Progression of a hepatosplenic gamma delta T-cell leukemia/lymphoma on hyperCVAD/MTX and ara-C: literature review and our institutional treatment approach

Case report of primary CD20 negative diffuse large B-cell lymphoma

Few groups of aggressive non-Hodgkin's lymphomas (NHL) that are refractory to standard chemotherapy are rarely reported. Primary CD20 negative diffuse large B cell lymphoma (DLBCL) without human immunodeficiency virus infection is an uncommon presentation and this case report is challenging in terms of diagnosis and treatment as well.

18F-FDG PET/CT findings in hepatosplenic Gamma-Delta T-cell lymphoma: case reports and review of the literature

Hepatosplenic Gamma Delta T cell lymphoma (γδHSTL) is a rare, highly aggressive, and rapidly lethal T cell lymphoma which manifests ¹⁸F-FDG PET/CT findings that can mimic benign conditions. Patients with γδHSTL present with unexplained symptoms of a hematologic malignancy like the B symptoms of lymphoma including weight loss, fevers, and night sweats, as well as, splenomegaly and hepatomegaly. Thrombocytopenia, anemia, or neutropenia are also common due to spleen, liver and bone marrow involvement. The peripheral blood, however, typically does not show abnormal T cells. The clinical and ¹⁸F-FDG PET/CT findings are presented for 3 patients with γδHSTL. Patients with γδHSTL may have a normal ¹⁸F-FDG PET/CT or an ¹⁸F-FDG PET/CT with any combination of the three findings: splenomegaly with intense FDG uptake; hepatomegaly with increased FDG uptake; and diffuse, increased FDG uptake in the bone marrow. Importantly, lymphadenopathy is usually absent, and most patients show morphologically normal lymph nodes with normal FDG uptake. Due to the aggressive nature of the disease, γδHSTL is a critical diagnosis to consider in patients who present with clinical signs of suspected hematologic malignancy and variable ¹⁸F-FDG PET/CT findings. The absence of lymphadenopathy and normal FDG uptake in lymph nodes are typical pertinent negative findings that differentiate γδHSTL from other lymphomas. A bone or liver biopsy is frequently necessary to establish the diagnosis and should be recommended.

Diagnosis and treatment of CD20 negative B cell lymphomas

CD20 negative B cell non-Hodgkin lymphoma (NHL) is rare and accounts for approximately 1-2% of B cell lymphomas. CD20- negative NHL is frequently associated with extranodal involvement, atypical morphology, aggressive clinical behaviour, resistance to standard chemotherapy and poor prognosis. The most common types of these include plasmablastic lymphoma, primary effusion lymphoma, large B-cell lymphoma arising from HHV8-associated multicentric Castleman’s disease, and ALK+ large B cell lymphoma. This review provides an overview of the diagnostic and treatment modalities for CD20 negative B cell NHL.

Progression of a hepatosplenic gamma delta T-cell leukemia/lymphoma on hyperCVAD/MTX and ara-C: literature review and our institutional treatment approach

A 24‐year‐old male presented with abdominal pain, fever, and palpable splenomegaly. His differential count revealed myelocytes, metamyelocytes, and nucleated red cells. A bone marrow biopsy confirmed a diagnosis of hepatosplenic gamma delta T‐cell leukemia/lymphoma. We describe here our center's diagnostic and treatment approach for this rare leukemia.