Primary ovarian large B-cell lymphoma in patient with juvenile rheumatoid arthritis treated with low dose Methotrexate

Burkitt Lymphoma Mimicking Advanced Stage Ovarian Carcinoma

Lymphoproliferative disorders presenting with clinical features similar to ovarian tumors are a rare clinical condition. Even though lymphomas of ovarian origin are rare, they should be considered during the differential diagnosis of tumors of ovarian origin. In this case report, we aimed to present a case of Burkitt lymphoma that mimics advanced ovarian carcinoma.

Large granular leukemia with concurrent central nervous system and articular infiltration in a cat

A 2-year-old female domestic shorthair cat was referred with a 2 month history of lethargy, weight loss, recurrent hyperthermia and polyarthropathy despite prednisolone. Upon physical examination, the cat showed apathy, hyperthermia, multiple appendicular joint pain and swelling. The CBC showed severe macrocytic normochromic non-regenerative anemia and thrombocytopenia. A population of immature large granular lymphocytes (LGL) was noted on blood smear. Abdominal ultrasonography revealed enlarged mesenteric lymph nodes (LNs), hyper echoic liver and splenomegaly. Cytology of fine needle aspirate of synovial fluid, spleen, liver, enlarged abdominal LNs and bone marrow supported a diagnosis of LGL leukemia with concurrent articular infiltration. A COP-based protocol was initiated with L-asparaginase (400 UI/kg intramuscularly) and prednisolone (1 mg/kg/day orally). However, the cat presented 1 week later with obtundation and paresis, indicating the involvement of the central nervous system (CNS). LGL were also observed on cerebrospinal fluid analysis. Histologic examination noted LGL in the spleen, liver and LNs. Immunohistochemistry (IHC) yielded negative results for both B- and T-cells thus suggesting NK-cells. The diagnosis was LGL leukemia with concurrent articular and CNS involvement. Articular infiltration with LGL is rarely reported in small animals, whereas CNS involvement was previously only suspected in a cat at necropsy.

Primary extra-nodal diffuse large B-cell lymphoma: A prognostic analysis of 141 patients

Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of lymphoma. Approximately 40% of DBLCL originates from extra-nodal sites, but the diversity of clinical presentations and the genetic and molecular alterations indicate that extra-nodal DLBCLs may be distinct disease entities. The aim of the present study was to highlight the various aspects of primary extra-nodal DLBCL (PE-DLBCL) based on a single center cohort. The data from 141 patients with PE-DLBCL treated at Peking Union Medical College Hospital were retrospectively evaluated. The primary extra-nodal sites involved were the gastrointestinal tract (n=42), central nervous system (CNS; n=38), breast (n=19), adrenal gland (n=15), female genital system (FGS; n=12), thyroid (n=8) and bone (n=7). The median overall survival rate was 28 months (range, 1–116). Multivariate analysis demonstrated that an International Prognostic Index (IPI) ≤2 (P=0.049), complete remission (CR) achieved following first-line therapy (P=0.001) and chemotherapy combined with rituximab (P<0.001) were positive prognostic factors. Patients with DLBCL with primary adrenal gland or female genital system (FGS) involvement exhibited a significantly higher risk of CNS recurrence (P<0.05). Rituximab treatment may have reduced the likelihood of CNS recurrence (P=0.005), whereas prophylaxis with intrathecal injection alone was not sufficient for prevention (P>0.05). In conclusion, IPI >2 and the lack of a CR following first-line therapy were independent prognostic risk factors for PE-DLBCL. Patients with primary adrenal gland or FGS involvement exhibited a higher risk of CNS relapse. Rituximab had a positive impact on the survival of patients with PE-DLBCL, also reducing the likelihood of CNS relapse.

Lymphoblastic Lymphoma Presenting as Bilateral Ovarian Mass in an Adolescent Girl

BACKGROUND

Lymphomas rarely involve the genital tract and non-Hodgkin lymphoma (NHL) presenting as ovarian tumor is rare. Precursor B-cell lymphoblastic lymphoma arising from the ovary is extremely rare and to our knowledge, only 5 cases have been reported in the literature.

CASE

A 15-year-old girl presented with bilateral ovarian masses, which, on biopsy proved to be precursor B-cell lymphoblastic lymphoma. She was treated with a Berlin-Frankfurt-Munster 90 protocol and she is alive in complete remission for more than 10 years.

SUMMARY AND CONCLUSION

NHL of the ovary should also be considered as a differential diagnosis in adolescent and young adults with ovarian masses. Attempt to make a preoperative diagnosis is crucial because ovarian NHL responds well to chemotherapy and has a good prognosis.

Case of primary bilateral diffuse large B-cell lymphoma of the ovary with plasmablastic features in an HIV-negative female patient

A 37-year-old woman from Puerto Rico presented to our clinic with symptoms of an abdominal distension progressively worsening over 1 year. A CT of an abdomen and pelvis with contrast was performed and revealed bilateral large heterogeneous pelvic adnexal masses with large ascites and right pleural effusion. Tumour markers CA 125 was 766 U/mL and lactate dehydrogenase was 654 U/L. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy with pelvic lymph node dissection and partial omentectomy. Pathology of ovarian masses revealed a diffuse large B-cell lymphoma. The staging work-up was negative, which pointed towards the diagnosis of primary ovarian lymphoma. The patient completed 8 cycles of cyclophosphamide, doxorubicin, vincristine, prednisolone chemotherapy. After 18 months of chemotherapy completion, she remains in remission.

Patients with primary diffuse large B-cell lymphoma of female genital tract have high risk of central nervous system relapse

The objective of this study was to evaluate retrospectively the clinical characteristics, treatments, and outcomes of patients with primary diffuse large B-cell lymphoma (DLBCL) of the female genital tract. The basic characteristics, treatments, and outcomes of six patients diagnosed with primary DLBCL of the female genital tract, including the ovary, uterine cervix, and vagina, treated in our hospital between 2000 and 2012, were analyzed retrospectively. Seven of 323 (2.2 %) newly diagnosed DLBCLs were diagnosed as primary female genital tract DLBCL. Six patients with complete medical data were included in the analysis. The median age at diagnosis was 52.5 years (range 20-65). The presenting symptoms included abnormal vaginal bleeding, increased vaginal discharge, abdominal fullness, and abdominal pain. Two patients had stage IE disease and four patients had stage IIE disease. Treatment included chemotherapy only in five patients, and combined chemotherapy and localized radiation in one patient. After a median follow-up of 58 months, four patients showed relapse in the central nervous system and two had died from progressive disease. The median progression-free survival was 27 months and the median overall survival for this group has not been reached. Patients with primary female genital tract DLBCL may have poor outcomes and a high risk of central nervous system relapse. Central nervous system prophylaxis might be considered in addition to systemic chemotherapy for DLBCL of the female genital tract.

Primary ovarian large B-cell lymphoma

The involvement of the ovary by malignant lymphoma is a well-known late manifestation of disseminated nodal disease. Primary ovarian lymphoma is rare. We herein describe a case of primary ovarian diffuse large B-cell lymphoma involving unilateral ovary in a 38-year-old woman which was detected incidentally. Preoperative ultrasonic imaging showed a 46∗42 mm heterogeneous cystic mass. Laparotomy revealed that left adnexal mass and left salpingo-oophorectomy was performed. The current diagnosis was determined after immunostaining. The patient was treated with R-CHOP regimen after the operation. She remains cancer-free 24 months after chemotherapy.

Unusual presentation of large B cell lymphoma: a case report and review of literature

Diffuse large B cell lymphoma (DLBCL) is the largest subtype of non-Hodgkin's lymphomas (NHLs) and is characterized by relatively frequent extranodal presentation. In these cases, the most common extranodal localizations are stomach, CNS, bone, testis and liver. Simultaneous detection of multiple extranodal involvement at presentation is quite uncommon, with the majority of these cases characterized by gastric or intestinal disease localization. Retrospective analysis concerning multifocal extranodal NHLs never pointed out disease features such as those described here. We report a patient with an unusual presentation of DLBCL, characterized by adrenal and renal involvement, associated with symptoms and signs of the cold agglutinin disease and a hypercoagulable state. Subsequently, computed tomography (CT) and fluorodeoxyglucose-positron emission tomography (FDG-PET) scanning disclosed a rapidly extensive spread to nodes and bones. Cytofluorimetric analysis of a renal specimen showed medium-to-large lympho-monocytoid elements positive for CD20 with monoclonal expression of immunoglobulin kappa light chain. Histopathological examination confirmed a renal CD20 positive DLBCL localization.