Extranodal lymphomas: Review of clinicopathologic and cytologic features

Pulmonary small cell carcinoma: Review, common and uncommon differentials, genomics and management

Lung cancer is the leading cause of cancer-related death worldwide. It is divided into sub-categories based upon morphology, immunostaining pattern, biology, molecular profile, and/or treatment options. Up until the early 2000s when driver mutations with targeted therapies were identified in a subset of adenocarcinomas, the most critical distinction of lung carcinomas was driven by differences in treatment between small cell carcinoma (SCC) and nonsmall cell lung carcinoma (NSCLC). The distinction between SCC and NSCLC remains critical in the 21st century for management, especially for advanced stage cancer. In the vast majority of cases, morphological features are sufficient to separate SCC from other types of lung cancers. In some instances, however, cytomorphological features and immunohistochemical overlap with other tumors, limited sample availability, and/or crush artifact pose diagnostic challenges. The aim of this review is to highlight salient features of SCC and ancillary studies to distinguish it from common and uncommon potential mimickers, as well as provide updates in genomics and management.

Comparison of Diagnostic Cytomorphology of Natural Killer/T-Cell Lymphoma (Nasal Type) in Conventional Smears, Liquid-Based Preparations, and Histopathology

Natural killer (NK)/T-cell lymphoma is formally referred to as extranodal NK/T-cell lymphoma, nasal type (ENKTCL), in the 2008 and 2016 World Health Organization (WHO) classifications. NK/T-cell lymphoma, nasal type, is a rare but clinically important lymphoid neoplasm. It is the predominant type of extranodal lymphoma associated with the Epstein–Barr virus (EBV). NK/T-cell lymphoma is marked by a wide cytomorphological spectrum. The cytological findings may be so subtle that NK/T-cell lymphoma could possibly be easily overlooked. Here, we report a case of NK/T-cell lymphoma involving the sinonasal region with lymph node involvement. Fine needle aspiration of the neck lymph node and punch biopsy of the nasal mucosa were performed. The diagnosis of NK/T-cell lymphoma was confirmed based on pathological and immunohistochemical analyses, as well as in situ hybridization for EBV-encoded mRNA (EBER). The present case report underlines the importance of prompt clinicopathological assessment in suspected cases. The comparison of cytomorphologic features of NK/T-cell lymphoma in various specimens is presented.

Extranodal lymphoma originating in the gluteal muscle with adjacent bone involvement and mimicking a soft tissue sarcoma

Introduction

Extranodal lymphoma (ENL) in the muscles is a rare manifestation of non-Hodgkin lymphoma (NHL). The aim of this case report is to describe and evaluate the clinical presentation and important radiologic features of ENL affecting the musculoskeletal system.

Presentation of case

We present a 52-year-old female with a 3-week history of left gluteal pain. Computed tomography (CT) showed a non-uniformly early enhancing mass in the left gluteal muscle, the tumor demonstrating central necrosis and adjacent bone involvement. Fluorine-18 fluorodeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT showed areas of increased ¹⁸F-FDG uptake in the left gluteal musculature, pelvic bones, para-aortic and mediastinal lymph nodes and both lungs. Histopathological examination showed a diffuse large B cell lymphoma (DLBCL). After 8 cycles of R-CHOP chemotherapy, the mass in the left gluteal muscle has completely disappeared

Discussion

Although destructive tumor originating in the gluteal muscle with adjacent bone involvement is more common in soft tissue sarcoma, lymphoma should be regularly included in the differential diagnosis. While CT is a useful modality for assessing soft tissue masses, disruption and injury of the surrounding tissues, PET/CT fusion is superior for the detection of unexpected extranodal sites of disease, or for exclusion of disease in the presence of nonspecific extranodal CT findings.

Conclusion

A rapid growth pattern and destructive masses that invade adjacent structures on CT are key findings of DLBCL, and ¹⁸F-FDG PET/CT is a useful imaging modality to accurately determine the disease stage and disease aggressiveness of NHL.

Long-term outcome of primary endocrine non-Hodgkin lymphomas: does the site make the difference?

AIM

Primary lymphomas of endocrine glands are extremely rare. Our study adds more data to the few published series regarding the incidence, clinical characteristics, management and overall survival (OS) by comparing the various diffuse large B-cell endocrine lymphomas. Moreover, it contributes to a better understanding of these neoplasms and provides concepts for future research.

METHODS

We retrospectively evaluated the clinical profile and the patterns of outcome among patients who were treated in our center with the diagnosis of aggressive, B-cell, primary endocrine lymphoma.

RESULTS

Between May 1980 and December 2011, 450 patients were diagnosed as primary extranodal non-Hodgkin lymphomas. Among them, 18 cases (4%) were primary testicular lymphoma (PTL), 8 cases (2%) were primary thyroid lymphoma (PTHL) and 4 cases (1%) were primary adrenal lymphoma (PAL). The therapeutic approaches employed were variable, including mainly chemotherapy in combination with radiotherapy and surgery. The median OS for the patients with PTL and PAL was 27 and 6 months, respectively. Better outcome was observed in patients with PTHL for whom the median OS has not been reached yet, whereas the PAL group had the worst prognosis.

CONCLUSIONS

The discrepancies in the outcome among endocrine lymphomas could be partly attributed to their biologic variability, which might be determined by the initial site involved. We conclude that treatment decisions should be made according to a multi-disciplinary approach to avoid unnecessary surgery. Existing treatment strategies for PTL and PAL fail to provide long-term survival, rendering the application of novel therapeutic approaches essential.

Extranodal non-hodgkin lymphomas of the oral cavity and maxillofacial region: a clinical study of 58 cases and review of the literature

PURPOSE

Approximately one third of non-Hodgkin lymphomas (NHLs) arise in tissues other than the lymph nodes. The purposes of this study are to evaluate the clinical outcome of NHLs of the oral cavity and maxillofacial region in a group of 58 patients who were diagnosed in our clinic and to discuss the clinical, histologic, and immunohistochemical features of these malignant neoplasms, as well as the prognosis.

MATERIALS AND METHODS

The study included 58 patients with extranodal NHLs of the oral cavity and maxillofacial region. There were 32 male and 26 female patients. The patients' ages ranged from 7 to 81 years. The most frequent sites of occurrence were the salivary glands (24 patients) and intraoral mucosa (21 patients). Other sites were the paranasal sinus (3 patients), Waldeyer ring (4 patients), bone of the jaws (3 patients), and orbit (3 patients). The histologic subtype was extranodal marginal zone lymphoma of the mucosa-associated lymphoid tissue (MALT) in 21 patients, diffuse large B-cell lymphoma (DLBCL) in 19, chronic lymphocytic leukemia in 10, mantle cell lymphoma in 4, follicular lymphoma in 2, Burkitt lymphoma/leukemia in 1, and B-cell acute lymphocytic leukemia (B-ALL) in 1. Of the DLBCL cases, 13 were stage IIE and 6 were stage IE. All the MALT lymphomas were stage IE.

RESULTS

The mean follow-up was 5 years after the initial diagnosis. A better prognosis was found in patients with MALT lymphomas (19 of 21 patients are alive) compared with those with DLBCLs (10 of 19 patients are alive).

CONCLUSIONS

MALT lymphomas have a more favorable outcome (about 90%) in comparison with DLBCLs. Careful examination of the oral cavity and neck by the maxillofacial surgeon is essential for the diagnosis and staging of lymphomas.

Malignant lymphoma of the head and neck

Malignant lymphomas represent approximately 5% of all malignant neoplasms of the head and neck area. They are classically divided into two subgroups, Hodgkin's lymphomas (HLs) and non-Hodgkin's lymphomas (NHLs). We describe the clinical characteristics of head and neck lymphomas and the methods to establish the diagnosis. The World Health Organization classification of lymphoid tissues describes more than 50 different histological types, and we analyse the most common staging system for lymphomas, the Ann Arbor staging system. Finally, the different therapeutic approaches are discussed.

A rare initial manifestation of acute lymphocytic leukemia: bilaterally enlarged kidneys and liver

A case with early presentation of acute lymphocytic leukemia with bilaterally enlarged kidneys and liver is presented. Both hepatic and renal infiltration with leukemic cells is a rare manifestation of acute lymphocytic leukemia.