performed on one case of PC-B-LBL and on that of PC-T-LBL. A specimen of PC-B-LBL and two specimens (early and late stage) of PC-T-LBL were investigated by microarray-based comparative genomic hybridization (CGH). All specimens revealed trisomy of chromosome 4. PC-T-LBL showed a gain of 1p36.33-p22.1 in the early stage and multiple chromosome gains/losses in the late stage. Our data suggest that trisomy 4 could be detected early in LBL and gain of 1p36.33-p22.1 could be an interesting marker in PC-T-LBL. LBL is an aggressive disease but, only in B-LBL, the cutaneous presentation seems to be a favorable prognostic factor and polychemotherapy is the best therapeutic approach. We suggest that PC-LBL should be included as a provisional clinicopathologic entity in future cutaneous lymphoma classification.
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Affiliation(s)
- Pamela Vezzoli
- UO Dermatologia, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Università degli Studi di Milano, Milan, Italy.
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28
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Lymphoblastic lymphoma. Crit Rev Oncol Hematol 2011; 79:330-43. [DOI: 10.1016/j.critrevonc.2010.12.003] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 11/09/2010] [Accepted: 12/23/2010] [Indexed: 12/21/2022] Open
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Abstract
INTRODUCTION An increased understanding of cellular signaling pathways, like the JAK?STAT pathway, and the identification of the JAK2 V617F mutation in the classic Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs), has generated great interest in the development of targeted JAK2 inhibitors. In a recently completed Phase I?II study, ruxolitinib, a selective orally available JAK1 and JAK2 inhibitor, has shown efficacy in patients with advanced myelofibrosis. Constitutive activation of the JAK?STAT pathway has also been implicated in other hematological malignancies suggesting a potential role of JAK kinase inhibitors in these malignancies. AREAS COVERED This article reviews the chemistry, pharmacodynamics, pharmacokinetics, clinical efficacy, safety and tolerability of ruxolitinib. The literature for this article was retrieved from PubMed database searches using the keywords ?ruxolitinib?, ?INCB 018424?, ?JAK2 inhibitors? and ?leukemia?. EXPERT OPINION The JAK?STAT signaling pathway plays a vital role in leukemogenesis. Ruxolitinib, a potent JAK1 and JAK2 inhibitor, known to decrease spleen size and alleviate constitutional symptoms in myelofibrosis, represents a potentially promising agent for the treatment of leukemias by inhibiting the JAK?STAT signaling. Further studies of ruxolitinib, in patients with acute and chronic leukemias, are now needed to establish the clinical usefulness of this promising drug.
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Affiliation(s)
- Kiran Naqvi
- University of Texas M.D. Anderson Cancer Center, Department of Leukemia, Houston, TX, USA
| | - Srdan Verstovsek
- University of Texas M.D. Anderson Cancer Center, Department of Leukemia, Houston, TX, USA
| | - Hagop Kantarjian
- University of Texas M.D. Anderson Cancer Center, Department of Leukemia, Houston, TX, USA
| | - Farhad Ravandi
- University of Texas M.D. Anderson Cancer Center, Department of Leukemia, Houston, TX, USA
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Broshtilova V, Balabanova M, Shtilionova S, Kempf W. Precursor B-lymphoblastic lymphoma in a 3-month-old baby. Int J Dermatol 2011; 50:730-2. [DOI: 10.1111/j.1365-4632.2010.04617.x] [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] [Indexed: 11/29/2022]
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Cortelazzo S, Intermesoli T, Oldani E, Ciceri F, Rossi G, Pogliani EM, Mattei D, Romani C, Cortelezzi A, Borlenghi E, Corti C, Peruta B, Spinelli O, Rambaldi A, Bassan R. Results of a lymphoblastic leukemia-like chemotherapy program with risk-adapted mediastinal irradiation and stem cell transplantation for adult patients with lymphoblastic lymphoma. Ann Hematol 2011; 91:73-82. [DOI: 10.1007/s00277-011-1252-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/02/2011] [Indexed: 10/18/2022]
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32
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Shiratori S, Kondo T, Fujisawa S, Kubota K, Kosugi M, Shono Y, Sugita J, Fujimoto K, Nishio M, Tanaka J, Koike T, Matsuno Y, Matsuno K, Asaka M, Imamura M. c-myc rearrangement in B-cell lymphoblastic lymphoma with the involvement of multiple extranodal lesions. Leuk Lymphoma 2011; 52:716-8. [DOI: 10.3109/10428194.2010.551158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ducassou S, Ferlay C, Bergeron C, Girard S, Laureys G, Pacquement H, Plantaz D, Lutz P, Vannier JP, Uyttebroeck A, Bertrand Y. Clinical presentation, evolution, and prognosis of precursor B-cell lymphoblastic lymphoma in trials LMT96, EORTC 58881, and EORTC 58951. Br J Haematol 2011; 152:441-51. [DOI: 10.1111/j.1365-2141.2010.08541.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Primary precursor B cell lymphoblastic lymphoma of uterine corpus: case report and review of the literature. Arch Gynecol Obstet 2011; 284:1289-92. [PMID: 21193918 DOI: 10.1007/s00404-010-1817-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2010] [Accepted: 12/10/2010] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Primary lymphomas of the female genital tract are rare. Most involve the cervix rather than the uterine corpus. Many cases of primary endometrial lymphoma are diagnosed as diffuse large B cell type, whereas the precursor B cell lymphoblastic type is extremely rare. MATERIALS AND METHODS We report a case of precursor B cell lymphoblastic lymphoma of uterine corpus which was successfully treated with surgery and chemotherapy. Staging evaluation revealed tumor limited to the uterine corpus (stage I(E)). After receiving a total abdominal hysterectomy, bilateral salpingooophorectomy, lymph node dissection and combination chemotherapy, the patient is currently free of disease after follow-up of 42 months. CONCLUSION If correct diagnosis is established and appropriate therapy is chosen, the prognosis of precursor B-LBL of uterine corpus is expected to be good. The literature on primary precursor B cell lymphoblastic lymphoma of the uterine corpus is reviewed.
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Kaszynski RH, Akatsuka S, Hiratsuka T, Jin G, Ozeki M, Okuno T, Nakamura T, Manabe T, Takakuwa T, Hiai H, Toyokuni S, Tamaki K, Tsuruyama T. A quantitative trait locus responsible for inducing B-cell lymphoblastic lymphoma is a hotspot for microsatellite instability. Cancer Sci 2010; 101:800-5. [PMID: 20353532 PMCID: PMC11159001 DOI: 10.1111/j.1349-7006.2009.01437.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/02/2009] [Accepted: 11/04/2009] [Indexed: 01/16/2023] Open
Abstract
While the molecular mechanisms underlying microsatellite instability (MSI) have been exhaustively investigated, identifying the patterns of MSI distribution within diverse cancer genomes has remained an elusive issue. In the present study, we conducted genome-wide MSI screening in B-cell lymphoblastic lymphomas (B-LBL) which spontaneously develop in the SL/Kh strain of mice. Tumor samples harvested from 16 mice were investigated using a framework map consisting of 150 microsatellite markers spaced at increments of roughly 0.5-3.0 centimorgans, spanning the entirety of mouse chromosomes (mus musculus chromosomes [MMU]) 3-6. MMU3 contains a quantitative trait locus (QTL), Bomb1 (bone marrow pre-B1), known to induce an aberrant expansion of pre-B cells in bone marrow prior to the onset of B-LBL in SL/Kh mice. The remaining chromosomes were selected on the basis of those most closely resembling MMU3 in terms of total estimated length (maximum variance 10 Mb). MSI was confirmed at 2
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Affiliation(s)
- Richard H Kaszynski
- Department of Forensic Medicine and Molecular Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Chang MH, Kim SJ, Kim K, Oh SY, Lee DH, Huh J, Ko YH, Choi CW, Yang DH, Won JH, Kim WS, Suh C. Clinical features and treatment outcomes of adult B- and T-lymphoblastic lymphoma: results of multicentre analysis in Korea. Leuk Lymphoma 2009; 50:1119-25. [PMID: 19557632 DOI: 10.1080/10428190902926999] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We performed a retrospective multicentre analysis to study the clinical features and treatment outcomes of B-lymphoblastic lymphoma (B-LBL) and T-lymphoblastic lymphoma (T-LBL) in Asian adult patients, and identify risk factors that predict relapse and poor prognosis. Fifty-five newly diagnosed patients (45 T-LBL and 10 B-LBL) were analysed. All patients were treated with intensive chemotherapy regimens including VPDL (vincristine, prednisolone, daunorubicin, L-asparaginase), CALGB (Cancer and leukemia group B), and Stanford/Northern California Oncology Group (NCOG). There was no difference of clinical features between B- and T-LBL except the frequent site of involvement. The overall response rate including complete response (28/55, 50.9%) and partial response (18/55, 32.7%) was 83.6%. Among 46 responders, 22 patients relapsed leading to 20 deaths. Partial responders showed more frequent relapse (10/18, 55.6%) than complete responders (11/28, 39.2%). The median progression-free survival (PFS) was 17 months (95% confidence interval, 11.5-22.5), and the 2-year overall survival was 52 +/- 7% with a median follow-up of 50 months (range 8-152). Treatment outcome of T-LBL and B-LBL was not significantly different in terms of response and survival. The presence of pleural effusion was significantly prognostic for overall and PFS (p < 0.05). In conclusion, clinical features and treatment outcome of Asian adult LBL were comparable to previous results, and the prognosis is still poor despite intensive chemotherapy.
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Affiliation(s)
- Myung Hee Chang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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37
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Berceanu A, Toujani S, Da Costa L, Itzhar N, Lapusan S, Bernheim A, Ribrag V. An unusual case of a lymphoblastic lymphoma with initial bilateral breast lesions but with c-myc and bcl-2 rearrangements. Leuk Lymphoma 2009; 48:415-7. [PMID: 17325907 DOI: 10.1080/10428190601114921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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38
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He MX, Zhu MH, Liu WQ, Wu LL, Zhu XZ. Primary lymphoblastic B-cell lymphoma of the stomach: A case report. World J Gastroenterol 2008; 14:3101-4. [PMID: 18494069 PMCID: PMC2712185 DOI: 10.3748/wjg.14.3101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Primary stomach lymphoblastic B-cell lymphoma (B-LBL) is a rare tumor. We describe a primary stomach B-LBL in a 38 years old female who presented with nonspecific complaints of fatigue and vomiting for 2 mo. Gastrofiberscopy revealed a large gastric ulcer, which was successfully resected. Pathology showed a lymphoblastic cell lymphoma arising from the stomach, and there was no evidence of disease at any extrastomach site. Immunohistochemical staining and gene rearrangement studies supported that the stomach tumor was a clonal B-cell lymphoma. Therefore, the diagnosis of B-LBL was made based on the stomach specimen.
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39
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Yoon DH, Sohn BS, Lee WJ, Lim SN, Kim EK, Park I, Kim KM, Jang G, Kim S, Lee DH, Huh J, Suh C. VPDL Chemotherapy for T-cell Lymphoblastic Lymphoma (T-LBL) in Adults: Comparison with Upfront Autologous Stem Cell Transplantation in a Single Center. THE KOREAN JOURNAL OF HEMATOLOGY 2008. [DOI: 10.5045/kjh.2008.43.3.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dok Hyun Yoon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byeong Seok Sohn
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wook Jin Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Nam Lim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Kyoung Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Inkeun Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyong Min Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geundoo Jang
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Shin Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Ho Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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40
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Cox DP, Treseler P, Dong R, Jordan RCK. Rare oral cavity presentation of a B-cell lymphoblastic lymphoma. A case report and review of the literature. ACTA ACUST UNITED AC 2007; 103:814-9. [PMID: 17531941 DOI: 10.1016/j.tripleo.2005.11.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 11/18/2005] [Accepted: 11/23/2005] [Indexed: 11/21/2022]
Abstract
Lymphoblastic lymphoma is an uncommon malignancy, with most cases showing a T-cell phenotype and presenting as a mediastinal mass. By contrast, B-cell lymphoblastic lymphoma/leukemia is a rare high-grade malignancy that comprises approximately 10% of all lymphoblastic lymphomas. Lymphomas of the oral cavity are rare and typically present as intraosseous lesions that are most commonly diffuse large B-cell type. Here we present what we believe is the first B-cell lymphoblastic lymphoma initially presenting in the oral cavity. The case involves a 46-year-old white woman who presented with a mass in the right mandible. This report discusses this rare malignancy, including clinical presentation, histopathologic features, immunologic profile, treatment, and prognosis. This case emphasizes the importance of recognizing rare entities that may present in the oral cavity and the impact of the disease and its management.
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Affiliation(s)
- Darren P Cox
- Department of Orofacial Sciences, University of California, San Francisco, California, USA
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41
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Abstract
Precursor B-cell lymphoblastic lymphoma (B-LBL) is a rare neoplasm composed of immature lymphocytes that demonstrate lymphoblastic morphology and express precursor and B-cell marker. It usually affects people of younger age group and causes multiple nodules on the head and neck area. The neoplasm is rare in old age. We report a case of B-LBL occurring in a 65-year-old man. He presented with multiple skin nodules on the scalp, the neck and the arm for 2 months. Histopathologic examination demonstrated diffuse dermal and subcutaneous monotonous infiltrates of medium-sized lymphoid cells with starry-sky pattern. Immunohistochemical study showed that the lymphoid cells of infiltrate showed precursor B-cell type. The patient has received combination chemotherapy three times and is being followed-up at the outpatient clinic.
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Affiliation(s)
- Ji-Yeon Kim
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
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42
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Jacobsen E, LaCasce A. Update on the therapy of highly aggressive non-Hodgkin’s lymphoma. Expert Opin Biol Ther 2006; 6:699-708. [PMID: 16805709 DOI: 10.1517/14712598.6.7.699] [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] [Indexed: 11/05/2022]
Abstract
This review focuses on the current understanding of the biology of highly aggressive non-Hodgkin's lymphomas, such as Burkitt's lymphoma, lymphoblastic lymphoma and adult T cell lymphoma/leukaemia. Specifically, this review will examine how our increased understanding of the pathophysiology of these diseases can be used to develop new therapies.
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Affiliation(s)
- Eric Jacobsen
- Dana-Farber Cancer Institute, Department of Medical Oncology, Harvard Medical School, Boston, MA, USA.
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43
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Cairo MS, Raetz E, Lim MS, Davenport V, Perkins SL. Childhood and adolescent non-Hodgkin lymphoma: new insights in biology and critical challenges for the future. Pediatr Blood Cancer 2005; 45:753-69. [PMID: 15929129 DOI: 10.1002/pbc.20342] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pediatric non-Hodgkin lymphoma (NHL) is a common and fascinating group of diseases with distinctive underlying genetic events that characterize the major histologic subtypes: diffuse large B-cell lymphoma, Burkitt lymphoma, anaplastic large cell lymphoma and lymphoblastic lymphoma. With systematic improvements in therapy over recent decades, the vast majority of children with NHL of all subtypes are now cured. The similarities and differences between adult and childhood presentations of disease, and whether or not some subtypes of NHL and leukemia are the same or different disease entities, are interesting questions that will be addressed with advances in our understanding of the molecular and genetic bases of these diseases. As is the case with other pediatric malignancies, growing emphasis is now being placed on the development of less toxic, targeted therapeutic approaches, and this review highlights some of the biological discoveries that will potentially open these avenues.
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Affiliation(s)
- Mitchell S Cairo
- Department of Pediatrics, Columbia University, New York, NY 10032, USA.
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44
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Nagasaki A, Miyagi T, Nakazato T, Taira N, Ohshima K, Kikuchi M, Takasu N, Masauda M. Very late central nervous system relapse in a patient with B cell lymphoblastic lymphoma. Acta Haematol 2004; 112:212-6. [PMID: 15564734 DOI: 10.1159/000081275] [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: 02/19/2004] [Accepted: 05/06/2004] [Indexed: 11/19/2022]
Abstract
Very late relapse of lymphoblastic lymphoma (LBL) is very rare. We report a case of a patient who developed central nervous system (CNS) relapse of LBL 16 years after the onset of the primary disease. An 8-year-old girl was hospitalized with a skin tumor in the occipital region on November 27, 1984. Examination of a biopsy of the skin tumor showed typical features of non-Hodgkin's lymphoma (diffuse medium-sized cell type). She received multiagent chemotherapy and went into remission. On July 4, 2000, she was hospitalized with persistent headache. Cranial magnetic resonance imaging showed a cerebellar lesion, which was hypointense on T1-weighted images and of heterogeneous intensity on T2-weighted images. A midline suboccipital craniotomy was performed and pathological examination revealed a diffuse proliferation of lymphoid cells, which were positive for terminal deoxynucleotidyl transferase, but negative for CD45RO, CD3 and CD20. Tumor cells stained positively for CD10, CD22, CD38 and HLA-DR. Revised immunohistochemistry of the primary specimens of skin tumor obtained 16 years earlier revealed a phenotype similar to that of the CNS disease. Polymerase chain reaction products for the immunoglobulin gene from both the skin and cerebellar specimens were an identical size. Thus, the original diagnosis of diffuse medium-sized lymphoma was revised to B cell LBL. An isolated CNS relapse of LBL was apparent in the present case. After salvage chemotherapy, the patient underwent high-dose chemotherapy with autologous peripheral blood stem cell support and subsequent craniospinal irradiation. She went into a lasting complete remission.
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Affiliation(s)
- Akitoshi Nagasaki
- Second Department of Internal Medicine, Faculty of Medicine, University of The Ryukyus, Okinawa, Japan.
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45
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Thomas DA, O'Brien S, Cortes J, Giles FJ, Faderl S, Verstovsek S, Ferrajoli A, Koller C, Beran M, Pierce S, Ha CS, Cabanillas F, Keating MJ, Kantarjian H. Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma. Blood 2004; 104:1624-30. [PMID: 15178574 DOI: 10.1182/blood-2003-12-4428] [Citation(s) in RCA: 184] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Therapy of lymphoblastic lymphoma (LL) has evolved with use of chemotherapy regimens modeled after those for acute lymphocytic leukemia (ALL). We treated 33 patients with LL with the intensive chemotherapy regimens hyper-CVAD (fractionated cyclophosphamide, vincristine, Adriamycin, and dexamethasone) or modified hyper-CVAD used for ALL at our institution. Induction consolidation was administered with 8 or 9 alternating cycles of chemotherapy over 5 to 6 months with intrathecal chemotherapy prophylaxis, followed by maintenance therapy. Consolidative radiation therapy was given to patients with mediastinal disease at presentation. No consolidation with autologous or allogeneic stem cell transplantation was performed. At diagnosis, 80% were T-cell immunophenotype, 70% were stages III to IV, 70% had mediastinal involvement, and 9% had central nervous system (CNS) disease. Of the patients, 30 (91%) achieved complete remission, and 3 (9%) achieved partial response. Within a median of 13 months, 10 patients (30%) relapsed or progressed. Estimates for 3-year progression-free and overall survival for the 33 patients were 66% and 70%, respectively. Estimates for the patients with known T-cell immunophenotype were 62% and 67%, respectively. No parameters (eg, age, stage, serum lactate dehydrogenase [LDH], beta(2) microglobulin) appeared to influence outcome except for CNS disease at presentation. Modification of the hyper-CVAD regimen with anthracycline intensification did not improve outcome. Other modifications of the program could include incorporation of monoclonal antibodies and/or nucleoside analogs, particularly for slow responders or those with residual mediastinal disease.
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Affiliation(s)
- Deborah A Thomas
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Unit 428, Houston, TX 77030, USA.
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46
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Altundag O, Yavas O, Altundag K, Gonen C, Turker A, Uner A. Unusual abdominal tumors, case 3. Primary omental T-cell lymphoblastic lymphoma. J Clin Oncol 2004; 22:1522-3. [PMID: 15084627 DOI: 10.1200/jco.2004.08.105] [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: 11/20/2022] Open
Affiliation(s)
- Ozden Altundag
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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47
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Nakagawa A, Nakamura S, Nakamine H, Yoshino T, Takimoto T, Horibe K, Ueda K. Pathology review for paediatric non-Hodgkin's lymphoma patients in Japan. Eur J Cancer 2004; 40:725-33. [PMID: 15010074 DOI: 10.1016/j.ejca.2003.09.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2003] [Revised: 08/19/2003] [Accepted: 09/03/2003] [Indexed: 10/26/2022]
Abstract
A central pathology review system with an immunophenotyping laboratory was established in Japan to support the clinical trial, the Japan Association of Childhood Leukaemia Study (JACLS) NHL-98, for patients with paediatric non-Hodgkin's lymphoma (NHL). Pathology samples from 155 clinically-suspected NHL cases were evaluated centrally initially using the Revised European-American Lymphoma (REAL) classification in a rapid review (within 2 weeks after surgery/biopsy) and then later at the consensus review (once a year). The samples were subsequently re-classified according to the new World Health Organisation (WHO) classification. After the pathology review, 96 (62%) patients were eligible for the study, and 58 of them (60%) had extra-nodal primaries. These NHL cases included B-cell lymphomas (precursor B-cell, 11; Burkitt, 18; diffuse large B-cell, 18; not otherwise specified, 3) and T/Natural Killer (NK)-cell lymphomas (precursor T-cell, 23; anaplastic large cell, 20; others, 3). There was excellent concordance in making the diagnoses (95/96, 99%) and typing (93/96, 97%) of NHL between the rapid and consensus reviews. Five cases, initially diagnosed as diffuse large B-cell lymphoma by the review, were re-classified as Burkitt lymphoma according to the immunocytochemical criteria by the WHO classification. A total of 59 (38%) cases were excluded from the study: they were Hodgkin lymphoma (7), leukaemias (11), reactive lymphoid hyperplasia (20), necrotizing lymphadenitis (7), no consensus diagnosis (1), insufficient materials (2), and others (11). This is the first report of the central pathology review from the paediatric NHL group study in Japan. Because various diseases, either neoplastic or reactive, mimicked NHL, clinically and histopathologically, the central pathology review system was critical and essential for patient enrollment and protocol assignment in our clinical trial. Through the two-step review system, highly reliable data were generated to support this study.
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Affiliation(s)
- A Nakagawa
- Department of Pathology, Aichi Medical University, Nagakute, Aichi 480-1195, Japan.
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48
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Jawa A, Mehta S, Grupp S, Kramer SS, Carpentieri DF, Dormans JP. Face and thigh swelling in a 6-year-old girl. Clin Orthop Relat Res 2003:309-18. [PMID: 14612661 DOI: 10.1097/01.blo.0000092961.12414.cb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Andrew Jawa
- Medical student, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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49
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Abstract
Lymphoblastic lymphoma (LBL) is a rare subtype of non-Hodgkin's lymphoma (NHL) with biological features similar to those of acute lymphoblastic leukaemia. In the majority of cases LBL shows a T-cell phenotype, and mediastinal tumours are the most frequent manifestation. Outcomes of LBL patients treated according to NHL or ALL-type regimens are reviewed. Since prophylaxis of CNS relapse and local recurrence emerged as important issues in the treatment of LBL the different options are discussed. Several studies have used autologous stem cell transplantation (SCT) in the primary treatment of LBL and results are reviewed. The analysis of published prognostic factors and models in LBL demonstrates that, at present, no convincing risk model is available for LBL treated according to contemporary intensive chemotherapy protocols. Therefore indications for SCT in first complete remission (CR) cannot be defined. Future prospects for improvement of treatment results in LBL include intensification of chemotherapy, definition of prognostic factors, evaluation of minimal residual disease and SCT in high-risk patients.
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Affiliation(s)
- Dieter Hoelzer
- J.W. Goethe University Hospital, Medical Clinic III, Theodor Stern Kai 7, 60590, Frankfurt, Germany
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50
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Hoelzer D, Gökbuget N, Digel W, Faak T, Kneba M, Reutzel R, Romejko-Jarosinska J, Zwolinski J, Walewski J. Outcome of adult patients with T-lymphoblastic lymphoma treated according to protocols for acute lymphoblastic leukemia. Blood 2002; 99:4379-85. [PMID: 12036865 DOI: 10.1182/blood-2002-01-0110] [Citation(s) in RCA: 167] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We treated 45 adult patients with T-lymphoblastic lymphoma (T-LBL) (age range 15-61 years) with 2 protocols designed for adult acute lymphoblastic leukemia (ALL). An encouraging cure rate of 90% was recently reported for T-LBL in children treated with a similar approach. In our study, an 8-drug standard induction was administered over 8 weeks including prophylactic cranial (24 Gy) and mediastinal irradiation (24 Gy) followed by consolidation and reinduction therapy. At diagnosis, 91% of the 45 patients showed a mediastinal tumor and 40% had pleural/pericardial effusions; 73% of the patients had stage III/IV disease. Overall, 42 patients (93%) achieved a complete remission (CR), 2 patients (4%) achieved a partial remission, and 1 patient (2%) died during induction. In patients with stage I-III disease (n = 18) the CR rate was 100% compared with 89% in stage IV (n = 27). There were 15 patients who relapsed (36%) within 12 months. The majority of relapses (47%) occurred in the mediastinum (n = 7) despite mediastinal irradiation with 24 Gy in 6 out of 7 patients. The estimates for overall survival, continuous CR, and disease-free survival at 7 years are 51%, 65%, and 62%, respectively. Stage, age, lactate dehydrogenase, and all other parameters had no influence on achievement of CR or outcome. This study demonstrates in a large cohort of patients with adult T-LBL that a high CR rate and a favorable outcome can be achieved with an ALL-type regimen. Mediastinal recurrence was the major obstacle and further improvement by intensification of chemotherapy, increased dose of mediastinal irradiation (36 Gy), and extended indications for stem cell transplantation seem to be required.
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Affiliation(s)
- Dieter Hoelzer
- Medical Clinic III, Department of Hematology, University of Frankfurt, Germany.
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