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Duan J, Li H, Zhen T, Liang J, Ge S, Zhang F, Han A. A clinicopathologic study of 13 cases of primary lymphoma in soft tissue and review of literature. AMERICAN JOURNAL OF BLOOD RESEARCH 2022; 12:144-155. [PMID: 36147605 PMCID: PMC9490106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 06/16/2023]
Abstract
Primary lymphoma in soft tissue is very rare. In order to understand the clinicopathological features of primary lymphoma in soft tissue, we found 13 cases (0.3%) of primary lymphoma in soft tissue by reviewing 4303 lymphomas diagnosed in our institution from 2010 to 2019. Tumors were found in the following sites: 8 in lower extremity (2 in leg, 1 in calf, 1 in knee and 4 in buttock), 1 in upper extremity (left shoulder) and 4 in the trunk (3 in waist and 1 in thoracolumbar). The most common histologic type was DLBCL (7/13, 54.8%). 6 cases of which had follow-up information. 25 patients were also selected by screening the English literature search (from Jan 2010 to December 2019) including 1102 studies. Compared to the results of literature review, our results are similar with them. The tumor sites were as follows: 10 in lower extremity, 4 in upper extremity, 9 in the trunk and 2 in masticatory muscle. The most common histological type was also DLBCL (n=11/25, 44%). Overall survival analysis of all 31 patients including our 6 cases with primary lymphoma in soft tissue showed no significant difference between different histological type (Log Rank P=0.120, Breslow P=0.157). The differential diagnosis includes malignant melanoma, rhabdomyosarcoma and metastatic carcinoma in soft tissue.
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Affiliation(s)
- Jing Duan
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Hui Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Tiantian Zhen
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Jiangtao Liang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Songhan Ge
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Fenfen Zhang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
| | - Anjia Han
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University Guangzhou, China
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Gao S, Shu H, Yang H. Imaging features of skeletal muscle lymphoma: a case report and literature review. BMC Med Imaging 2021; 21:136. [PMID: 34565344 PMCID: PMC8474738 DOI: 10.1186/s12880-021-00667-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 09/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diffuse large B cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma (NHL), occurring predominantly in older people. Skeletal muscle lymphoma is a rare form of DLBCL, most frequently affecting the thigh, upper extremities, calf, and pelvis. CASE PRESENTATION We report a case of skeletal muscle DLBCL that was diagnosed using ultrasound (US)-guided biopsy. A 70-year-old man presented with progressive swelling and pain in the left lower extremity and an elevated erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP), ferritin, and CA125 levels. US, magnetic resonance imaging (MRI), and computed tomography (CT) showed diffuse lesions in several muscles of the left lower extremity. Positron emission tomography/CT (PET/CT) showed FDG-uptake in the affected muscles. The patient was treated with chemotherapy and achieved a good response. A systematic review of the literature published between 1992 and 2019 was conducted to investigate the role of imaging, including imaging-guided biopsy, in the diagnosis of skeletal muscle lymphoma. CONCLUSIONS Skeletal muscle lymphoma is rare. US and MRI features include enlargement of muscular structures, with preservation of the architecture of the tissue and surrounding anatomical structures. Definitive diagnosis relies on histological and immunohistological analysis of a sample obtained through imaging-guided biopsy.
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Affiliation(s)
- Shuxi Gao
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning Province, Republic of China
| | - Hong Shu
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Hua Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, 110004, Liaoning Province, Republic of China.
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Jonjić N, Valković T, Vujaklija DV, Ilijaš KM. Diagnostic challenge of soft tissue extranodal Hodgkin lymphoma in core-needle biopsy: case report. Scott Med J 2020; 66:40-45. [PMID: 32659181 DOI: 10.1177/0036933020941262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hodgkin lymphoma (HL) is an uncommon malignancy usually limited to the lymph nodes and lymphatic system while extranodal involvement is much less common than in non-Hodgkin lymphoma. The current report presents an unusual case of primary classical HL (cHL), nodular sclerosis type with mixed cellularity in buttock soft tissue of 78-year old man. Primary lymphoma of the gluteal muscle is a rare disease and primary cHL is even rarer. In addition, to this unusual extranodal presentation, the present case highlight a diagnostic challenge in fine-needle biopsy masquerading a low grade sarcoma, primarily myxoinflammatory fibrosarcoma or an inflammatory lesion. However, surgical biopsy and immunohistochemistry guided correct diagnosis that was of major interest for further successful treatment.
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Affiliation(s)
- Nives Jonjić
- Pathologist, 112565Clinical Hospital Center Rijeka, Croatia
| | - Toni Valković
- Hematologist, 112565Clinical Hospital Center Rijeka, Croatia
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Abstract
RATIONALE Primary extra-nodal non-Hodgkin lymphoma (PE-NHL) arising in the region of the buttocks is rare. After reviewing the literature from the last 20 years, we found only 3 reported lymphomas originating from soft tissue of the buttocks. In our case, positron emission tomography/computed tomography (PET/CT) was performed for the first time, both before and after treatment, to determine the initial stage of PE-NHL and the curative effects of treatment. PATIENT CONCERNS We report the case of a 71-year-old woman who was admitted to our hospital due to pain, skin redness, rising skin temperature, and swelling in the right hip. DIAGNOSES After an initial misdiagnosis of local infection, a histological examination and PET/CT were performed which revealed evidence of non-Hodgkin marginal zone B cell lymphoma of Ann Arbor stage II. INTERVENTIONS Following unsuccessful treatment with cephalosporin, the patient was successfully treated with rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) chemotherapy. OUTCOMES Comparison of the PET/CT scans taken before and after treatment showed that the lesion size had decreased, as had the fluorodeoxyglucose (FDG) uptake seen in the subcutaneous tissue of the right buttock with standardized uptake value max (SUVmax) 11.6 versus 2.5, respectively. Subsequently, no relapse or distant metastasis has been detected. LESSONS Young doctors should suspect PE-NHL in similar cases. PET/CT is valuable in the diagnosis and treatment of PE-NHL, as well as for accurately determining PE-NHL stage and aggressiveness.
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Affiliation(s)
- Xiang Meng Li
- Hematology Department of the Affiliated Hospital of Hebei University
| | - Hai Song Zhang
- Hematology Department of the Affiliated Hospital of Hebei University
| | - Xiao Li Dai
- Hematology Department of the Affiliated Hospital of Hebei University
| | - Jian Hong Shi
- Head of the Central Laboratory of Hebei University, Hebei province, China
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Gonzalez-Benavides N, Cardenas-de la Garza JA, Rodriguez-Vivian C, Ocampo-Candiani J, Welsh O. Skeletal Muscle Diffuse Large B-Cell Lymphoma in the Gluteal Region. Turk J Haematol 2018; 35:310-311. [PMID: 29983404 PMCID: PMC6256831 DOI: 10.4274/tjh.2018.0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Nereyda Gonzalez-Benavides
- Autonomous University of Nuevo León, Dr. Jose E. Gonzalez Faculty of Medicine and University Hospital, Department of Dermatology, Monterrey, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Autonomous University of Nuevo León, Dr. Jose E. Gonzalez Faculty of Medicine and University Hospital, Department of Dermatology, Monterrey, Mexico
| | - Candelario Rodriguez-Vivian
- Autonomous University of Nuevo León, Dr. Jose E. Gonzalez Faculty of Medicine and University Hospital, Department of Dermatology, Monterrey, Mexico
| | - Jorge Ocampo-Candiani
- Autonomous University of Nuevo León, Dr. Jose E. Gonzalez Faculty of Medicine and University Hospital, Department of Dermatology, Monterrey, Mexico
| | - Oliverio Welsh
- Autonomous University of Nuevo León, Dr. Jose E. Gonzalez Faculty of Medicine and University Hospital, Department of Dermatology, Monterrey, Mexico
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Skeletal Muscle Lymphoma Presenting with Chronic Compartment Syndrome of Leg after Trauma. Case Rep Oncol Med 2018; 2018:4078672. [PMID: 29808140 PMCID: PMC5902122 DOI: 10.1155/2018/4078672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/18/2018] [Accepted: 03/08/2018] [Indexed: 12/21/2022] Open
Abstract
Compartment syndrome may be acute or chronic based on the clinical course and etiology. Here, we report the first known case to be diagnosed with skeletal muscle-derived B-cell lymphoma presenting with chronic compartment syndrome after trauma. A 62-year-old woman sought medical attention due to a one-month history of painful left lower leg swelling and paresthesia of the medial side of the foot after falling over. The patient underwent fasciotomy and debridement under the preoperative diagnosis of fasciitis and myositis with associated compressive neuropathy. Preoperative laboratory tests were within normal limits. Postoperative pathologic examination and bone marrow aspiration revealed B-cell lymphoma with bone marrow involvement postoperatively. Tumor lysis syndrome took place, presenting with drowsiness, poor appetite, and oliguria, after the operation along with multiple organ failure. Awareness of the differential diagnoses of compartment syndrome in such clinical situation is crucial because it may lead to different examination and treatment plan preoperatively.
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Spetsieris N, Giannakopoulou N, Variami E, Zervakis K, Rougala N, Garefalakis G, Skarlatou V, Viniou NA, Diamantopoulos P. Isolated skeletal muscle recurrence of an originally nodal diffuse large B cell lymphoma: A case report and review of the literature. Medicine (Baltimore) 2018; 97:e9608. [PMID: 29504987 PMCID: PMC5779756 DOI: 10.1097/md.0000000000009608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Diffuse large B cell lymphoma (DLBCL) is a malignancy of the B cells with extranodal primary involvement being estimated at 30% to 40% of cases. Primary skeletal muscle presentation of DLBCL is extremely rare, with an estimated incidence of about 0.5% of extranodal lymphomas, presenting mostly in the lower extremities. The possible mechanisms of muscle involvement of DLBCL include primary extranodal disease, extension from adjacent organs (such as lymph nodes) or disseminated disease. PATIENT CONCERNS We report a case of a 70-year-old woman with an advanced initially nodal DLBCL, treated with R-CHOP, that presented with an enlargement of her left thigh and restricted mobility 3 months after completion of chemotherapy. Imaging studies were performed, which showed possible infiltration of the muscles of the left thigh, without any nodal disease present. DIAGNOSES Muscle biopsy documented the recurrence of the lymphoma at the left thigh. INTERVENTIONS The patient started second-line treatment with gemcitabine and vinorelbine. OUTCOMES A partial response was achieved after the first cycle. LESSONS The remarkable element lies in the reappearance of the lymphoma at the left thigh muscles, with no radiographic or clinical evidence of involvement of lymph nodes, despite the extensive lymph node disease at initial presentation. The further management of such recurrences remains to be clarified, as the odd biological behavior of the malignant cells dictates a special handling of the disease.
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Diffuse B Cell Non-Hodgkin's Lymphoma Presenting Atypically as Periprosthetic Joint Infection in a Total Hip Replacement. Case Rep Orthop 2017. [PMID: 28626592 PMCID: PMC5463129 DOI: 10.1155/2017/7195016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The occurrence of extranodal primary B cell non-Hodgkin's lymphoma is rare. Total hip replacement is one of the most common orthopaedic procedures performed. There has been an increased incidence of primary lymphomas involving periprosthetic sites. Chronic inflammation due to metal debris arising from the prosthetic implants has been evidenced as one of the causes for the development of soft tissue lymphomas albeit rarely. We describe a case report of a 77-year-old patient who had underwent a cemented total hip replacement in the past who further developed large B cell primary non-Hodgkin's lymphoma. She presented initially with signs and symptoms highly suggestive of underlying periprosthetic infection. The radiological imaging was also indicative of periprosthetic infection. The diagnosis was eventually confirmed after an open biopsy. This case underlines the importance of considering and including soft tissue malignancy in the differential diagnosis of suspected chronic periprosthetic infection.
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Elkourashy SA, Nashwan AJ, Alam SI, Ammar AA, El Sayed AM, Omri HE, Yassin MA. Aggressive Lymphoma "Sarcoma Mimicker" Originating in the Gluteus and Adductor Muscles: A Case Report and Literature Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:47-53. [PMID: 27398038 PMCID: PMC4934407 DOI: 10.4137/ccrep.s39052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/10/2016] [Accepted: 05/23/2016] [Indexed: 12/27/2022]
Abstract
Extranodal lymphoma (ENL) occurs in approximately 30%–40% of all patients with non-Hodgkin lymphoma and has been described in almost all organs and tissues. However, diffuse large B-cell lymphoma is the most common histological subtype of non-Hodgkin lymphoma, primarily arising in the retroperitoneal region. In this article, we report a rare case of an adult male diagnosed with primary diffuse large B-cell lymphoma of the gluteal and adductor muscles with aggressive bone involvement. All appropriate radiological and histopathological studies were done for diagnosis and staging. After discussion with the lymphoma multidisciplinary team, it was agreed to start on R-CHOP protocol (rituximab, cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin®), and prednisone) as the standard of care, which was later changed to R-CODOX-M/R-IVAC protocol (rituximab, cyclophosphamide, vincristine (Oncovin®), doxorubicin, and high-dose methotrexate alternating with rituximab, ifosfamide, etoposide, and high-dose cytarabine) due to inadequate response. Due to the refractory aggressive nature of the disease, subsequent decision of the multidisciplinary team was salvage chemotherapy and autologous stem cell transplant. The aim of this case report was to describe and evaluate the clinical presentation and important radiological features of extranodal lymphoma affecting the musculoskeletal system.
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Affiliation(s)
- Sarah A Elkourashy
- Clinical Fellow, Department of Hematology and BMT, National Center for Cancer Care and Research (NCCCR) - Hamad Medical Corporation (HMC), Doha, Qatar
| | - Abdulqadir J Nashwan
- Nurse Educator, Nursing Department, National Center for Cancer Care and Research (NCCCR) - Hamad Medical Corporation (HMC), Doha, Qatar
| | - Syed I Alam
- Radiology Specialist, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Adham A Ammar
- Laboratory Consultant, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Ahmed M El Sayed
- Orthopedic Consultant, Department of Surgery, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Halima El Omri
- Hematology Consultant, Department of Hematology and BMT, National Center for Cancer Care and Research (NCCCR)-Hamad Medical Corporation (HMC), Doha, Qatar
| | - Mohamed A Yassin
- Hematology Consultant, Department of Hematology and BMT, National Center for Cancer Care and Research (NCCCR)-Hamad Medical Corporation (HMC), Doha, Qatar
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An Unusual Case of Extranodal Diffuse Large B-Cell Lymphoma Infiltrating Skeletal Muscle: A Case Report and Review of the Literature. Case Rep Pathol 2016; 2016:9104839. [PMID: 27247818 PMCID: PMC4877472 DOI: 10.1155/2016/9104839] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/18/2016] [Indexed: 02/07/2023] Open
Abstract
Diffuse large B-cell lymphoma is extranodal in approximately 40% of cases, arising in nearly any organ system. DLBCL involvement of soft tissue and in particular skeletal muscle is extremely rare, comprising less than 1% of all extranodal non-Hodgkin lymphomas (NHL). We report a case of a 79-year-old man that presented with a DLBCL of the left triceps. In particular, we describe an unusual histologic appearance of pseudoglandular structures, resembling adenocarcinoma. We performed a review of lymphoma cases involving skeletal muscle diagnosed at our institution over the past 15 years as well as thorough PubMed review of the literature. We discuss the features of lymphoma involving skeletal muscle as it pertains to clinical characteristics, histologic subtype, tumor localization, diagnostic studies, therapy, and outcome. Finally, we highlight the diagnostic difficulties that can present in these rare and often challenging cases.
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