Non-Hodgkin lymphoma arising in lower urinary tract

Systemic non-Hodgkin's lymphoma initially presenting as a bladder mass

Urinary bladder lymphomas are rare lesions which may be primary bladder lymphomas or part of systemic lymphoma with bladder involvement. We report a case of non-Hodgkin's lymphoma (NHL) in a 73-year-old female who presented with bladder tumor which on evaluation revealed NHL with extensive systemic involvement. The management of such an advanced case is discussed here with literature review.

[Primary lymphoma of the bladder: a case report]

Les tumeurs de vessie constituent les tumeurs les plus fréquentes de l'appareil uro-génital chez l'homme, le type histologique est dominé par le carcinome urothéliale, la localisation primitive du lymphome malin est extrêmement rare et constitue souvent une surprise diagnostique quand elle est retrouvée. Nous rapportons à travers cette observation le cas d'un patient pris en charge au sein de notre formation qui a bénéficié, suite a un bilan d'hématurie objectivant une formation bourgeonnante intra vésicale a l’échographie abdominale, d'une résection transurétrale de la vessie d'un polype géant dont les résultats anapathologies sont revenus en faveur d'un lymphome primitif de la vessie, le patient a bénéficié d'une chimiothérapie adjuvante a base de RCHOP, les suites étaient simples et une surveillance cystoscopique et scannographique n'a pas objectivé de récidive avec un recul de 18 mois. Le lymphome primitif de la vessie est une entité rare, sa chimio sensibilité fait de ce type de tumeur une maladie curable, le diagnostic est histologique et vu la rareté de l'affection aucun consensus n'est standardisé.

Primary lymphomas of the prostate: two case reports and a review of the literature

Introduction

Non-Hodgkin lymphoma (NHL) is a common disease, but primary lymphoma of the prostate is rare.

Material and methods

Here we present two cases of primary NHL of the prostate and a review of the relevant literature.

Results

Both of them had no abnormal lymph node or hepatolienal enlargement. The first case underwent prostatic biopsy which indicated that it was NHL. The patient underwent combination chemotherapy three times, then a radical cystoprostatectomy. In the second case, the prostatic biopsy was not helpful for diagnosis. Therefore a radical prostatectomy was performed before the proper chemotherapy been given. He died half a year later because of a cerebrovascular accident.

Conclusions

We think it is difficult to get an accurate early diagnosis when the lymphoma occurs only in the prostate. Even the prostatic biopsy could not provide clear evidence. Early and appropriate treatment can extend the survival time and improve the quality of life.

Prostatic hypertrophy and prostatic infiltration in small lymphocytic lymphoma

Extranodal involvement in non-Hodgkin's lymphoma (NHL) is not really that rare, but prostatic infiltration is uncommon and rarely detected clinically. Prostatic involvement by lymphoma can cause signs and symptoms of prostatic obstruction. Here we report a patient with prostatic infiltration due to NHL diagnosed 7 years earlier. The literature is also reviewed.

Primary non-Hodgkin's lymphoma of the bladder with bone marrow involvement

Involvement of the lower urinary tract by advanced non-Hodgkin's lymphoma (NHL) has been reported in up to 13% of cases, but primary NHL of the urinary bladder is very rare. A 35-year-old man was admitted to our hospital with a chief complaint of gross hematuria with left flank pain on April 12, 2001. Cystoscopy revealed an edematous broad-based mass on the left lateral wall of the bladder, and transurethral biopsy showed NHL, diffuse large B-cell type. Abdomino-pelvic CT scan demonstrated left-side hydronephrosis and hydroureter with left proximal ureter infiltration and thickening of the left lateral wall of the bladder with perivesical fat infiltration without lymph node enlargement. Full-scale staging work-up revealed the bone marrow as the solely involved site. The lesions of the bladder and left urinary tract were nearly completely regressed after two cycles of systemic cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) chemotherapy with simultaneous restoration of urinary function.

Primary lymphoma of the bladder: a report of three cases

BACKGROUND

Primary lymphoma of the bladder is rare and its management is an evolving field.

AIMS

To highlight primary lymphoma of the bladder as a possible diagnosis in cases of bladder neoplasm and to illustrate the currently favoured management options.

METHODS

Three cases of primary bladder lymphoma are reported and management is reviewed.

RESULTS

Each of the three cases was managed differently with each management approach yielding a favourable outcome.

CONCLUSION

Chemotherapy combined, if necessary, with surgery or radiation therapy, should be the standard of care, depending on the full histological diagnosis.

Malignant lymphoma of the bladder: evidence from 36 cases that low-grade lymphoma of the MALT-type is the most common primary bladder lymphoma

Patients with malignant lymphoma of the bladder were studied, and three clinical groups were defined: those with primary lymphoma localized in the bladder, lymphoma presenting in the bladder as the first sign of disseminated disease (nonlocalized lymphoma), and recurrent bladder involvement by lymphoma in patients with a history of malignant lymphoma (secondary lymphoma). The differences in these groups regarding lymphoma type, clinical presentation, and clinical outcome were studied. Mayo Clinic Tissue Registry records from 1940 to 1996 were searched to identify patients with lymphomas involving the bladder. The lymphomas were classified based on review of the histology and immunophenotype performed by immunoperoxidase methods. Clinical records were reviewed. Presenting symptoms included urinary frequency, dysuria, hematuria, and lower abdominal and back pain. Primary lymphoma was present in six patients. All were B-cell lineage low-grade lymphomas of the mucosa-associated lymphoid tissue (MALT) type. No patient had recurrent lymphoma or died of lymphoma. Nonlocalized bladder lymphoma occurred in 17 patients; one with low-grade lymphoma of the MALT type, four with follicle center lymphomas, and 12 with large cell lymphomas. Excluding two patients who died postoperatively, median survival was 9 years. Six patients died of lymphoma in the follow-up period. Secondary bladder lymphoma occurred in 13 patients: two with low-grade lymphoma of the MALT type, one with follicle center lymphoma, one with mantle cell lymphoma, and nine with diffuse large cell lymphomas. Median survival in this group was 0.6 years. Low-grade lymphoma of the MALT type was the most frequent type of primary bladder lymphoma and was associated with an excellent prognosis. The bladder can be the presenting site of lymphomatous involvement in patients with more widespread disease. Survival in this group is quite favorable and is presumably dependent on lymphoma histologic type, stage of disease, and other prognostic factors. Bladder involvement by recurrent lymphoma is a sign of widely disseminated disease and is associated with a very poor prognosis.

Primary lymphoma of the bladder: a unique cystoscopic appearance

Primary lymphoma of the bladder is a rare disorder that occurs in the fifth to seventh decades, with a female preponderance. Although computed tomographic scanning is the best diagnostic imaging study, cystoscopic biopsy and immunoperoxidase staining are needed to make the diagnosis. Primary lymphoma of the bladder has a good prognosis and responds to a variety of therapeutic modalities. Throughout the literature, authors have described primary lymphoma of the bladder as a submucosal tumor, smooth, nonulcerative, edematous, friable, or even hemorrhagic. We present what we believe to be the first photographic image of the cystoscopic appearance of primary lymphoma of the bladder.

Case report: primary non-Hodgkin's lymphoma of the bladder

Primary lymphoma of the bladder is uncommon. Less than 75 cases have been reported so far in the literature. Two further cases are reported here and relevant literature is reviewed.

Primary lymphoma of female urethra: long-term control by radiation therapy

We report a case of primary urethral lymphoma successfully managed by external beam radiation therapy. Long-term freedom from recurrence in this case suggests irradiation is a viable treatment option for this rare malignancy.

Non-Hodgkin's lymphoma of the bladder--CT and MRI appearances

Computed tomography (CT) appearances of two patients with primary bladder non-Hodgkin's lymphoma are presented with magnetic resonance imaging (MRI) correlation in one. The differences between primary and secondary bladder lymphoma with respect to their clinical presentation, course and prognosis are described. Bladder lymphoma is a rare tumour which often presents as a large multilobular submucosal mass, and such an appearance may suggest the diagnosis. Bladder lymphoma, however, cannot be differentiated from the more common transitional cell carcinoma on the basis of CT attenuation values or enhancement patterns, or MRI signal characteristics. The diagnosis must, therefore, be made by histology. Other differential diagnoses and the role of various imaging techniques in the diagnosis and management of bladder lymphoma are considered.

Primary lymphoma of prostate: transrectal ultrasonic appearance

In the case presented, primary lymphoma of the prostate was diagnosed by ultrasonically guided transrectal biopsy. Primary lymphoma of the prostate should be included in the differential diagnosis of a hypoechoic lesion found on ultrasonic evaluation of the prostate in a young adult.

Primary malignant lymphoma of the bladder

We treated 11 patients with primary malignant lymphoma of the bladder. The typical patient is a woman more than 50 years old who presents with urgency and frequency of micturition, and occasionally gross hematuria. Hydronephrosis is present in half of the patients and cystoscopy usually reveals a solid tumor. Partial cystectomy, when feasible, with or without radiotherapy and chemotherapy is the usual treatment modality. When localized to the bladder, malignant lymphoma has an over-all favorable prognosis.

Non-prostatic malignant disease mimicking prostatic cancer

Three patients with pelvic tumours (2 cases of pelvic sarcoma and 1 case of metastatic bronchial carcinoma) presented with symptoms and signs suggestive of prostatic carcinoma. Transrectal ultrasonic scanning with perineal biopsy facilitated the diagnosis. The prognosis of pelvic sarcoma was poor following radiotherapy.

Malignant lymphoma of the lower urinary tract. A clinicopathological study with review of the literature

The clinical and histopathological findings are reported in 3 primary malignant lymphomas of the lower urinary tract. Two arose in the bladders of a 70-year-old man and a 67-year-old woman. The first was histologically low grade and the patient remains free of disease after more than 7 years. The second was an intermediate grade neoplasm and the patient died after 39 months. The third tumour was found in the urethra of a 76-year-old woman and it appears to represent only the third primary malignant lymphoma described at this site. The bladder is an uncommon primary site of extranodal lymphoma. Most patients present with haematuria and cystoscopy shows 1 or more solid, round, tumour-like masses. Histological grade, particularly follicle formation, appears to have predictive value.

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.

Use of immunohistochemistry for identification of primary lymphoma of the bladder

Primary lymphoma of the bladder is a rare entity, and when found in such an unusual location it frequently is difficult to distinguish between a lymphoma and an undifferentiated carcinoma. Immunohistochemical staining techniques have been used to identify tumor cell origins when the tissue type or a primary site of involvement is unknown. We report a case of primary lymphoma (nonHodgkin's type) of the bladder and the use of immunohistochemical staining to distinguish definitively tissue type and then specific immunotype.

Primary malignant lymphoma of urinary bladder

A case of primary malignant lymphoma of the urinary bladder is described. The classic presentation of gross hematuria and dysuria with a benign clinical course is illustrated. From a review of the literature and our experience, we conclude that localized primary lymphoma of the bladder, especially those with favorable histologic findings, often does not require medical or surgical intervention. Persistent irritative bladder symptoms can be palliated adequately with external beam radiotherapy, while surgical intervention is rarely indicated.