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Akbar M, Clasen-Linde E, Specht L. Extranodal NK/T-cell lymphoma, nasal type, with extranasal presentation - a case report and a review of the literature. Acta Oncol 2020; 59:1480-1487. [PMID: 32689856 DOI: 10.1080/0284186x.2020.1795250] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Extranodal NK/T-cell lymphoma (ENKTCL), nasal type is a very rare and aggressive non-Hodgkin lymphoma. Most commonly it occurs in the upper aerodigestive tract. But, it can also manifest at locations such as the skin, soft tissue, gastrointestinal tract (GI), lungs, testis, etc. These locations are designated as extranasal ENKTCL. The patients with the latter have often more adverse clinical features and poorer survival rate compared with nasal sites. We present a case of an 83-year-old patient with a primary ENKTCL, nasal type, with extranasal presentation in the right upper eyelid. MATERIAL AND METHODS Materials for the literature review was obtained by a comprehensive search on PubMed, which yielded 82 eligible cases with extranasal ENKTCL. RESULTS Sixty-eight cases (83 %) were localized as primary ENKTCL in the lungs (17), central nervous system (CNS) (14), testis (11), GI-tract (7), skin (6), orbit and intraocular tissue (4), pancreas (2), adrenal gland (2), breast (1), etc. 14 cases (17 %) presented as extended or disseminated diseases involving exclusively organs outside the upper aerodigestive tract. There was no systematic pattern of organ involvement in the extended/disseminated ENKTCL. 63 % of the patient with localized extranasal ENKTCL and about 50% of patients with extended/disseminated disease were reported to have died of the disease. Treatment strategies varied with no preferred option. Among the used treatment options were chemotherapy, radiotherapy, surgery, stem cell transplantation alone or in different combinations. CONCLUSION ENKTCL is a highly aggressive disease which may present in extranasal areas. Although the tumors respond to both chemotherapy and radiotherapy, durable complete remissions are very rare.
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Affiliation(s)
- Momena Akbar
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
| | - Erik Clasen-Linde
- Department of Pathology, Rigshospitalet, University of Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Rigshospitalet, University of Copenhagen, Denmark
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Guedes JCR, da Cunha KDAPF, Machado JRDS, Pinto LW. Nasal-type extranodal T-cell/NK lymphoma in association with hemophagocytic syndrome. An Bras Dermatol 2018; 93:422-425. [PMID: 29924244 PMCID: PMC6001101 DOI: 10.1590/abd1806-4841.20187097] [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] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 08/25/2017] [Indexed: 12/05/2022] Open
Abstract
Extranodal NK/T-cell lymphoma nasal type is a rare disease that mainly affects the nasal cavity and paranasal sinuses of males in the fifth decade of life. It has aggressive and locally destructive behaviour, and can be complicated by the hemophagocytic syndrome, conferring high lethality to the disease. This article describes a case of NK/T-cell lymphoma nasal type in a previously healthy patient, exemplifying its rapid and fulminant course.
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Affiliation(s)
- Juliana Chaves Ruiz Guedes
- Service of Dermatology, Hospital Universitário
Gaffrée e Guinle, da Universidade Federal do Estado do Rio de Janeiro
(HUGG-UniRio), Rio de Janeiro (RJ), Brazil
- Service of Dermatology, Instituto Nacional do Câncer (Inca),
Rio de Janeiro (RJ), Brazil
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Kobayashi R, Suzuki D, Hori D, Kishimoto K, Sano H, Nakazawa A, Yasuda K, Kobayashi K. Spontaneous improvement in a pediatric patient with peripheral T-cell lymphoma. Pediatr Int 2015; 57:1035-7. [PMID: 26508191 DOI: 10.1111/ped.12784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/25/2015] [Accepted: 07/28/2015] [Indexed: 11/30/2022]
Abstract
Peripheral T-cell lymphoma (PTCL) is rare in children, and it has a poor prognosis compared with other types of lymphoma. We report the case of a 7-year-old boy with spontaneous improvement of PTCL complicated by hemophagocytic syndrome as the initial symptom. He complained of pain and swelling of the right neck and presented with high fever. Pancytopenia, liver dysfunction, elevated ferritin and soluble interleukin 2 receptor were noted on laboratory tests. Peripheral blood plasma and white blood cells were positive for Epstein-Barr virus (EBV) genome but, after several days, the fever abated and laboratory data improved. On histopathology of lymph node biopsy, he was diagnosed as having PTCL not otherwise specified (PTCL-NOS) with EBV infection. He received no chemotherapy and was disease free at the last follow up, 6 years 8 months after onset. This is probably the first case of spontaneous improvement in PTCL-NOS. Careful treatment planning is therefore necessary in PTCL-NOS, given the possibility of spontaneous improvement of symptoms.
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Affiliation(s)
- Ryoji Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
| | - Daiki Hori
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
| | - Kenji Kishimoto
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
| | - Hirozumi Sano
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
| | - Atsuko Nakazawa
- Department of Pathology, National Center for Child Health and Development, Setagaya, Tokyo, Japan
| | - Kazue Yasuda
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
| | - Kunihiko Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan
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Kobayashi R, Fujita N, Mitsui T, Iwasaki F, Suzumiya J, Kuroda H, Nishimura R, Sasahara Y, Takeshita Y, Kato K, Okumura H, Sakamaki H, Yabe H, Kawa K, Kato K, Suzuki R. Stem cell transplantation for paediatric patients with non-anaplastic peripheral T-cell lymphoma in Japan. Br J Haematol 2012; 159:88-93. [DOI: 10.1111/bjh.12001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 06/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Ryoji Kobayashi
- Department of Paediatrics; Sapporo Hokuyu Hospital; Sapporo; Japan
| | - Naoto Fujita
- Department of Paediatrics; Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital; Hiroshima; Japan
| | - Tetsuo Mitsui
- Department of Paediatrics; Yamagata University School of Medicine; Yamagata; Japan
| | - Fuminori Iwasaki
- Department of Haematology; Kanagawa Children's Medical Centre; Yokohama; Japan
| | - Junji Suzumiya
- Department of Oncology/Haematology; Shimane University Hospital Cancer Centre; Fukuoka; Japan
| | - Hiroshi Kuroda
- Department of Paediatrics; Kyoto City Hospital; Kyoto; Japan
| | - Ryosei Nishimura
- Department of Paediatrics; Kanazawa University School of Medicine; Kanazawa; Japan
| | - Youji Sasahara
- Department of Paediatrics; Tohoku University School of Medicine; Sendai; Japan
| | - Yasushi Takeshita
- Department of Paediatrics; Nara Medical University School of Medicine; Nara; Japan
| | - Keisuke Kato
- Department of Paediatrics; Ibaraki Children's Hospital; Mito; Japan
| | - Hirokazu Okumura
- Department of Internal Medicine; Toyama Prefectural Central Hospital; Toyama; Japan
| | - Hisashi Sakamaki
- Department of Haematological Medicine; Tokyo Metropolitan Cancer and Infectious Diseases Centre Komagome Hospital; Bunkyo-ku; Japan
| | - Hiromasa Yabe
- Depatment of Paediatrics; Specialized Clinical Science; Tokai University School of Medicine; Isehara; Japan
| | - Keisei Kawa
- Japanese Red Cross Kinki Block Blood Centre; Osaka; Japan
| | - Koji Kato
- Division of Haematology/Oncology; Children's Medical Centre; Japanese Red Cross Nagoya First Hospital; Nagoya; Japan
| | - Ritsuro Suzuki
- Department of Haematopoietic Stem Cell Transplantation Data Management; Nagoya University School of Medicine; Nagoya; Japan
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Kelesidis T, Humphries R, Terashita D, Eshaghian S, Territo MC, Said J, Lewinski M, Currier JS, Pegues D. Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis in Los Angeles County. J Med Virol 2012; 84:777-85. [PMID: 22431026 DOI: 10.1002/jmv.23267] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Data on Epstein-Barr virus-related hemophagocytic lymphohistiocytosis (EBV-HLH) in adults in the United States remain very limited. A cluster of four cases of EBV-HLH was observed in a 4-month period at a tertiary center in Los Angeles County (LA County) and the clinical and molecular characteristics identified in these cases are being described. EBV typing, immunophenotypic and molecular genetic studies were performed. Diagnostic criteria that may be used to identify EBV as a cause of HLH in adults are also being suggested. Finally, the crude incidence rate for HLH in LA County was determined and was compared to the worldwide crude incidence rate for HLH. The cases each occurred in young male adult residents of California and were associated with evidence of EBV reactivation and ferritin levels of >20,000 µg/L. A higher rate of cases of EBV-HLH in 2010 was found at UCLA Medical Center than for 2007-2009 (4.9/10,000 hospital discharges vs. 0.14/10,000 hospital discharges, respectively; P = 0.0017). The cases were associated with EBV type 1, and the insertion of the codon CTC (leucine) was found in numerous of the EBNA-2 gene sequences. The annual incidence of secondary, non-familial HLH was estimated to be 0.9 cases per million persons >15 years of age in LA County. Although EBV-HLH is a rare disease, the incidence in adults in Western countries may be underestimated.
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Affiliation(s)
- Theodoros Kelesidis
- Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Li DM, Lun LD. Mucor irregularis infection and lethal midline granuloma: a case report and review of published literature. Mycopathologia 2012; 174:429-39. [PMID: 22744721 DOI: 10.1007/s11046-012-9559-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 05/28/2012] [Indexed: 12/16/2022]
Abstract
Mucor irregularis (Rhizomucor variabilis) infection and lethal midline granuloma (LMG) are characterized by progressive swelling, ulceration, and destruction of the central face that is usually fatal. Pathological features are inflammation, necrosis, and granulation. LMG has been called by various names, and in recent years, it has been known as NK/T cell lymphoma. However, diagnosis still relies on the progressive necrosis course rather than malignancy in histology. The disease has long challenged physicians, particularly when it worsens with radiotherapy or chemotherapy but sometimes achieves total remission without anti-malignancy therapies. We describe a 35-year-old man who had typical clinical-pathological symptoms of LMG, which turned out to be primary M. irregularis infection; that was diagnosed by positive tissue culture and fungal elements in histology. The patient was successfully treated with antifungal therapy (liposomal amphotericin B, total 4,600 mg and amphotericin B total 277 mg, over a duration of 70 days). We hereby review current knowledge about the epidemiology, clinical manifestations, radiographic characteristics, and pathologic features of LMG with those of M. irregularis infection and their associations. We conclude that primary M. irregulars infection can mimic the clinico-pathological symptoms of LMG and the condition responds favorably to aggressive antifungal therapy.
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Affiliation(s)
- Dong Ming Li
- Department of Dermatology, Research Center for Medical Mycology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100191, China.
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Rodríguez-Pinilla SM, Barrionuevo C, García J, Ángeles MDL, Pajares R, Casavilca S, Montes J, Martínez A, Montes-Moreno S, Sánchez L, Piris MÁ. Epstein-Barr virus-positive systemic NK/T-cell lymphomas in children: report of six cases. Histopathology 2011; 59:1183-93. [DOI: 10.1111/j.1365-2559.2011.04047.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Jordan MB, Allen CE, Weitzman S, Filipovich AH, McClain KL. How I treat hemophagocytic lymphohistiocytosis. Blood 2011; 118:4041-52. [PMID: 21828139 PMCID: PMC3204727 DOI: 10.1182/blood-2011-03-278127] [Citation(s) in RCA: 743] [Impact Index Per Article: 57.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 07/27/2011] [Indexed: 12/12/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of pathologic immune activation, occurring as either a familial disorder or a sporadic condition, in association with a variety of triggers. This immune dysregulatory disorder is prominently associated with cytopenias and a unique combination of clinical signs and symptoms of extreme inflammation. Prompt initiation of immunochemotherapy is essential for survival, but timely diagnosis may be challenging because of the rarity of HLH, its variable presentation, and the time required to perform diagnostic testing. Therapy is complicated by dynamic clinical course, high risk of treatment-related morbidity, and disease recurrence. Here, we review the clinical manifestations and patterns of HLH and describe our approach to the diagnosis and therapy for this elusive and potentially lethal condition.
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Affiliation(s)
- Michael B Jordan
- Divisions of Immunobiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Primary nasal-type natural killer/T-cell lymphoma of pterygopalatine fossa. J Craniofac Surg 2010; 21:444-7. [PMID: 20216452 DOI: 10.1097/scs.0b013e3181cfe9db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Primary tumors that originated from the pterygopalatine fossa are seen rarely. In this paper, the case of a 69-year-old woman who complained of a 2-month history of headache, extending to the left part of the face, teeth, and shoulder, is reported. She had undergone right total mastectomy and axillar dissection of a spindle cell-type metaplastic carcinoma of the breast 1 year ago. Computed tomographic and magnetic resonance images showed a mass originating from the pterygopalatine fossa. Pathologic examination of the biopsy specimen of the mass revealed a nasal-type extranodal natural killer/T-cell lymphoma with CD45 and intense CD56 staining. Our case shows that a nasal-type extranodal natural killer/T-cell lymphoma should be thought in mind for the differential diagnosis of primary tumors of the pterygopalatine fossa.
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Kobayashi R, Yamato K, Tanaka F, Takashima Y, Inada H, Kikuchi A, Kumagai MA, Sunami S, Nakagawa A, Fukano R, Fujita N, Mitsui T, Tsurusawa M, Mori T. Retrospective analysis of non-anaplastic peripheral T-cell lymphoma in pediatric patients in Japan. Pediatr Blood Cancer 2010; 54:212-5. [PMID: 19856396 DOI: 10.1002/pbc.22329] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Reports of non-anaplastic peripheral T-cell lymphoma (PTCL) in pediatric patients are relatively rare. PROCEDURE We performed a retrospective analysis in patients with PTCL over an 18-year period (1991-2008). RESULTS We could analyze clinical data in 21 patients with non-anaplastic PTCL; 10 were female and 10 male. Median age of onset was 11 years (range: 1-21 years). There were nine patients with PTCL, not otherwise specified (PTCL-NOS); ten with extranodal NK/T-cell lymphoma, nasal type; one with angioimmunoblastic T-cell lymphoma; and one with subcutaneous panniculitis-like T-cell lymphoma. Initial lesions involved cervical lymph nodes in five patients, and the skin in five patients. In five patients, hemophagocytic syndrome (HPS) was the initial clinical feature. There were 12 patients with advanced stage disease (stages III and IV). Chemotherapy and radiation was administered in 18 and 2 patients, respectively. Among the two patients who did not receive chemotherapy and radiation, one patient died while being treated for HPS but another improved spontaneously. Although 5 patients relapsed, 18 of 21 patients remained alive without disease at last follow-up. Five-year overall survival rate was 85.2%. CONCLUSIONS Generally, the outcome results of conventional chemotherapy for high-risk PTCL are poor in adult patients. However, the excellent results in our study suggest that PTCL of childhood is quite different from that of adulthood. Although this study is first report about PTCL of Asian children, the number of patients was small in this study. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Ryoji Kobayashi
- Department of Pediatrics, Sapporo Hokuyu Hospital, Shiroishiku, Sapporo, Japan.
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Primary radiotherapy showed favorable outcome in treating extranodal nasal-type NK/T-cell lymphoma in children and adolescents. Blood 2009; 114:4771-6. [PMID: 19812381 DOI: 10.1182/blood-2009-07-235853] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Abstract
Extranodal nasal-type natural killer (NK)/T-cell lymphoma is rarely observed in children and adolescents. We aim to investigate the clinical features, prognosis, and treatment outcomes in these patients. Thirty-seven patients were reviewed. There were 19, 14, 2, and 2 patients with stage I, stage II, stage III, and stage IV diseases, respectively. Among the patients with stage I and II disease, 19 patients received initial radiotherapy with or without chemotherapy, and 14 patients received chemotherapy followed by radiotherapy. The 4 patients with stage III and IV disease received primary chemotherapy and radiation of the primary tumor. Children and adolescents with extranodal nasal-type NK/T-cell lymphoma usually presented with early-stage disease, high frequency of B symptoms, good performance, low-risk age-adjusted international prognostic index, and chemoresistance. The complete response rate after initial radiotherapy was 73.7%, which was significantly higher than the response rate after initial chemotherapy (16.7%; P = .002). The 5-year overall survival (OS) and progression-free survival (PFS) rates for all the patients were 77.0% and 68.5%, respectively. The corresponding OS and PFS rates for patients with stage I and II disease were 77.6% and 72.3%, respectively. Children and adolescents with early-stage extranodal nasal-type NK/T-cell lymphoma treated with primary radiotherapy had a favorable prognosis.
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