A rare case of diffuse large B-cell lymphoma presenting as a malignant mass in both duodenum and ascending colon

Primary intestinal diffuse large B-cell lymphoma: novel insights and clinical perception

Background

Extranodal Non-Hodgkin lymphoma (NHL) is more prevalent in the gastrointestinal (GI) tract than in other sites. This study aimed to explore the clinical features and prognostic factors of primary intestinal diffuse large B-cell lymphoma (PI-DLBCL), in order to provide new references for basic research and clinical diagnosis and treatment of the rare extranodal malignant lymphoma.

Methods

The clinical data of 88 patients with PI-DLBCL admitted to Fujian Medical University Union Hospital from June 2011 to June 2022 were retrospectively studied, the clinical and pathological features, diagnosis and treatment process and prognosis of PI-DLBCL were analyzed, and univariate and multivariate analysis of prognostic factors was carried out. The Kaplan-Meier method was used for survival analysis. Meanwhile, the latest literature from PubMed was retrieved to systematically discuss the research progress in the diagnosis and treatment of PI-DLBCL.

Results

Among the 88 patients with PI-DLBCL included in this study, 60 cases were males (68.18%), 28 cases were females (31.82%), and 62 patients (70.45%) were complaining of abdominal pain, and the second most common clinical manifestation was changes in bowel habits in 16 (18.18%), with a median age of onset of 57 (17-82) years. The first-line treatment regimen was surgery combined with R-CHOP chemotherapy (56.82%). The median follow-up time was 72 (1-148) months, 51 (57.95%) of 88 patients with PI-DLBCL survived, 30 patients (34.09%) died, 7 patients (7.95%) were lost to follow-up, and the PFS rates of 1-year, 3-year and 5-year were 57.95%, 29.55% and 15.91%, and the OS rates of 1-year, 3-year and 5-year were 79.55%, 45.45% and 28.41%, respectively. The results of univariate Cox regression analysis showed that ECOG score, Lugano stage, B symptoms, IPI score, white blood cells, serum LDH, albumin, β2 microglobulin were the influencing factors of OS in PI-DLBCL patients, and ECOG score, Lugano stage, B symptoms, IPI score, white blood cells, serum LDH, albumin, β2 microglobulin were all the influencing factors of PFS in PI-DLBCL patients. The results of multivariate Cox analysis showed that Lugano stage may be an independent prognostic factor affecting OS and PFS in PI-DLBCL patients.

Conclusion

PI-DLBCL is more common in middle-aged and elderly men, clinical manifestations lack specificity, first-line treatment is mainly surgery combined with standard chemotherapy regimens. The Lugano stage may be an independent prognostic factor affecting OS and PFS in PI-DLBCL patients.

Multifocal Primary Extranodal Non-Hodgkin Lymphoma: A Report of a Rare Case

Primary extranodal non-Hodgkin lymphoma (NHL) is a rare manifestation of lymphoid malignancies and typically arises in tissues outside the lymph nodes and can involve various organs and anatomical sites presenting unique challenges in diagnosis and treatment. Multifocal primary extranodal NHL, characterized by simultaneous involvement of multiple extranodal sites, presents a diagnostic and therapeutic challenge due to its uncommon presentation and varied clinical manifestations. Despite advances in diagnostic modalities and treatment strategies for NHL, multifocal involvement poses unique clinical dilemmas requiring a multidisciplinary approach for accurate diagnosis and optimal therapeutic intervention. In this case report, we describe a rare case of multifocal primary extranodal NHL in a 29-year-old female, highlighting the complexities associated with its diagnosis and management. Through this case presentation, we aim to underscore the importance of recognizing and addressing the intricacies of multifocal primary extranodal NHL to enhance clinical outcomes and improve patient care. It also highlights the diagnostic complexity and clinical challenges associated with multifocal primary extranodal NHL. A multidisciplinary approach involving haematologists, oncologists, radiologists, and pathologists is crucial for the accurate diagnosis and optimal management of such cases. Additionally, further research is warranted to better understand the underlying pathogenesis and improve treatment strategies for this rare presentation of NHL.