Extranodal non-Hodgkin's lymphoma

Primary extranodal diffuse large B-cell lymphoma in the rituximab era: a single center, retrospective analysis

OBJECTIVES

To analyse the clinical characteristics and therapeutic response of Chinese patients with primary extranodal diffuse large B-cell lymphoma DLBCL (PE-DLBCL).

METHODS

We analysed the clinical features and outcomes of 197 patients who were newly diagnosed with PE-DLBCL between January 2015 and December 2020.

RESULTS

The gastrointestinal tract showed the highest rate of involvement (34%), followed by the central nervous system (CNS) and intraocular system (31.5%). The 3-year overall survival (OS) rate was 81% for the entire group and 79% for those with CNS and vitreoretinal involvement. Ann Arbour stage, lactate dehydrogenase level, International Prognostic Index > 2, and complete remission (CR) were significantly related to the survival of patients with PE-DLBCL. The lack of CR was the only independent adverse prognostic factor for OS.

CONCLUSION

The clinical outcomes of patients with PE-DLBCL at our centre were encouraging, especially for patients with CNS and vitreoretinal involvement.

Clinical Characteristics, Outcomes, and Risk Factors for Patients with Diffuse Large B-Cell Lymphoma and Development of Nomogram to Identify High-Risk Patients

OBJECTIVES

To analyse the clinical features, outcomes, and risk factors of patients with diffuse large B-cell lymphoma (DLBCL) in China, with the aim to establish a new prognostic model based on risk factors.

METHODS

Clinical features and outcomes of 564 patients newly diagnosed with DLBCL from Jan 2009 to May 2017 were analyzed retrospectively. Variables were screened by LASSO regression and nomogram was constructed.

RESULTS

The 5-year overall survival (OS) of the cohort was 75%. The 5-year OS of patients differentiated by International Prognostic Index (IPI) score was 90% (score 0-2), 73% (score 3), and 51% (score 4-5), respectively. Age > 60, Eastern Cooperative Oncology Group (ECOG) > 1, Ann Arbor stage III-IV, bone marrow involvement, low level of albumin (ALB), and lymphatic/monocyte ratio (LMR) were independent predictors of OS. The predictive model was developed based on factors including age, bone marrow involvement, LMR, ALB, and ECOG scores. The predictive ability of the model (AUC, 0.77) was better than that of IPI (AUC, 0.74) and NCCN-IPI (AUC, 0.69). The 5-year OS of patients in the low-, intermediate-, and high-risk groups identified by the new predictive model was 89%, 70%, and 33%, respectively.

CONCLUSIONS

The new prediction model had better predictive performance and could better identify high-risk patients.

Primary extra-nodal diffuse large B-cell lymphoma: A prognostic analysis of 141 patients

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of lymphoma. Approximately 40% of DBLCL originates from extra-nodal sites, but the diversity of clinical presentations and the genetic and molecular alterations indicate that extra-nodal DLBCLs may be distinct disease entities. The aim of the present study was to highlight the various aspects of primary extra-nodal DLBCL (PE-DLBCL) based on a single center cohort. The data from 141 patients with PE-DLBCL treated at Peking Union Medical College Hospital were retrospectively evaluated. The primary extra-nodal sites involved were the gastrointestinal tract (n=42), central nervous system (CNS; n=38), breast (n=19), adrenal gland (n=15), female genital system (FGS; n=12), thyroid (n=8) and bone (n=7). The median overall survival rate was 28 months (range, 1–116). Multivariate analysis demonstrated that an International Prognostic Index (IPI) ≤2 (P=0.049), complete remission (CR) achieved following first-line therapy (P=0.001) and chemotherapy combined with rituximab (P<0.001) were positive prognostic factors. Patients with DLBCL with primary adrenal gland or female genital system (FGS) involvement exhibited a significantly higher risk of CNS recurrence (P<0.05). Rituximab treatment may have reduced the likelihood of CNS recurrence (P=0.005), whereas prophylaxis with intrathecal injection alone was not sufficient for prevention (P>0.05). In conclusion, IPI >2 and the lack of a CR following first-line therapy were independent prognostic risk factors for PE-DLBCL. Patients with primary adrenal gland or FGS involvement exhibited a higher risk of CNS relapse. Rituximab had a positive impact on the survival of patients with PE-DLBCL, also reducing the likelihood of CNS relapse.

Primary Hodgkin's Disease of the Stomach. A Case Report

Primary gastric Hodgkin's disease is rare and has been reported in only 2 % of patients with primary gastric lymphomas. Its existence is quite controversial, and new immunohistochemical techniques and flow cytometry have reduced the frequency of diagnosis of this pathology. The authors describe a case of primary gastric Hodgkin's disease in a 61-year-old woman.

Gastric infiltration of diffuse large B-cell lymphoma: Endoscopic diagnosis and improvement of lesions after chemotherapy

Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of the non-Hodgkin’s lymphoma (NHL) accounting for about 40% of all NHLs. This is a case report about the endoscopic appearance of a DLBCL with infiltration to the stomach in a 39-year-old female. She had a 6-mo history of lumbar and left upper quadrant pain with intermittent episodes of melena. A computer tomography (CT) scan showed mural thickening of the gastric antrum. Endoscopic examination revealed multiple gastric ulcers. Definite diagnosis could be made by endoscopic biopsies and the patient had a good response to chemotherapy. This response correlated well with a further endoscopic follow-up. A follow-up endoscopic examination could be considered to evaluate a good response to chemotherapy in DLBCL patients with secondary gastric dissemination.

Non-Hodgkin's lymphoma of the sphenoid sinus presenting as isolated oculomotor nerve palsy

Background

Solitary involvement of the sphenoid sinus has rarely been reported in non-Hodgkin's lymphoma. Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus.

Case presentation

A 53-year-old woman presented with a three-month history of headache and diplopia. Neurological examination revealed complete left oculomotor nerve palsy. Magnetic Resonance Imaging (MRI) demonstrated a homogenous soft-tissue lesion occupying the left sphenoid sinus and invading the left cavernous sinus. The patient underwent transsphenoidal biopsy and the lesion was histologically diagnosed as non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20 and negative for CD3. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. There was no enhancing lesion noted on follow-up MRI.

Conclusion

It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare. The cranial nerve deficits can resolve dramatically after chemotherapy.

Clinicopathologic features and prognostic factors of primary extranodal non-Hodgkin's lymphomas in Turkey

Clinical, histopathologic, and prognostic features of 114 patients with primary extranodal non-Hodgkin's lymphoma were evaluated. Median age of the patients was 48 (range, 15-76) and the ratio of male/female was 55/59. Thirty-seven patients had stage 1, 55 patients stage II, 6 patients stage III, and 16 patients stage IV. The most common sites of primary extranodal non-Hodgkin's lymphoma were the gastrointestinal (GI) tract and head-neck region. Stomach (66%) and tonsils (33%) were the most frequently involved organ in GI tract and head-neck region, respectively. Eighty percent of patients had intermediate or high-grade lymphomas, 20% had low-grade subtypes. Complete remission was achieved in 83% of all patients with chemotherapy +/- radiotherapy +/- surgery. Overall and disease-free survival at 5 years were 63% and 59%, respectively. In conclusion, clinical and histopathologic characteristics and prognosis of our cases with primary extranodal non-Hodgkin's lymphoma were usually similar to those of the cases in Western countries with some differences in the incidence of some specific primary extranodal non-Hodgkin's lymphomas and in the histopathologic subtypes.

Extranodal non-Hodgkin's lymphoma of the head and neck: presentation in the facial bones

1. The most common site of ENL is the head and neck, with Waldeyer's ring and specifically, the tonsil, standing as the most frequent area of involvement. Most patients have intermediate or high-grade histologies. 2. Patients present with identical signs and symptoms as squamous cell carcinoma of the head and neck, underscoring the importance of a thorough otolaryngological examination. 3. Biopsy samples should be submitted as fresh and permanent samples specifically labeled for lymphoma evaluation. 4. A thorough and timely staging work-up should be conducted once a positive biopsy diagnosis is obtained. 5. Treatment consists of radiation and/or chemotherapy. Prognosis depends on histology, stage, and site of lesion. Newer treatment strategies may lead to improved survival for patients with head and neck NHL.

Primary extranodal non-Hodgkin's lymphoma in adults: clinicopathological and survival characteristics

Among 318 cases of non-Hodgkin's lymphoma (NHL) treated in our unit, 145 (45.6%) had primary extranodal NHL (PE-NHL). The stomach was the most common site (42.1%), followed by the PE-NHL of the head and neck region. Histologically aggressive histologies (65.5% intermediate and 20.7% high grade) predominated. 89.6% of the cases were localized (stage IE, 51% and stage II, 38.6%) but 28% had B symptoms. CR was achieved in 82.1% of the cases. 5-years disease free survival and overall survival were both 65%. Factors that influence prognosis were stage and high grade histology. Among various primary sites the Waldeyer's ring, small intestine and testes had the worse prognosis. Compared to nodal NHL, the PE-NHL were more frequently localized, belonged more often to aggressive histologies and had more often distal extranodal relapses. CR rates and disease free and overall survival were significantly better for PE-NHL. The survival rates, however, listed according to stage and histology for nodal and PE-NHL were not different. We conclude that although PE-NHL differed from nodal NHL in several respects, prognosis is mainly a factor of stage and histology rather than of the primary localization per se.

Immunophenotypic analysis of extranodal non-Hodgkin's lymphomas in the oral cavity

Fifty cases of extranodal non-Hodgkin's lymphoma arising in the oral cavity were reclassified using the updated Kiel classification. In order to determine the antigenic phenotype of the proliferating cells in oral lymphoma, we used a panel of paraffin effective antibodies that are known to react with lymphocyte- and histiocyte-associated antigens. The median age of the patients was 53 years, with a male predominance (M:F = 1.9: 1). The great majority of oral non-Hodgkin's lymphomas were B-cell lymphomas. There were 12 low-grade B-cell lymphomas (comprising one mucosa-associated lymphoid tissue, four centrocytic and seven centroblastic-centrocytic lymphomas) and 25 high-grade tumors (comprising 17 centroblastic, two immunoblastic, two Burkitt's and four lymphoblastic lymphomas). All 37 B-cell malignancies showed reactivity for L 26 and KiB 3. A monotypic immunoglobulin staining pattern, as revealed by light chain restriction, was found in 21 cases (57%) of the non-Hodgkin's lymphomas confirming their B-cell origin. Furthermore, monotypic staining for kappa-chain predominated (16/21 kappa, 5/21 lambda). Only a small number (6 cases) was of T-cell lineage and all cases showed positive reaction for UCHL 1, MT 1 and DFT 1. In one of six T-cell lymphomas, Ber-H 2 positive anaplastic large cell lymphoma was detected. Such a case was documented for the first time in the primary extranodal non-Hodgkin's lymphoma of the oral cavity. Five cases could be assigned with certainty to the histiocytic system. These cases were positive for cathepsin D and KP 1 LN 3, which recognized Ia (HLA-DR) antigens, was demonstrated most frequently in high-grade B-cell lymphomas, T-cell lymphomas and true histiocytic lymphomas.

HTLV-I induced extranodal lymphomas

HTLV-I induced not only nodal but also primary extranodal lymphomas. In this report we describe 12 patients with HTLV-I induced extranodal T-cell lymphoma collected from the literature and our institute experience. There were 5 males and 7 female patients of middle age positive for HTLV-I antibody. The sites of primary tumor were gastrointestinal, Waldeyer's ring, skin, facial sinuses, and the pleura. All of these were histologically diffuse lymphomas and most of them were found to be a helper/inducer T-cell phenotype, showing integration of HTLV-I proviral DNA. Late leukemic changes and skin infiltration often occurred, but hypercalcemia was rare. Survival time varied from 4 to 35 months, and late organ infiltrations were common. These HTLV-I induced extranodal lymphomas were compared with HTLV-I unrelated extranodal lymphomas or HTLV-I induced nodal lymphomas (lymphoma type ATL). Between 1981 and 1990, we had 110 ATL patients and of these, 5 (4.6%) were HTLV-I induced primary extranodal lymphomas. The frequency of HTLV-I induced extranodal lymphoma might be much higher than expected because until now attention has not been paid to this entity. From the present review, it is suggested that HTLV-I could cause primary extranodal lymphoma which may have some different characteristics from other types of lymphoma. Therefore, patients with T-cell extranodal lymphomas should be investigated further for the presence of HTLV-I antibody and the tumor cells should be examined for the integration of HTLV-I proviral DNA using Southern blot analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Post renal transplantation non-Hodgkin's lymphoma: Local experience and review of the literature

Among a population of 600 renal transplant patients, only three cases (0.5%) have developed a non-Hodgkin's lymphoma, while in the same population, 28 cases (4.6%) have developed a Kaposi's sarcoma. The significant low incidence of lymphoma in the Saudi grafted population must be underlined, particularly because of the very high incidence of this malignancy among either the post-transplant Western population, up to 20% of the cancers, or the Saudi general population where the incidence can reach 15% of malignancies.

Epstein-Barr virus antibody patterns preceding the diagnosis of non-Hodgkin's lymphoma

Immunosuppressed patients who develop non-Hodgkin's lymphoma (NHL) have abnormal antibody responses against the Epstein-Barr virus (EBV) prior to the diagnosis of malignancy. To see if this is also true of "spontaneous" cases in the general population, we undertook a collaborative serologic case-control study. From 4 serum banks containing specimens from over 240,000 persons, 104 subjects were identified for whom a blood specimen had been stored an average of 63 months before diagnosis of NHL, and 259 controls matched for age, sex, ethnic group and date of serum collection. The relative risks (RR) for subsequent development of NHL associated with elevated levels of IgG and IgM antibodies against viral capsid antigen were 2.5 (95% confidence interval = 1.1-5.7) and 3.2 (1.3-7.5), respectively; these associations increased with age at diagnosis. For the nuclear antigen, the distribution of titers for cases was more restricted than that of controls, with fewer cases having either elevated or low titers, RR = 0.5 (0.2-1.4) and 0.5 (0.2-1.2), respectively. Cases had significantly lower antibody titers against the cytomegalovirus, RR = 0.4 (0.2-0.9). These findings suggest that, at least for some patients, NHL is preceded by an enhanced level of endogenous immunosuppression with resultant EBV activation. This observation supports the role of EBV either directly in the development of NHL or as a primary marker of immune dysfunction.

Results of radiotherapy in patients with stage I orbital non-Hodgkin's lymphoma

This paper describes the results of radiotherapy in early stage orbital non-Hodgkin's lymphoma. From 1970 to 1985, 33 orbital localizations in 30 patients were treated. The total dose applied ranged from 21 to 57 Gy (2 Gy per fraction), two-thirds of all patients received a dose of 40 Gy. The complete-response rate was 94% and the 10 years actuarial survival was 90%; no significant difference in survival was observed between patients with low grade or intermediate grade lymphoma. No local recurrence was detected during follow up and 20% of the patients developed generalized disease. Two optic nerve neuropathies and three retinopathies were observed in five patients, four of these occurred at a dose level of less than 43 Gy. Keratitis occurred in 58% of the patients treated, a sicca syndrome in 30% and cataract of different grades in 58% of the patients treated. Although local control was excellent, severe complications were observed in 13% of the patients who received a dose of less than 43 Gy.

A radiotherapeutic experience for localized extranodal non-Hodgkin's lymphoma: prognostic factors and re-evaluation of treatment modality

Between 1966 and 1988, 149 patients were treated with radiotherapy for localized extranodal lymphoma. The average total dose given was 39.8 Gy for low grade disease and 48.7 Gy for all other disease. Of the 149 patients, 60 also received adjuvant chemotherapy. Twenty-four had low grade lymphoma, 109 had intermediate grade disease, and 16 had high grade disease, histologically. The distribution of histological grade and T/B phenotype varied with the primary site. Low grade lymphomas were found mainly in the orbit, and T-cell lymphomas were found in the nasal cavity and nasopharynx. The 5-year survival rates according to tumor location were 89% for oral cavity, 86% for paranasal sinus, 83% for thyroid, 69% for orbit, 47% for Waldeyer's ring (WAR), 44% for testis, 23% for CNS, 21% for nasal cavity and 60% for other sites. Histological grade and T/B phenotype both had prognostic importance. Combined chemotherapy significantly improved the survival rate only for disease with intermediate or high grade histology. Other prognostic factors according to the primary site were the bulk of lymph node for WAR disease, the radiation dose for CNS disease, bone erosion for orbital disease, stridor for disease of the thyroid, and the tumor stage for disease of both the testis and the thyroid.

Gastrointestinal lymphoma

Primary GI lymphoma is a rare clinical entity. A primary nodal tumor should be ruled out. Symptoms may not be localizing and B symptoms are less common. A tissue diagnosis, preferably by transmural biopsy for small intestinal involvement, often reveals a high-grade morphology. The staging work-up should include a bone marrow examination, although formal staging laparatomy is not always required. Patients with Mushoff stage IE or IIE1 disease do better than those with extraregional nodal disease or distant metastatic involvement. Surgical resection with clear margins is required in order to maximize the changes for cure. Chemotherapy or radiotherapy may give a survival advantage when used as adjuvant treatment for selected stage IE and IIE disease. Chemotherapy should be used after surgical debulking in more advanced disease in order to minimize the chance for bleeding or performation. Future randomized, multi-institutional trials will give more direction as to the best modes of management.

Primary malignant lymphomas of the spleen. A morphologic and immunohistochemical analysis of 17 cases

Seventeen cases of primary malignant lymphoma of the spleen (PMLS) were identified among 500 splenectomy specimens showing involvement by Hodgkin's disease or non-Hodgkin's lymphoma. All PMLS represented non-Hodgkin's lymphoma and most of them were of B-cell origin. In two cases PMLS were associated with hamartomas of the spleen (splenomas). Histologic and immunohistochemical studies did not reveal any differences between PMLS and disseminated malignant lymphomas with splenic involvement with regard to morphologic features, immunophenotype, host cell infiltrates, or proliferation activity. The reasons for the infrequent occurrence of primary lymphomas in the spleen may not be sought in a special immunophenotype of PMLS, a vigorous host response in the spleen, or in a lower proliferation activity of splenic lymphomas.

Primary nasal-paranasal oropharyngeal lymphoma in the pediatric age group

Nasal-paranasal oropharyngeal (NPOP) non-Hodgkin's lymphoma (NHL) is a disease of the very young (median age, 5 years) and of the aging adult (median age, 50-60 years). Of a total of 208 pediatric patients with NHL studied, 20 (9.6%) had primary NPOP. Sixty percent of the patients had Stage I and II disease. Primary sites were maxillary sinus in eight patients; tonsils in eight; posterior pharynx in two; mandible in one; and orbit in one patient. Histologically, the disease is different than that of the adults since most patients had B-cell lymphomas of the diffuse undifferentiated type (Rappaport) or small cell non-cleaved types (Lukes-Collins, Kiel, and Working Formulation). None of these patients had gastrointestinal involvement. All patients were treated with the LSA2-L2 regimen and radiation therapy was given to primary unresectable tumors and regional metastases. The lymphoma event-free survival was 75%, with a median observation period of 99+ months. In staging systems that refer mostly to amount of disease outside of the primary (such as ours, Murphy's, and the Ann Arbor staging systems) stage did not correlate well with disease-free survival. In the TNM staging of 1977, a staging system that refers to size of primary tumor as well as regional and systemic disease, stage correlated better with prognosis and survival. In our staging system, eight of 12 patients (66.7%) with Stage I and II disease; four of four with Stage III; two of two with Stage IVA; and zero of two with Stage IVB survived. In the TNM staging system, three of three patients with Stage II and III disease and 12 of 18 patients (67%) with Stage IV disease survived. All recurrences occurred early suggesting that early intensification of chemotherapy may produce better results.

Combined surgery and chemotherapy for the treatment of primary gastrointestinal intermediate- or high-grade non-Hodgkin's lymphomas

Fifty-five consecutive patients with primary gastrointestinal intermediate or high grade non-Hodgkin's lymphoma were analysed to assess the efficacy of chemotherapy following surgical tumour resection. Histological subtypes were high grade (n = 18), intermediate grade (n = 36) and unclassified (n = 1). The majority of patients had gastric presentation (71%) and localised disease (84%). Surgery consisted of radical resection in 25 patients (45%) and partial or palliative excision in the remaining cases (22 and 8 respectively). Four subjects died within 3 months of surgery, two patients refused adjuvant chemotherapy and 49 completed the postoperative chemotherapeutic programme. Chemotherapy included either Fi2/74 (adriamycin + vincristine + bleomycin + cyclophosphamide + prednisone) or Fi3/74 (adriamycin + VM26 + bleomycin + cyclophosphamide + prednisone). Excluding the group who underwent radical tumour resection, postoperative chemotherapy induced complete remission in 81% of the remaining 30 patients. The 10-year cause-specific survival for the 53 treated patients was 76% (median follow-up 58 months) with a stable curve plateau after 80 months. Proportional-hazard multivariate statistics showed that survival was influenced by type of surgical resection (P less than 0.05) and stage (P less than 0.05), whereas age, sex and histological subtype were not influential. Our data indicate that chemotherapy following surgical resection of gastrointestinal lesion induces long-term remission in primary gastrointestinal lymphomas.

Stage IE nonHodgkin's lymphoma of the testis: a need for a brief aggressive chemotherapy

Primary nonHodgkin's lymphoma of the testis is a localized disease in 50 per cent of the cases. Clinical records and pathological material from 9 stage IE cancer patients treated at our institutions were reviewed. All but 1 patient had B cell type lymphomas of intermediate (6) or high (3) grade according to the Working Formulation. Mean survival was 49 months and actuarial survival was 74 per cent at 5 years. Chemotherapy differed with time and frequently was associated with subdiaphragmatic involved field and prophylactic contralateral testis radiotherapy. In view of the good prognosis of patients receiving doxorubicin-based chemotherapy and recent reports on low stage nonHodgkin's lymphoma we recommend an aggressive brief therapy for stage IE lymphoma of the testis after orchiectomy.

Malignant lymphomas of the nasal cavity and paranasal sinuses

The incidence of malignant lymphomas in the nasal cavity and paranasal sinuses was found to be 0.17% of all malignant lymphomas and 0.44% of all extranodal malignant lymphomas registered in the Kiel Lymph Node Registry from 1972 to 1987. Fifty-nine cases of malignant lymphoma presenting in the nasal cavity and paranasal sinuses were investigated with morphological and immunological methods. The median age of the patients was 64.5 years, with a female predominance (m:f = 0.87:1). In the 59 cases a marked preponderance of B-cell lymphomas was found (centroblastic n = 15, immunoblastic n = 8, Burkitt's lymphoma n = 6, Immunocytoma n = 3, centrocytic n = 1, centroblastic/centrocytic n = 1, plasmacytic n = 11); only a small number (n = 5) was of T-cell lineage (pleomorphic types). Nine further cases could not be assigned with certainty to either the T or B cell system. Angiocentricity with infiltration and destruction of vessel walls by tumour cells was demonstrated only in the T-cell lymphomas; the B-cell lymphomas, in contrast, often surrounded and compressed blood vessels with intact endothelium. No similarity to malignant lymphomas of mucosa associated lymphoid tissue, such as those in the gastrointestinal tract, was detected.

Primary prostatic involvement in non-Hodgkin lymphoma

We report 3 cases of primary extranodal lymphoma of the prostate, an unusual extranodal presentation rarely diagnosed antemortem. Symptoms of prostatism associated with an enlarged hard prostate with pyuria and hematuria in younger patients should suggest the diagnosis. Urine cytologic examination should aid in the diagnosis of this condition.

Radiotherapy versus radiotherapy plus chemotherapy in stages I and II non-Hodgkin's lymphoma of the upper digestive and respiratory tract

From 1975 through 1985 88 patients with a primary manifestation of non-Hodgkin's lymphoma in the upper digestive and respiratory tract were referred to our hospital. Fifty-seven of them were in Stage I or II. The results of therapy in 48 evaluable patients are the subject of this retrospective study. Low, intermediate, and high grade malignant histologic features were encountered in 6, 27, and 15, respectively. The authors compared retrospectively the patients treated with radiotherapy (RT) with those who received additionally chemotherapy (RT + CT). Patients have been followed for a minimum of 1 year. Four of 29 patients with intermediate-grade or high-grade malignant lymphoma treated with CT and RT relapsed whereas eight of 13 patients treated with RT alone relapsed. Actuarial survival curves differed significantly in favour of the CT and RT group. These figures were also significant when the high-grade lymphomas plus centroblastic lymphomas were considered. It is recommended to add CT to RT in both Stage I and II NHL of high-grade and intermediate-grade malignancy.

Stage I and II Waldeyer's ring and oral-sinonasal non-Hodgkin's lymphoma

Sixty-six patients with Ann Arbor Stage I and II Waldeyer's ring and oral-sinonasal non-Hodgkin's lymphoma are presented. Ten-year survival was better for the 32 patients with Waldeyer's ring non-Hodgkin's lymphoma (Stage I, 83%; Stage II, 75%) than for the 34 with oral-sinonasal non-Hodgkin's lymphoma (Stage I, 47%; Stage II, 50%). Diffuse large cell lymphomas were common in patients with Waldeyer's ring involvement (59%). In those affected in the oral-sinonasal region, 38% had high-grade lymphoma. There was a high incidence of extranodal relapses outside of the gastrointestinal tract in patients with oral-sinonasal lymphoma (10 cases). Gastrointestinal tract relapse occurred commonly in patients with Waldeyer's ring lymphoma and was found in five cases.

Primary extranodal non-Hodgkin's lymphoma

A total of 52 of 238 patients (22%) with non-Hodgkin's lymphoma presented with disease in a primary extranodal site. The gastrointestinal tract was the commonest site involved (50%) and diffuse large cell was the commonest histological sub-type of the lymphoma (64%). Survivorship analysis of these patients, treated predominantly with chemotherapy, suggests that long-term survival is associated with: low-grade malignancy--median survival greater than 120 months; localized disease or spread of disease confined to the regional lymph nodes--median survival 65.5 months; and the use of aggressive combination chemotherapy for intermediate grade malignancy when the disease is localized or spread is confined to the regional lymph nodes--median survival greater than 110 months.

Combination chemotherapy only for stage II non-Hodgkin's lymphoma

Twenty-six previously untreated patients with clinical stage (CS) II B non-Hodgkin's lymphoma (NHL) were treated with systemic chemotherapy only. Patients received bleomycin, adriamycin, cyclophosphamide, vincristine and prednisone (BACOP). All patients had intermediate- or high-grade lymphoma. Objective response was demonstrated in 25 patients (96%), with 21 patients (81%) achieving complete remission (CR). Two of CR patients developed unsalvageable relapse, the remaining 19 patients are still alive and disease-free. The median duration of CR has not been reached. Of four patients (15%) with documented partial remission (PR), three were salvaged using second-line therapy. Over a median follow-up of 12 months (range, 3-30), 22 patients (85%) are alive and disease-free, of whom 16 (62%) have survived more than 1 yr. Bulky disease or gastrointestinal tract (GIT) involvement did not influence the CR rate. Our results compared favorably with radiation therapy for stage II NHL; however, a larger controlled and randomized study is warranted.

Non-Hodgkin lymphoma arising in lower urinary tract

Primary involvement of the bladder and prostate by non-Hodgkin lymphoma is exceedingly rare. Usually bladder lymphoma can be cured by aggressive local therapy, but the prognosis of prostatic lymphoma is poor. The devastating clinical course of a young man with primary lymphoma involving the prostate and bladder base is reported to emphasize the heterogeneity of this group of tumors and to encourage precise tumor classification. Prognosis depends on the tumor stage and the specific lymphoma cell-type as defined by conventional histologic and immunologic criteria. Management should be tailored according to tumor grade, stage, and site.

Non-Hodgkin's lymphomas presenting with gastrointestinal involvement

Between 1978 and 1983 a total of 33 patients with non-Hodgkin's lymphoma (NHL) involving the gastrointestinal tract were seen in our institution. Pathological classification was performed according to Kiel. Low grade NHL was diagnosed in 17, high grade NHL in 16 patients. The most frequent histological entity was lymphoplasmocytoid immunocytoma (11 patients). The most common sites of origin were the stomach (23 patients) and the ileocecal region (6 patients). The majority of patients presented with stage I and II disease (20 of 33 patients). As a rule primary therapy consisted of surgery with curative intent. Most of the patients received additional chemotherapy or radiotherapy. Patients with limited disease and complete tumour resection showed long-term survival from 12+ to 57+ months (mean 32.9+ months). Patients with advanced disease (stage III and IV) and only palliative surgery or with lymphoblastic lymphoma had a probability of survival of less than 12 months.

Radiochemotherapy for non-Hodgkin's lymphoma in palatine tonsil

From January 1966 to December 1980, 367 cases of non-Hodgkin's lymphoma (NHL) were autopsied at Kobe University Hospital. The rate of extranodular type was 76.7% and the most common site of origin was the palatine tonsil. Of 133 patients with NHL in the palatine tonsil, at the Kobe University Hospital 110 were treated. All of the patients were treated by irradiation. Sixty-one patients were treated by irradiation alone. Forty-nine patients were treated in addition with conventional chemotherapy using vincristine, cyclophosphamide, endoxan a, and prednisolone. In 14 of 49 patients, adjuvant immunochemotherapy using a Streptococcus pyogenes (OK-432) was added at maintenance dose in combination with induction radiochemotherapy. The survival curve of the patients treated by radiochemotherapy is better than that of the patients treated by irradiation alone. The survival rates at 0 to 1, 1 to 2, and 2 to 3 years for the patients treated by radiochemotherapy were 81.5, 66.3, and 59.0%, respectively, significantly higher than those of the radiotherapy group. The 5-year survival rates of the radiotherapy group were 50.2% for Stage I and 26.5% for Stage II patients. The rates increased to 78% and 41.8% by radiochemotherapy. The extranodal NHL of Stage II also frequently develops into the advanced stage and adjuvant chemotherapy is necessary for such patients.

Prognostic factors for non-cleaved follicular center-cell lymphomas and immunoblastic sarcoma. A Bayesian approach

The Bayesian multivariate statistical method was applied to determine the relative strength and optimal combination of 17 variables in predicting survival of 151 patients with non-Hodgkin's lymphomas assigned as non-cleaved follicular center-cell and immunoblastic sarcoma types according to the classification of Lukes & Collins. Considering all the factors simultaneously, the analysis showed that the combination of stage, Hb level and location of the lymphoma was included in the best predictive model at each survival time studied. Additional factors were erythrocyte sedimentation rate, thrombocyte count and leucocyte count. Of the histological variables, only growth pattern and mitotic ratio in the biopsy specimen remained significant. At manually controlled computer simulation with these best indicators, this model would have given a correct classification for 69-78% of the patients at the 4 survival times studied. One can thus expect about 70% correct prognoses using this model.

[Non-Hodgkins's lymphomas - current aspects of clinical diagnosis and therapy]

Non-Hodgkin-Lymphomas (NHL), classified according to "Kiel" or Rappaport", may be subdivided into those with low or with high malignancy. Corresponding to clinical stage and to histological subtype, therapeutic recommendations are discussed. 1. Limited stage: An irradiation with curative intention seems possible. In cases with unfavourable histology relapses are frequent, and an additional or exclusive therapy with cytostatics appears to be of increasing importance. 2. Advanced stages and favourable histology: The value of an early and intensive use of cytostatics is questioned. 3. Advanced stages and unfavourable histology: Cure of the lymphoma seems feasible when intensive cytostatic regimes are applied.

Primary gastric lymphomas. A clinicopathologic study of 58 cases with long-term follow-up and literature review

A large series of primary gastric lymphomas with long-term follow-up (average, 12.8 years) is reported. A number of factors known to affect nodal lymphoma were examined. Five- and ten-year survival rates were 57 and 46%, respectively. Statistically significant favorable prognostic variables were smaller tumor size (less than or equal to 7 cm), superficial mural invasion (submucosal only), and pathologic Stage I disease; these variables were intimately interrelated. A favorable influence on survival was discerned concerning histologic type and nodular histology, although still below statistical significance. No significant relation to survival was observed concerning clinical weight loss or palpable mass, vascular invasion, mode of therapy, or histologic subtypes of "histocytic" lymphoma. Of patients who succumbed to disease, 75% did so within two years (average, 1.8 years); however, later recurrence and death may occur. An argument for resection of localized disease is presented. Mitotic index and nuclear diameter were of diagnostic importance, and associated lesions such as pseudolymphomas are discussed in relation to pathogenesis. Histologic variation within tumors suggested visualization of clonal development in non-Hodgkin's lymphomas.

Nasal T-cell lymphoma as a type of so-called "lethal midline granuloma"

Six cases were described in which an initial clinical diagnosis of "rhinitis gangrenosa progressiva" or lethal midline granuloma was made. The histological examinations of their surgical and autopsy specimens proved that their nasologic diseases could all be identified as malignant lymphoma arising from the nasal cavity, showing the general histologic characteristics reported for T-cell lymphomata derived from peripheral T-cells. This histologic observation was then confirmed by immunofluorescence studies using various antisera directed toward either human T- or B-cell-surface antigens. These studies clearly demonstrated that their malignant cells bore human Ly-l-like antigen but lacked human TL-like and Ia-like antigens as well as surface-bound immunoglobulins, indicating their peripheral T-cell origin. These data may suggest that so-called "rhinitis gangrenosa progressiva" or lethal midline granuloma contains at least two distinct disease categories, one of which is Wegener's granulomatosis, and the other of which is nasal T-cell lymphoma as described herein.