1
|
Abbott S, Nikolousis E, Badger I. Intestinal lymphoma--a review of the management of emergency presentations to the general surgeon. Int J Colorectal Dis 2015; 30:151-7. [PMID: 25374417 DOI: 10.1007/s00384-014-2061-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2014] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Intestinal non-Hodgkin's lymphoma (NHL) is uncommon but not rare. This paper aims to review the recent evidence for the management of perforated NHL of the intestine, consider when chemotherapy should be commenced and examine the likely outcomes and prognosis for patients presenting as surgical emergencies with this condition. METHODS MEDLINE and Cochrane databases were searched using intestinal lymphoma, clinical presentation, perforation, management and prognosis. The full text of relevant articles was retrieved and reference lists checked for additional articles. FINDINGS Emergency surgery was required at disease presentation for between 11 and 64% of intestinal NHL cases. Perforation occurs in 1-25% of cases, and also occurs whilst on chemotherapy for NHL. Intestinal bleeding occurs in 2-22% of cases. Obstruction occurs more commonly in small bowel (5-39%) than large bowel NHL and intussusceptions occur in up to 46%. Prognosis is generally poor, especially for T cell lymphomas. CONCLUSIONS There is a lack of quality evidence for the elective and emergency treatment of NHL involving the small and large intestine. There is a lack of information regarding the impact an emergency presentation has on the timing of postoperative chemotherapy and overall prognosis. It is proposed that in order to develop evidence-based treatment protocols, there should be an intestinal NHL registry.
Collapse
Affiliation(s)
- S Abbott
- Department of Colorectal Surgery, New Cross Hospital, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK,
| | | | | |
Collapse
|
2
|
Chen JH, Ho CL, Chen YC, Chao TY, Kao WY. Clinicopathological analysis and prognostic factors of 11 patients with primary non-Hodgkin lymphoma of the small intestine in a single institute. Oncol Lett 2014; 8:876-880. [PMID: 25013511 PMCID: PMC4081397 DOI: 10.3892/ol.2014.2209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 04/16/2014] [Indexed: 12/22/2022] Open
Abstract
The gastrointestinal (GI) tract is the most common extranodal site of involvement in non-Hodgkin lymphoma (NHL). Primary GI NHL is frequently discussed in survival analyses. Primary intestinal NHL is significantly different from primary gastric NHL with regard to its clinical features, pathological subtype, treatment and prognosis. The small intestine is involved in lymphoma less often than the large intestine. The present study aimed to analyze the clinical and pathological characteristics of primary NHL of the small intestine and its prognostic factors. A retrospective analysis was performed on clinical data from 313 cases of NHL that occurred between 1995 and 2008 in the Tri-Service General Hospital (National Defense Medical Center, Taipei, Taiwan). Among these cases, 11 cases of primary NHL of the small intestine were identified. A Cox model was used to perform the multivariate analysis. The Kaplan-Meier method was used for the survival analysis. From the 11 patients with primary NHL of the small intestine, seven patients were male (63.6%) and four patients were female (36.3%). Furthermore, nine patients (81.8%) were diagnosed with B-cell lymphoma, of which five (45.5%) were also diagnosed with diffuse large B-cell lymphoma (DLBL). Abdominal pain and/or distention were present in six (54.5%) of the patients and jejunum involvement was also observed in six (54.5%) of the 11 patients. The mean overall survival (OS) time of the 11 patients was 27.2 months and the four-year survival rate was 36.3%. The mean OS time in the patients with jejunum involvement was shorter than in those without jejunum involvement (16.9 vs. 39.6 months), although this difference was not significant (P=0.657). Surgical treatment was performed on four of the six patients with jejunum involvement due to an acute abdomen or perforation-related peritonitis. The results of the present study indicate that DLBL is the most common subtype of primary lymphoma of the small intestine, and that the site involved in NHL may affect the potential for surgery in patients with intestinal lymphoma. Furthermore, patients with primary lymphoma of the small intestine have been found to have a poor outcome compared with those with lymphoma in other regions of the GI tract. In the present study, a similar trend was observed, however, the sizes of the subgroups of primary lymphoma of the small intestine were too small for individual analysis.
Collapse
Affiliation(s)
- Jia-Hong Chen
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Ching-Liang Ho
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yeu-Chin Chen
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Tsu-Yi Chao
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Woei-Yau Kao
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| |
Collapse
|
3
|
Kim SJ, Choi CW, Mun YC, Oh SY, Kang HJ, Lee SI, Won JH, Kim MK, Kwon JH, Kim JS, Kwak JY, Kwon JM, Hwang IG, Kim HJ, Lee JH, Oh S, Park KW, Suh C, Kim WS. Multicenter retrospective analysis of 581 patients with primary intestinal non-hodgkin lymphoma from the Consortium for Improving Survival of Lymphoma (CISL). BMC Cancer 2011; 11:321. [PMID: 21798075 PMCID: PMC3160411 DOI: 10.1186/1471-2407-11-321] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/29/2011] [Indexed: 12/27/2022] Open
Abstract
Background Primary intestinal non-Hodgkin lymphoma (NHL) is a heterogeneous disease with regard to anatomic and histologic distribution. Thus, analyses focusing on primary intestinal NHL with large number of patients are warranted. Methods We retrospectively analyzed 581 patients from 16 hospitals in Korea for primary intestinal NHL in this retrospective analysis. We compared clinical features and treatment outcomes according to the anatomic site of involvement and histologic subtypes. Results B-cell lymphoma (n = 504, 86.7%) was more frequent than T-cell lymphoma (n = 77, 13.3%). Diffuse large B-cell lymphoma (DLBCL) was the most common subtype (n = 386, 66.4%), and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) was the second most common subtype (n = 61, 10.5%). B-cell lymphoma mainly presented as localized disease (Lugano stage I/II) while T-cell lymphomas involved multiple intestinal sites. Thus, T-cell lymphoma had more unfavourable characteristics such as advanced stage at diagnosis, and the 5-year overall survival (OS) rate was significantly lower than B-cell lymphoma (28% versus 71%, P < 0.001). B symptoms were relatively uncommon (20.7%), and bone marrow invasion was a rare event (7.4%). The ileocecal region was the most commonly involved site (39.8%), followed by the small (27.9%) and large intestines (21.5%). Patients underwent surgery showed better OS than patients did not (5-year OS rate 77% versus 57%, P < 0.001). However, this beneficial effect of surgery was only statistically significant in patients with B-cell lymphomas (P < 0.001) not in T-cell lymphomas (P = 0.460). The comparison of survival based on the anatomic site of involvement showed that ileocecal regions had a better 5-year overall survival rate (72%) than other sites in consistent with that ileocecal region had higher proportion of patients with DLBCL who underwent surgery. Age > 60 years, performance status ≥ 2, elevated serum lactate dehydrogenase, Lugano stage IV, presence of B symptoms, and T-cell phenotype were independent prognostic factors for survival. Conclusions The survival of patients with ileocecal region involvement was better than that of patients with involvement at other sites, which might be related to histologic distribution, the proportion of tumor stage, and need for surgical resection.
Collapse
Affiliation(s)
- Seok Jin Kim
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Vallicelli C, Coccolini F, Catena F, Ansaloni L, Montori G, Di Saverio S, Pinna AD. Small bowel emergency surgery: literature's review. World J Emerg Surg 2011; 6:1. [PMID: 21214933 PMCID: PMC3025845 DOI: 10.1186/1749-7922-6-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/07/2011] [Indexed: 12/15/2022] Open
Abstract
Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.
Collapse
Affiliation(s)
- Carlo Vallicelli
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Coccolini
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Dept., Ospedali Riuniti Hospital, Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Antonio D Pinna
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| |
Collapse
|
5
|
Niu GJ, Chen ZL, Li XR, Tang CH. Significance of TRX-1 and STAT-3 expression in primary malignant tumors of the small intestine. Shijie Huaren Xiaohua Zazhi 2010; 18:2327-2332. [DOI: 10.11569/wcjd.v18.i22.2327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To detect the expression of thioredoxin-1 (TRX-1) and signal transducer and activator of transcription 3 (STAT-3) and to analyze their relation to clinicopathological features in primary malignant tumors of the small intestine.
METHODS: The expression of TRX-1 and STAT-3 in primary malignant tumors of the small intestine and matched tumor-adjacent normal tissue was detected by immunohistochemistry. The relationship between TRX-1 and STAT-3 expression and clinicopathological features in primary malignant tumors of the small intestine was then analyzed.
RESULTS: Overexpression of TRX-1 and STAT-3 was detected in primary malignant tumors of the small intestine. The positive rates of TRX-1 and STAT-3 expression were significantly higher in tumor tissue than in tumor-adjacent normal tissue (both P < 0.01). The intensity of TRX-1 and STAT-3 expression was significantly higher in moderately and poorly differentiated tumor tissue than in well differentiated tumor tissue (P < 0.05 or 0.01). Increased expression of TRX-1 and STAT-3 is significantly correlated with lymph node metastasis and TNM stage (P < 0.05 or 0.01). There is a positive correlation between the expression of TRX-1 and STAT-3 in malignant tumors of the small intestine (r = 0.881, P < 0.01).
CONCLUSION: TRX-1 and STAT-3 are overexpressed in primary malignant tumors of the small intestine, indicating that high expression of TRX-1 and STAT-3 may be involved in the genesis, development and progression of the disease.
Collapse
|
6
|
Abstract
A 65-year-old woman with a medical history of diabetes mellitus type 2, hypertension, an old cerebrovascular accident, and seizure disorder presented to the emergency room with lower abdominal pain of 4 weeks duration. Upon physical examination, her abdomen was soft and bowel sounds were present, but there was diffuse tenderness in her lower abdomen with some guarding. A computed tomography scan of her abdomen with oral and intravenous contrast showed significantly thickened small bowel loops with subjacent lymphadenopathy. Biopsies obtained during esophagogastroduodenoscopy and colonoscopy showed acute and chronic inflammation. A double balloon enteroscopy (DBE) was then performed, which showed stricture in the jejunum from which the biopsy was obtained. The biopsy showed marginal cell lymphoma. The patient is presently undergoing chemotherapy. Double balloon enteroscopy is a new elegant endoscopical technique that seems promising, as the endoscopist can reach undiscovered small bowel segments. It seems to be well tolerated and safe. For the first time, it provides the means to endoscopically investigate and treat disorders of the small intestine that have previously been inaccessible to conventional endoscopy.
Collapse
|
7
|
Small Intestine. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
8
|
Affiliation(s)
- Lale Kostakoglu
- Department of Radiology, Division of Nuclear Medicine, The New York Presbyterian Hospital Weill Medical College of Cornell University, New York, NY, USA
| | | |
Collapse
|
9
|
|
10
|
|
11
|
Frizzi JD, Rivera DE, Harris JA, Hamill RL. Lymphoma arising in an S-pouch after total proctocolectomy for ulcerative colitis: report of a case. Dis Colon Rectum 2000; 43:540-3. [PMID: 10789754 DOI: 10.1007/bf02237202] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The gastrointestinal tract is the most common extranodal site of primary non-Hodgkin's lymphoma. We present a case of a 50-year-old male with primary B cell lymphoma arising in an S-pouch eight years after a total proctocolectomy for ulcerative colitis. After chemoradiotherapy the patient remained asymptomatic, with an intact S-pouch. Pouch conservation is feasible in patients with primary lymphoma of the pouch, using chemoradiotherapy and close follow-up examinations.
Collapse
Affiliation(s)
- J D Frizzi
- Department of Surgery and Pathology, Eisenhower Army Medical Center, Fort Gordon, Georgia 30905, USA
| | | | | | | |
Collapse
|
12
|
Abstract
Lymphoma can often present in unusual situations. This article provides a comprehensive review of the literature in which both non-Hodgkin's lymphoma and Hodgkin's disease are discussed.
Collapse
Affiliation(s)
- G A Young
- Kanematsu Laboratories, Royal Prince Alfred Hospital, Department of Medicine, Camperdown, NSW 2050, Australia.
| |
Collapse
|
13
|
Abstract
PURPOSE To clarify the natural history of primary lymphoma of the small bowel and identify preferred treatments for it. MATERIALS AND METHODS A retrospective analysis of 61 patients with primary lymphoma of the small bowel was performed. The Ann Arbor stages were I in 20 patients, II in 28, and IV in 13. After resection or biopsy, 15 patients were treated with radiation therapy, 26 with chemotherapy, and 16 with combined-modality therapy. Four patients underwent no adjuvant treatment after resection. RESULTS The actuarial 10-year overall survival and relapse-free survival for the patients with intermediate- and high-grade lymphoma were 47% and 53%, respectively. For the patients with low-grade lymphoma, these rates were 81% and 62%. For patients who underwent radiation therapy, combined-modality therapy, or chemotherapy, the recurrence rates inside the abdomen or pelvis were one of 12, two of 15, and five of 20, respectively, and those outside the abdomen or pelvis were four of 12, one of 15, and zero of 20, respectively. Four of the five abdominopelvic recurrences of disease in the chemotherapy group were among the nine patients who had Ann Arbor stage II disease. CONCLUSION Chemotherapy lowered the recurrence rate outside the abdomen or pelvis. Patients with stage II disease may benefit most from radiation therapy.
Collapse
Affiliation(s)
- C S Ha
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
| | | | | | | | | | | |
Collapse
|
14
|
Halme L, Mecklin JP, Juhola M, Krees R, Palmu A. Primary gastrointestinal non-Hodgkin's lymphoma. A population based study in central Finland in 1975-1993. Acta Oncol 1997; 36:69-74. [PMID: 9090970 DOI: 10.3109/02841869709100736] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gastrointestinal lymphomas have been uncommon, but the frequency of their predisposing conditions is increasing. The objective of the present study is to determine the frequency of gastrointestinal lymphomas in the area of central Finland as well as the influence of clinical features and therapeutical approaches on the survival of these patients. All samples of gastrointestinal non-Hodgkin's lymphomas diagnosed of patients living in the province of central Finland in 1975-1993 were re-examined. In central Finland the mean annual frequency of new gastrointestinal lymphomas was 10/1000000 in 1975-1984 and 16.0/1000000 in 1985-1993. The total incidence of gastrointestinal lymphomas in Finland adjusted for age to the world standard population was 12.5/1000000 in 1992. Two patients with peripheric T-cell lymphoma had a coeliac disease. Other predisposing conditions were not found. The stage of distribution of the lymphoma (p < 0.01) and radicality of the surgery (p < 0.01) were the most influencing factors on the survival of these patients. In conclusion the early distinction of gastrointestinal lymphomas is vital because of an increasing frequency of predisposing factors and a better prognosis due to new combination therapies.
Collapse
Affiliation(s)
- L Halme
- Fourth Department of Surgery, Helsinki University Hospital, Finland
| | | | | | | | | |
Collapse
|