1
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Fukumoto K, Watanabe R, Tsutsumi M, Takakuwa T, Miyamoto M, Hayashi N, Yamada S, Furumitsu Y, Hino M, Hashimoto M. Lymphoproliferative disorder progressing after partial remission following immunosuppressive drugs withdrawal in a patient with rheumatoid arthritis. Mod Rheumatol Case Rep 2024; 8:243-248. [PMID: 38343283 DOI: 10.1093/mrcr/rxae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/18/2024] [Accepted: 01/28/2024] [Indexed: 07/09/2024]
Abstract
Lymphoproliferative disorders (LPDs) are serious complications that arise in patients with rheumatoid arthritis (RA) receiving immunosuppressive drugs (ISDs). Here, we reported a 73-year-old woman diagnosed with RA at 60 years of age and treated with methotrexate, bucillamine, prednisolone, and infliximab. She was referred to our hospital, Osaka Metropolitan University Hospital, with general malaise, pancytopenia, a right adrenal mass, and enlarged periaortic lymph nodes. Epstein-Barr virus was detected in serum. We suspected LPD development and performed a bone marrow biopsy, on which no malignant cells could be detected. Upon ISDs withdrawal, her symptoms and blood counts improved, and the right adrenal mass and enlarged lymph nodes regressed. The patient was followed up for clinical LPD. However, 7 months after the initial visit to our hospital, she developed fever and pancytopenia. A repeat bone marrow biopsy confirmed the diagnosis of Epstein-Barr virus-positive diffuse large B-cell lymphoma complicated by haemophagocytic syndrome. After pulse steroid therapy, the patient received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, which resulted in a complete response. In conclusion, when LPDs develop in patients with RA during ISD treatment, LPDs can progress and complicate haemophagocytic syndrome after partial remission following ISDs withdrawal. Therefore, we should carefully follow up RA patients with LPDs, and aim to achieve an early diagnosis of LPD and promptly initiate chemotherapy.
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Affiliation(s)
- Kazuo Fukumoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
- Department of Medical Education and General Practice, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Minako Tsutsumi
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Teruhito Takakuwa
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masafumi Miyamoto
- Department of Internal Medicine, Ohno Memorial Hospital, Osaka, Japan
| | - Noriyuki Hayashi
- Department of Internal Medicine, Ohno Memorial Hospital, Osaka, Japan
| | - Shinsuke Yamada
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Furumitsu
- Department of Internal Medicine, Ohno Memorial Hospital, Osaka, Japan
| | - Masayuki Hino
- Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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2
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Knauft J, Schenk T, Ernst T, Schnetzke U, Hochhaus A, La Rosée P, Birndt S. Lymphoma-associated hemophagocytic lymphohistiocytosis (LA-HLH): a scoping review unveils clinical and diagnostic patterns of a lymphoma subgroup with poor prognosis. Leukemia 2024; 38:235-249. [PMID: 38238443 PMCID: PMC10844097 DOI: 10.1038/s41375-024-02135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a severe hyperinflammatory syndrome driven by pathologic activation of cytotoxic T-lymphocytes and macrophages. Despite advances in diagnostics and management, adult patients with lymphoma-associated HLH (LA-HLH) harbor particularly poor prognosis and optimal treatment remains challenging. As systematic data on LA-HLH are scarce, we aimed to synthesize research evidence by thorough analysis of the published literature in PubMed (MEDLINE-database) within the context of a scoping review. Of 595 search results, 132 articles providing information on 542 patients were reviewed and analyzed. Median patient age was 60 years (range, 18-98) with male predominance (62.7%). B- and T-NHL were equally represented (45.6% and 45.2%), Hodgkin's lymphoma was reported in 8.9% of the cases. The majority of patients (91.6%) presented in Ann-Arbor-Stages III and IV, and bone marrow infiltration was observed in a significant proportion of patients (61.5%). Soluble CD25 levels were markedly elevated (median 10,000 U/ml), with levels beyond 10,000 U/ml indicating unfavorable prognosis for 30-day and overall survival. 66.8% of the patients died after median 5.1 months. LA-HLH remains a clinical challenge requiring specialized management. Timely diagnosis and appropriate lymphoma-specific treatment are of utmost importance to enhance patient outcomes.
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Affiliation(s)
- Johanna Knauft
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Schenk
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Thomas Ernst
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Ulf Schnetzke
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany
| | - Paul La Rosée
- Klinik für Innere Medizin II, Onkologie, Hämatologie, Immunologie, Infektiologie und Palliativmedizin, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany
| | - Sebastian Birndt
- Klinik für Innere Medizin II, Hämatologie und internistische Onkologie, Universitätsklinikum Jena, Jena, Germany.
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3
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Li N, Jiang M, Wu WC, Zhou HJ, Zou LQ. Lymphoma-associated hemophagocytic syndrome: a retrospective study from a single center. Hematology 2022; 27:909-916. [DOI: 10.1080/16078454.2022.2113600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Na Li
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- Department of Oncology, West China fourth hospital, West China School of Public Health, Sichuan University, Chengdu, People’s Republic of China
| | - Ming Jiang
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Wan-chun Wu
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Hui-jie Zhou
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Li-qun Zou
- Department of Medical Oncology of Cancer Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
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4
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Bourbon E, Maucort-Boulch D, Fontaine J, Mauduit C, Sesques P, Safar V, Ferrant E, Golfier C, Ghergus D, Karlin L, Lazareth A, Bouafia F, Pica GM, Orsini-Piocelle F, Rocher C, Gros FX, Parrens M, Dony A, Rossi C, Ghesquières H, Bachy E, Traverse-Glehen A, Sarkozy C. Clinicopathological features and survival in EBV-positive diffuse large B-cell lymphoma not otherwise specified. Blood Adv 2021; 5:3227-3239. [PMID: 34427583 PMCID: PMC8405194 DOI: 10.1182/bloodadvances.2021004515] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/21/2021] [Indexed: 12/16/2022] Open
Abstract
In this retrospective study, we report 70 cases of Epstein-Barr virus (EBV)+ diffuse large B-cell lymphoma not otherwise specified (DLBCL-NOS) among 1696 DLBCL-NOS cases diagnosed between 2006 and 2019 (prevalence of 4.1%). At diagnosis, median age was 68.5 years; 79% of the cases presented with an advanced-stage disease (III-IV), 48% with extranodal lesions, and 14% with an hemophagocytic lymphohistiocytosis (HLH) (8 at diagnosis and 1 on therapy). A total of 46 cases presented a polymorphic pattern, and 21 were monomorphic. All had a non-germinal center B phenotype, with the majority of tumor cells expressing CD30 and programmed death ligand 1 (98% and 95%, respectively). Type II and III EBV latency was seen in 88% and 12% of the cases, respectively. Patients were treated with immunochemotherapy (59%) or chemotherapy (22%), and 19% received palliative care due to advanced age and altered performance status. After a median follow-up of 48 months, progression-free survival (PFS) and overall survival (OS) at 5 years were 52.7% and 54.8%, respectively. Older age (>50 years) and HLH were associated with shorter PFS and OS in multivariate analysis (PFS: hazard ratio [HR], 14.01; 95% confidence interval [CI], 2.34-83.97; and HR, 5.78; 95% CI, 2.35-14.23; OS: HR, 12.41; 95% CI, 1.65-93.53; and HR, 6.09; 95% CI, 2.42-15.30, respectively). Finally, using a control cohort of 425 EBV- DLBCL-NOS, EBV positivity was associated with a shorter OS outcome within patients >50 years (5-year OS, 53% [95% CI, 38.2-74] vs 60.8% [95% CI, 55.4-69.3], P = .038), but not in younger patients.
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Affiliation(s)
- Estelle Bourbon
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
| | - Delphine Maucort-Boulch
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
- Centre national de la recherche scientifique (CNRS), Unité Mixte de Recherche (UMR) 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Juliette Fontaine
- Service d'Anatomie Pathologique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Claire Mauduit
- Service d'Anatomie Pathologique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Pierre Sesques
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Violaine Safar
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Emmanuelle Ferrant
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Camille Golfier
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Dana Ghergus
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Lionel Karlin
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Anne Lazareth
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Fadhela Bouafia
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
| | - Gian Matteo Pica
- Service d'Hématologie, Centre hospitalier Métropole Savoie, Chambéry, France
| | | | - Clément Rocher
- Service d'Hématologie, Groupement Hospitalier Nord Dauphiné, Bourgoin Jallieu, France
| | | | - Marie Parrens
- Service d'Anatomie et de Pathologie, Centre Hospitalo-Universitaire de Bordeaux, Bordeaux, France
- INSERM U1053, BaRITOn, Université de Bordeaux, Bordeaux, France
| | - Arthur Dony
- Service d'Hématologie, Hôpital Nord-Ouest, Villefranche-sur-Saône, France
| | - Cédric Rossi
- Service d'Hématologie, Centre Hospitalier Universitaire de Dijon, Dijon, France
- INSERM UMR 1231, Dijon, France
| | - Hervé Ghesquières
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- EA LIB (Lymphoma ImmunoBiology), Université Claude Bernard Lyon 1, Lyon, France; and
| | - Emmanuel Bachy
- Service d'Hématologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- EA LIB (Lymphoma ImmunoBiology), Université Claude Bernard Lyon 1, Lyon, France; and
| | - Alexandra Traverse-Glehen
- Université de Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France
- Service d'Anatomie Pathologique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite Cedex, France
- EA LIB (Lymphoma ImmunoBiology), Université Claude Bernard Lyon 1, Lyon, France; and
| | - Clémentine Sarkozy
- Département d'Innovation thérapeutique, Institut Gustave Roussy, Villejuif, France
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5
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Ricard JA, Charles R, Tommee CG, Yohe S, Bell WR, Flanagan ME. Epstein Virus Barr-Positive Diffuse Large B-Cell Lymphoma Associated with Hemophagocytic Lymphohistiocytosis. J Neuropathol Exp Neurol 2021; 79:915-920. [PMID: 32647871 DOI: 10.1093/jnen/nlaa061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/25/2019] [Accepted: 06/04/2020] [Indexed: 11/15/2022] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare and often fatal disease if not diagnosed and treated promptly. HLH can be due to genetic factors or infections, malignancies and collagen-associated vascular diseases. Malignancy-associated HLH is not only more common in the setting of T/NK-cell lymphomas, but may also rarely be seen in the setting of B-cell lymphoma. Here, we describe a unique case of a patient who initially was diagnosed with HLH secondary to Epstein Barr virus (EBV) infection and subsequently developed EBV-positive diffuse large B-cell lymphoma affecting the brain. This case highlights the spectrum of findings associated with EBV infections and the challenges in diagnosing underlying diseases associated with HLH.
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Affiliation(s)
- Jocelyn A Ricard
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - River Charles
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Carolina Gil Tommee
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Sophia Yohe
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - W Robert Bell
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Margaret E Flanagan
- From the Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
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6
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Fujikura K, Yamashita D, Yoshida M, Ishikawa T, Itoh T, Imai Y. Cytogenetic complexity and heterogeneity in intravascular lymphoma. J Clin Pathol 2020; 74:244-250. [PMID: 32763919 DOI: 10.1136/jclinpath-2020-206573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To characterise the karyotypic abnormalities and heterogeneities in intravascular lymphoma (IVL). METHODS G-banded karyotyping was performed on biopsy specimens from a single-centre IVL cohort comprising intravascular large B-cell lymphoma (IVLBCL, n=12) and NK/T-cell lymphoma (IVNKTCL, n=1). RESULTS Five IVLBCL cases and one IVNKTCL case (total 46%) were found to have normal karyotypes, and the cytogenetic abnormalities observed in the other seven IVLBCL cases (54%) were investigated further. These seven karyotypes were uniformly complex with an average of 13 aberrations. The seven cases all had abnormalities involving chromosome 6, with 57% involving structural abnormalities at 6q13, and chromosome 8, with 43% involving abnormalities at 8p11.2. In addition, 71% had aberrations at 19q13. On average, 4.4 chromosomal gains and losses were detected per case. Cytogenetic heterogeneities were observed in six cases (86%) and tetraploidy in three cases (43%). There was no significant difference in progression-free survival (p=0.92) and overall survival (p=0.61) between the IVLBCL cases with complex and normal karyotypes. CONCLUSION Approximately half of IVLBCL cases had a highly heterogeneous pattern of karyotypes with different clonal numerical and structural chromosome aberrations.
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Affiliation(s)
- Kohei Fujikura
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan .,Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Yamashita
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Yoshida
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
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7
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Klairmont MM, Cheng J, Martin MG, Gradowski JF. Recurrent Cytogenetic Abnormalities in Intravascular Large B-Cell Lymphoma. Am J Clin Pathol 2018; 150:18-26. [PMID: 29767679 DOI: 10.1093/ajcp/aqy023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data characterizing the cytogenetic landscape of intravascular large B-cell lymphoma (ILBCL) are limited. Here, we developed a comprehensive karyotypic data set to identify recurrent cytogenetic abnormalities in ILBCL. METHODS Cases of ILBCL with complete cytogenetic analysis were identified from an institutional database and the literature. The combined data were systematically reviewed for the presence of recurrent abnormalities. RESULTS Four new cases were identified and combined with 25 karyotypes previously published in the literature. Karyotypes were uniformly complex with a median of 10 aberrations. In total, 72.4% had abnormalities involving chromosome 1, with 31.0% involving rearrangements of 1p13 or 1q21; 58.6% had abnormalities involving chromosome 6, which in almost all cases involved 6q; 34.5% had abnormalities involving chromosome 14, with 27.6% involving rearrangements of 14q32; and 55.2% had abnormalities of chromosome 18, with 37.9% harboring trisomy 18. CONCLUSIONS Recurrent cytogenetic abnormalities involving chromosomes 1, 6q, and 18 are present in greater than 50% of ILBCL.
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Affiliation(s)
- Matthew M Klairmont
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Jinjun Cheng
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Mike G Martin
- Department of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, Memphis
| | - Joel F Gradowski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
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8
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Linnik Y, Nicka C, Lansigan F, Loo E, Liu X. Intravascular Large B-Cell Lymphoma Within a Thyroid Nodule: A Diagnostic Pitfall. Int J Surg Pathol 2018; 26:428-431. [DOI: 10.1177/1066896918763282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a subtype of diffuse large B-cell lymphoma, where the neoplastic lymphoid proliferation resides predominantly within the lumens of blood vessels but with no or few circulating neoplastic cells in the peripheral circulation. Focal or subtle involvement in some cases can cause the diagnosis to be misinterpreted or even overlooked, delaying the initiation of appropriate treatment. Our report focuses on a 78-year-old woman with a progressively enlarging thyroid mass, verified by ultrasound. She underwent a hemithyroidectomy, and microscopic evaluation demonstrated nodular thyroid parenchyma with atypical large cells in an intravascular distribution pattern identified on high magnification. Thorough evaluation showed that the large intravascular cells were positive CD20, PAX-5, and Ki-67 by immunoperoxidase staining, which lead to the diagnosis of IVLBCL. This case emphasizes the subtle appearance of IVLBCL, which may be missed on low-power light microscopy, and the need for careful evaluation of thyroid resection specimens.
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Affiliation(s)
| | | | | | - Eric Loo
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Xiaoying Liu
- Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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9
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Yang SY, Lin CH, Chang CH. Bullous Sweet's syndrome with figurate erythema and cutaneous hemophagocytosis. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Bone Marrow-Liver-Spleen Type of Large B-Cell Lymphoma Associated with Hemophagocytic Syndrome: A Rare Aggressive Extranodal Lymphoma. Case Rep Hematol 2017; 2017:8496978. [PMID: 28835859 PMCID: PMC5556984 DOI: 10.1155/2017/8496978] [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] [Received: 04/10/2017] [Accepted: 06/28/2017] [Indexed: 11/17/2022] Open
Abstract
Recently, an unusual subtype of large B-cell lymphoma (LBCL) with distinctive clinicopathologic features has been recognized; it is characterized by involvement of bone marrow with or without liver and/or spleen, but no lymph node or other extranodal sites, usually associated with fever, anemia, and hemophagocytic lymphohistiocytosis (HLH). Because of this distinctive clinical presentation, it has been designated "bone marrow-liver-spleen" (BLS) type of LBCL. To date there is only one series of 11 cases of BLS type of LBCL with detailed clinical, pathologic, and cytogenetic data. Herein, we describe a case of BLS type LBCL presenting with associated HLH in a 73-year-old female. The bone marrow core biopsy showed cytologically atypical large lymphoma cells present in a scattered interstitial distribution and hemophagocytosis and infrequent large lymphoma cells were seen in the bone marrow aspirate smears. Circulating lymphoma cells were not seen in the peripheral blood smears. The patient underwent treatment with chemotherapy (R-CHOP) but unfortunately passed away 2 months after initial presentation. BLS type of LBCL is a very rare and clinically aggressive lymphoma whose identification may be delayed by clinicians and hematopathologists due to its unusual clinical presentation and pathologic features.
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11
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Bains A, Mamone L, Aneja A, Bromberg M. Lymphoid malignancy-associated hemophagocytic lymphohistiocytosis: Search for the hidden source. Ann Diagn Pathol 2017. [PMID: 28648938 DOI: 10.1016/j.anndiagpath.2017.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Secondary hemophagocytic lymphohistiocytosis (HLH) is an uncommon, but life-threatening syndrome of highly stimulated and ineffective immune dysregulation. It is not a disease entity by itself and the current diagnosis of secondary (acquired) HLH is based on constellation of nonspecific clinical and laboratory parameters indicative of overactive immune response. The presenting symptoms are often nonspecific and could potentially be missed, leading to a fatal outcome. Patients with malignancy-associated HLH have a relatively unfavorable overall survival compared with non-malignancy-associated HLH. In this retrospective study, nine adult patients with secondary HLH were identified. Of these four cases were associated with a malignancy and despite a high degree of suspicion, the underlying lymphoid malignancy was not initially evident. Three out of four patients with lymphoid malignancy-associated HLH died over a very short course of time following the diagnosis. The outcome was significantly different for the control group of patients with other underlying cause(s) for HLH. These cases emphasize the importance of a thorough search for a hidden malignant source in patients with secondary HLH for prompt diagnosis and institution of malignancy specific treatment.
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Affiliation(s)
- Ashish Bains
- Department of Pathology and Laboratory Medicine, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA.
| | - Linda Mamone
- Department of Pathology and Laboratory Medicine, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA.
| | - Amandeep Aneja
- Department of Pathology and Laboratory Medicine, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA.
| | - Michael Bromberg
- Department of Hematology and Oncology, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA 19140, USA.
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12
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Genetic analysis of B-cell lymphomas associated with hemophagocytic lymphohistiocytosis. Blood Adv 2016; 1:205-207. [PMID: 29296936 DOI: 10.1182/bloodadvances.2016002006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022] Open
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13
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Park SH, Lee EY, Chung JS. A rare case of diffuse large B cell lymphoma-associated hemophagocytic syndrome initially present in the bone marrow with a favorable clinical course. Blood Res 2016; 51:144-7. [PMID: 27382563 PMCID: PMC4931936 DOI: 10.5045/br.2016.51.2.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 06/03/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Sang Hyuk Park
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine and Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Joo Seop Chung
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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14
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Yanagihori H, Oyama N, Kawakami Y, Sakuma-Oyama Y, Nakamura K, Iwatsuki K, Kaneko F. A Case of Intravascular Large B-Cell Lymphoma with Multiple Organ Involvement. J Dermatol 2014; 30:910-4. [PMID: 14739519 DOI: 10.1111/j.1346-8138.2003.tb00347.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Accepted: 08/19/2003] [Indexed: 11/28/2022]
Abstract
Intravascular large B-cell lymphoma (IVL) is a rare systemic disease characterized by clonal proliferation of neoplastic lymphoid cells within the capillary lumina of small blood vessels. The most common sites of involvement are cerebrovascular or sinusoid areas, resulting in a wide variety of neurologic deficits. Herein we describe a case of IVL that presented with multiple internal and external organ involvements, including the skin, bilateral kidneys, and lung, and with an aggressive clinical course. The confirmative diagnosis was based on the microscopic findings of the skin lesion with a B-cell immunophenotype. The patient suffered from repeated severe dyspnea, hypoxemia, and high-grade fever with a simultaneous increase in serum lactate dehydrogenase and soluble IL-2 receptor levels. These manifestations responded dramatically to intravenous injection of corticosteroid (500 mg/day for 3 days). Despite various clinical presentations, no neurological abnormality was observed until the patient died 12 months after the initial combination chemotherapy.
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MESH Headings
- Diagnosis, Differential
- Fatal Outcome
- Female
- Humans
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/secondary
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/secondary
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Multiple Organ Failure
- Neoplasm Metastasis
- Skin Neoplasms/diagnosis
- Skin Neoplasms/diagnostic imaging
- Skin Neoplasms/drug therapy
- Skin Neoplasms/secondary
- Tomography, X-Ray Computed
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Affiliation(s)
- Hirokatsu Yanagihori
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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15
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Abstract
Hemophagocytic lymphohistiocytosis (HLH) covers a wide array of related life-threatening conditions featuring ineffective immunity characterized by an uncontrolled hyperinflammatory response. HLH is often triggered by infection. Familial forms result from genetic defects in natural killer cells and cytotoxic T-cells, typically affecting perforin and intracellular vesicles. HLH is likely under-recognized, which contributes to its high morbidity and mortality. Early recognition is crucial for any reasonable attempt at curative therapy to be made. Current treatment regimens include immunosuppression, immune modulation, chemotherapy, and biological response modification, followed by hematopoietic stem-cell transplant (bone marrow transplant). A number of recent studies have contributed to the understanding of HLH pathophysiology, leading to alternate treatment options; however, much work remains to raise awareness and improve the high morbidity and mortality of these complex conditions.
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Affiliation(s)
- Melissa R George
- Department of Pathology, Penn State Milton S Hershey Medical Center, Hershey, PA, USA
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16
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Bogusz AM, Joyce R, Kolodny G, Buck T, Pihan G, Bhargava P. An unusual patient with shortness of breath--clinical, radiologic, and pathologic pitfalls. Am J Hematol 2014; 89:558-63. [PMID: 24496963 DOI: 10.1002/ajh.23689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 01/29/2014] [Accepted: 01/30/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Agata M. Bogusz
- Department of Pathology and Laboratory Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Robin Joyce
- Department of Medicine; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Gerald Kolodny
- Department of Radiology; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Thomas Buck
- Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - German Pihan
- Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
| | - Parul Bhargava
- Department of Pathology; Beth Israel Deaconess Medical Center; Boston Massachusetts
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17
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Sano H, Kobayashi R, Tanaka J, Hashino S, Ota S, Torimoto Y, Kakinoki Y, Yamamoto S, Kurosawa M, Hatakeyama N, Haseyama Y, Sakai H, Sato K, Fukuhara T. Risk factor analysis of non-Hodgkin lymphoma-associated haemophagocytic syndromes: a multicentre study. Br J Haematol 2014; 165:786-92. [DOI: 10.1111/bjh.12823] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 01/23/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Hirozumi Sano
- Department of Paediatrics; Sapporo Hokuyu Hospital; Sapporo Japan
| | - Ryoji Kobayashi
- Department of Paediatrics; Sapporo Hokuyu Hospital; Sapporo Japan
| | - Junji Tanaka
- Stem Cell Transplantation Centre; Hokkaido University Hospital; Sapporo Japan
| | - Satoshi Hashino
- Stem Cell Transplantation Centre; Hokkaido University Hospital; Sapporo Japan
| | - Shuichi Ota
- Department of Haematology; Sapporo Hokuyu Hospital; Sapporo Japan
| | - Yoshihiro Torimoto
- Third Department of Internal Medicine; Asahikawa Medical College; Sapporo Japan
| | | | - Satoshi Yamamoto
- Department of Haematology; Sapporo City General Hospital; Sapporo Japan
| | - Mitsutoshi Kurosawa
- Department of Haematology; National Hospital Organization Hokkaido Cancer Centre; Sapporo Japan
| | - Naoki Hatakeyama
- Department of Paediatrics; Sapporo Medical College; Sapporo Japan
| | - Yoshihito Haseyama
- Department of Haematology; KKR Sapporo Medical Centre; Tonan Hospital; Sapporo Japan
| | - Hajime Sakai
- Department of Haematology; Teine Keijinkai Hospital; Sapporo Japan
| | - Kazuya Sato
- Department of Haematology; Hokkaido P.W.F.A.C Asahikawa-Kosei General Hospital; Asahikawa Japan
| | - Takashi Fukuhara
- Department of Palliative Care Medicine; Hokkaido P.W.F.A.C Sapporo-Kosei General Hospital; Sapporo Japan
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18
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Arima H, Maruoka H, Nasu K, Tabata S, Kurata M, Matsushita A, Imai Y, Takahashi T, Ishikawa T. Impact of occult bone marrow involvement on the outcome of rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone therapy for diffuse large B-cell lymphoma. Leuk Lymphoma 2013; 54:2645-53. [DOI: 10.3109/10428194.2013.788697] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Geyer H, Karlin N, Palen B, Mesa R. Asian-variant intravascular lymphoma in the African race. Rare Tumors 2012; 4:e10. [PMID: 22532908 PMCID: PMC3325737 DOI: 10.4081/rt.2012.e10] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 12/12/2011] [Indexed: 01/28/2023] Open
Abstract
Intravascular Large B-cell lymphoma (IVLBCL) is an exceptionally rare form of non-Hodgkin lymphoma (NHL) distinguished by the preferential growth of neoplastic cells within blood vessel lumen. Challenging to detect and deemed disseminated at diagnosis, this condition is characterized by a highly aggressive, inconspicuous course with a high mortality rate. We describe the case of a 48 year-old African-American female presenting with a two month history of low-grade fevers and malaise. Laboratory data was notable for anemia, thrombocytopenia, elevated liver function tests, and hematuria. An extensive work-up for infectious, rheumatologic and malignant causes was negative. Her symptoms progressed and within two weeks, she was admitted for disseminated intravascular coagulation (DIC). Her course was complicated by diffuse pulmonary hemorrhage and ultimately, care was withdrawn. Autopsy identified widespread CD-20 positive intravascular large B-cell lymphoma with significant hepatosplenic involvement, characteristic of the Asian variant IVLBCL. This case uniquely highlights development of the Asian variant IVLBVL in a previously undescribed race. Identified by its intraluminal vascular growth pattern, IVLBCL generally spares lymphatic channels. Diagnosis and differentiation of this condition from other hematological malignancies via skin, visceral and bone marrow biopsy is imperative as anthracycline-containing chemotherapies may significantly improve clinical outcomes. This article outlines the common presentation, natural course, and treatment options of IVLBCL, along with the histopathology, immunohistochemistry, and chromosomal aberrations common to this condition.
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Affiliation(s)
- Holly Geyer
- Division of Hematology - Oncology, Mayo Clinic, Scottsdale, AZ, USA
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20
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Hagihara M, Inoue M, Hua J, Iwaki Y. Lymphocyte-depleted Hodgkin lymphoma complicating hemophagocytic lymphohistiocytosis as an initial manifestation: a case report and review of the literature. Intern Med 2012; 51:3067-72. [PMID: 23124152 DOI: 10.2169/internalmedicine.51.8275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Hemophagocytic lymphohistocytosis (HLH) is commonly associated with infectious diseases or T/NK cell-lymphoma; however that with Hodgkin lymphoma (HL) was rarely reported. Herein, we describe a young male diagnosed with lymphocyte-depleted HL (LD-HL) complicated by HLH as an initial manifestation. He was given high-dose steroid therapy plus recombinant thrombomodulin, and subsequent ABVd (doxorubicin, bleomycin, vinblastine, dacarbazine) treatment. In spite of the achievement of a partial remission treated with one cycle of ABVd, he relapsed after 3 cycles. To our knowledge, the present case is very rare, and more intensive treatment might be needed for the long-term control of HLH-complicated HL.
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21
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Abstract
We report a 59-year-old man with intravascular large B-cell lymphoma (IVLBCL) associated with hemophagocytic syndrome, disseminated intravascular coagulopathy, and lung involvement. G-banding analysis of the metaphase spreads obtained from the bone marrow showed that the lymphoma cells were near-tetraploid and included two homologues of the 14q+ chromosome. Spectral karyotyping revealed that complex translocations occurred among chromosomes 3, 12, 14, and 19, and additional materials of 14q+ were from chromosome 19 with the breakpoint at 14q32 and 19q13. To the best of our knowledge, this is the first report describing t(14;19)(q32;q13) in IVLBCL.
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Affiliation(s)
- Taishi Kobayashi
- Department of Hematology, Hyogo Prefectural Amagasaki Hospital, Japan
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22
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Deisch J, Fuda FB, Chen W, Karandikar N, Arbini AA, Zhou XJ, Wang HY. Segmental tandem triplication of the MLL gene in an intravascular large B-cell lymphoma with multisystem involvement: a comprehensive morphologic, immunophenotypic, cytogenetic, and molecular cytogenetic antemortem study. Arch Pathol Lab Med 2009; 133:1477-82. [PMID: 19722759 DOI: 10.5858/133.9.1477] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2008] [Indexed: 11/06/2022]
Abstract
An association between intravascular large B-cell lymphoma (IVLBCL) and the mixed lineage leukemia (MLL) gene has never been demonstrated. Here, we report an IVLBCL in a 47-year-old Asian man. Morphologically, the atypical lymphoid infiltrate was entirely confined in the lumina of capillaries, small vessels, and sinusoidal space. Within the kidney, the neoplastic lymphoid cells exhibited both the glomerular and peritubular capillary distribution pattern. Conventional cytogenetic analysis from the bone marrow aspirates displayed a complex karyotype, with a notable triple tandem repeat at band segment q22-q25 of chromosome 11. Fluorescence in situ hybridization with an MLL probe set, performed on both interphase cells and metaphase spreads, confirmed the presence of 3 copies of the MLL gene on the derivative chromosome 11. From this finding and 3 other IVLBCL cases reported in the literature, we conclude that MLL may play an important role in the lymphomagenesis of IVLBCL at least in a subset of cases.
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Affiliation(s)
- Jeremy Deisch
- Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390, USA
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23
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Narimatsu H, Morishita Y, Saito S, Shimada K, Ozeki K, Kohno A, Kato Y, Nagasaka T. Usefulness of Bone Marrow Aspiration for Definite Diagnosis of Asian Variant of Intravascular Lymphoma: Four Autopsied Cases. Leuk Lymphoma 2009; 45:1611-6. [PMID: 15370213 DOI: 10.1080/10428190410001683769] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Asian variant of intravascular lymphoma (AIVL) is characterized by hemophagocytic syndrome, pancytopenia and hepatosplenomegaly but usually lacks any neurological abnormality and skin lesions, which are typical features of classical intravascular lymphoma (IVL). An ante-mortem diagnosis of AIVL is difficult due to the absence of visible lymphoma lesions and unspecific clinical manifestations. A definite diagnosis relies on the presence of neoplastic B cells in the lumina of small vessels. Paraffin block samples of aspirated bone marrow clots were obtained from 4 patients with clinically suspected IVL and subjected to immunohistopathological analysis. All samples exhibited CD 20+ or CD 79a+ lymphoma cells proliferating intravascularly as well as erythrocytic hemophagocytosis. The distribution of neoplastic cells in the structure of the bone marrow allowed IVL to be distinguished from bone marrow invasions due to other types of lymphoma. We demonstrated the successful establishment of a definite ante-mortem diagnosis of AIVL in 3 of 4 patients by the rapid and simple method of using aspirated bone marrow samples.
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Affiliation(s)
- Hiroto Narimatsu
- Department of Hematology and Oncology, JA Aichi Showa Hospital, Konan, Japan.
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24
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Matsue K, Asada N, Takeuchi M, Yamakura M, Kimura SI, Odawara J, Aoki T. A clinicopathological study of 13 cases of intravascular lymphoma: experience in a single institution over a 9-yr period. Eur J Haematol 2008; 80:236-44. [DOI: 10.1111/j.1600-0609.2007.01008.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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[Pathogenesis and morphology of hemophagocytic syndrome in the spleen]. DER PATHOLOGE 2008; 29:158-64. [PMID: 18210111 DOI: 10.1007/s00292-008-0970-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hemophagocytic syndrome (macrophage activation syndrome) is a group of disorders characterized by clinical, histological and biological symptoms of T-lymphocytes/NK cell-driven macrophage stimulation with subsequent hemophagocytosis which can be observed in various organs, particularly in the bone marrow and spleen. The main clinical symptoms include cytopenia, multiple organ dysfunction, fever unresponsive to antibiotics, hepatosplenomegaly and rash. Besides rare inherited immune system anomalies (primary hemophagocytic syndrome), the most prevalent etiologies of hemophagocytic syndrome are infections (viral, bacterial and parasitic), cancers, lymphoproliferative disorders and systemic diseases. Hemophagocytic syndrome is treated with immunosuppressives, cytostatic drugs, plasmapheresis and intravenous immunoglobulins/anti-TNF antibodies and due to the multiorgan involvement and the associated high mortality, recognition of early serum changes, such as very high levels of ferritin is mandatory. The most relevant histological changes are the increase of histiocytes showing evidence of phagocytosis of erythroid cells, platelets and granulocytes as well as in the spleen a rarefaction of the white pulpa with lack of lymph follicles and abundant lymphocytes, plasma cells and plasma cell precursors in the pulpa cords.
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26
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Takahashi T, Minato M, Tsukuda H, Yoshimoto M, Tsujisaki M. Successful treatment of intravascular large B-cell lymphoma diagnosed by bone marrow biopsy and FDG-PET scan. Intern Med 2008; 47:975-9. [PMID: 18480585 DOI: 10.2169/internalmedicine.47.0808] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Early diagnosis of intravascular large B-cell lymphoma (IVLBCL) is difficult, but is critical for longer survival for the patients. We report a case of IVLBCL that was diagnosed with the help of FDG-PET. A 76-year-old woman was referred to us for the evaluation of her elevated serum LDH. She presented with general malaise and high fever. There were no skin lesions or neurological involvement. FDG-PET imaging showed increased uptake of FDG in the vertebra, bilateral femurs, sternum, and iliac bones. A diagnosis of IVLBCL was made by bone marrow biopsy. She was successfully treated with rituximab and modified CHOP therapy.
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MESH Headings
- Aged
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Bone Marrow/pathology
- Bone Marrow Cells/pathology
- Bone Marrow Examination
- Cyclophosphamide/therapeutic use
- Doxorubicin/analogs & derivatives
- Doxorubicin/therapeutic use
- Female
- Fever of Unknown Origin/etiology
- Fluorodeoxyglucose F18
- Humans
- In Situ Hybridization, Fluorescence
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Positron-Emission Tomography
- Prednisone/therapeutic use
- Rituximab
- Translocation, Genetic
- Vincristine/therapeutic use
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27
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Xanthopoulos V, Galanopoulos AG, Paterakis G, Apessou D, Argyrakos T, Goumakou E, Papadhimitriou SI, Savvidou I, Georgiakaki M, Anagnostopoulos NI. Intravascular B-cell lymphoma with leukemic presentation: case report and literature review. Eur J Haematol 2007; 80:177-81. [PMID: 18076638 DOI: 10.1111/j.1600-0609.2007.00984.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intravascular lymphoma is an extremely rare, disseminated, and aggressive extranodal CD20+ non-Hodgkin's lymphoma characterized by the presence of lymphoma cells only in the lumina of small vessels. We report a 72-year-old woman with a diagnosis of intravascular lymphoma presented with splenomegaly and leukemic appearance in the peripheral blood smear. Her clinical course was rapidly deteriorated before the initiation of specific chemotherapy and finally died due to multiorgan insufficiency. Bone marrow biopsy revealed a characteristic infiltration of CD5, CD10 B-cell lymphoma. To our knowledge, this is the first reported case of a CD5, CD10 intravascular B-cell lymphoma with leukemic presentation in peripheral blood with multiple cytogenetic aberrations.
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28
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Ishii E, Ohga S, Imashuku S, Yasukawa M, Tsuda H, Miura I, Yamamoto K, Horiuchi H, Takada K, Ohshima K, Nakamura S, Kinukawa N, Oshimi K, Kawa K. Nationwide survey of hemophagocytic lymphohistiocytosis in Japan. Int J Hematol 2007; 86:58-65. [PMID: 17675268 DOI: 10.1532/ijh97.07012] [Citation(s) in RCA: 306] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH), a disorder of the mononuclear phagocyte system, can be classified into two distinct forms: primary HLH (FHL) and secondary HLH. To clarify the epidemiology and clinical outcome for each HLH subtype, we conducted a nationwide survey of HLH in Japan. Since 799 patients were diagnosed in 292 institutions of Japan between 2001 and 2005, the annual incidence of HLH was estimated as 1 in 800,000 per year. Among them, 567 cases were actually analyzed in this study. The most frequent subtype was Epstein-Barr virus (EBV)-associated HLH, followed by other infection- or lymphoma-associated HLH. Age distribution showed a peak of autoimmune disease- and infection-associated HLH in children, while FHL and lymphoma-associated HLH occurred almost exclusively in infants and the elderly, respectively. The 5-year overall survival rate exceeded 80% for patients with EBV- or other infection-associated HLH, was intermediate for those with FHL or B-cell lymphoma-associated HLH, and poor for those with T/NK cell lymphoma-associated HLH (<15%). Although this nationwide survey establishes the heterogeneous characteristics of HLH, the results should be useful in planning prospective studies to identify the most effective therapy for each HLH subtype.
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Affiliation(s)
- Eiichi Ishii
- Department of Pediatrics, Ehime University Graduate School of Medicine, Ehime, Japan.
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29
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Abstract
Hemophagocytic syndrome includes fever, hepatosplenomegaly, cytopenias, coagulopathy, and abnormal liver function tests, with some patients developing lymphadenopathy and cutaneous eruptions. Herein we report two cases of dermal perivascular hemophagocytosis identified in skin biopsies of two patients with no additional symptoms attributable to hemophagocytic syndrome. Biopsies showed capillary ectasia with dermal perivascular infiltrates. The overlying epidermis and adjacent subcutaneous fat was unremarkable. The infiltrate consisted of perivascular neutrophils and benign histiocytes with predominately phagocytized erythrocytes and occasional engulfed karyorrhectic debris. Perivascular nuclear dust (leukocytoclasia) and extravasated erythrocytes were present, but other factors typically found in leukocytoclastic vasculitis were absent, namely fibrin deposition and endothelial hypertrophy and/or necrosis. This appears to be hemophagocytosis, possibly associated with late lesions of leukocytoclastic vasculitis. Both hemophagocytosis and leukocytoclastic vasculitis are associated with activated immunity with increased cytokines and/or immune complexes. It is important to consider this uncommon finding in the evaluation of indeterminate cutaneous eruptions.
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Affiliation(s)
- Nicole L Draper
- Department of Pathology, College of Medicine, University of South Florida, Tampa, FL 33612-4799, USA.
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30
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Han AR, Lee HR, Park BB, Hwang IG, Park S, Lee SC, Kim K, Lim HY, Ko YH, Kim SH, Kim WS. Lymphoma-associated hemophagocytic syndrome: clinical features and treatment outcome. Ann Hematol 2007; 86:493-8. [PMID: 17347847 DOI: 10.1007/s00277-007-0278-6] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Accepted: 02/23/2007] [Indexed: 11/25/2022]
Abstract
The clinical features and prognostic factor of lymphoma-associated hemophagocytic syndrome (LAHS), diagnosed according to World Health Organization classification, were investigated by reviewing the clinical records of 29 patients between September 1994 and September 2006. Compared with patients with T or natural killer (NK)/T cell LAHS, patients with B cell LAHS were older (p = 0.022), were less likely to exhibit disseminated intravascular coagulation (DIC; p = 0.011), and had less direct involvement of bone marrow (p = 0.03). Clinical response was achieved in 15 (65.2%) and complete remission (CR) was achieved in 4 (17%) of 23 patients who received chemotherapy. Four patients received high-dose chemotherapy and autologous stem cell transplantation (A-SCT), and three of these four patients showed CR. The median survival was 36 days (95%CI, 20.2-51.8). Univariate analysis showed that poor performance status (p = 0.028), T or NK/T cell lymphoma (p = 0.016), presence of jaundice (p = 0.063), the presence of DIC (p = 0.002), and poor clinical response to treatment (p < 0.001) predicted poor overall survival. These data suggest that the clinical features differ significantly between B cell LAHS and T or NK/T cell LAHS. Intensive treatment including high-dose chemotherapy and A-SCT should be investigated.
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Affiliation(s)
- A-Reum Han
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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31
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Shimizu I, Ichikawa N, Yotsumoto M, Sumi M, Ueno M, Kobayashi H. Asian variant of intravascular lymphoma: aspects of diagnosis and the role of rituximab. Intern Med 2007; 46:1381-6. [PMID: 17827836 DOI: 10.2169/internalmedicine.46.0066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The Asian variant of intravascular lymphoma (AIVL) is a rare non-Hodgkin's lymphoma, characterized by hemophagocytic syndrome and the absence of neurological abnormality or skin lesions, which are typical features of classical IVL. The purpose of this study was to describe the characteristics and outcomes of AIVL patients. PATIENTS AND METHODS We conducted a retrospective chart review of AIVL patients who were admitted to our institution between January 1999 and December 2006. RESULTS Eight patients met the criteria. All patients presented with typical clinical features, including fever, hepatosplenomegaly, and cytopenia. The median time from onset to diagnosis was 4 weeks (range 2-12). Pathological diagnoses were made by bone marrow biopsy in three patients, transjugular liver biopsy in two patients, splenectomy in two patients, and percutaneous liver biopsy in one patient. All patients were treated with CHOP-like chemotherapy and rituximab was administered in five patients. Six patients achieved complete response, one achieved partial response, and two patients had central nervous system (CNS) relapse. Among the five patients treated with rituximab, four are still alive, with a median follow-up of 28 months. CONCLUSION A CHOP-like regimen with rituximab may be effective for AIVL cases, but, as in classical IVL, CNS prophylaxis should be considered.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asian People
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/secondary
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prednisolone/therapeutic use
- Retrospective Studies
- Rituximab
- Vascular Neoplasms/diagnosis
- Vascular Neoplasms/drug therapy
- Vascular Neoplasms/pathology
- Vincristine/therapeutic use
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Affiliation(s)
- Ikuo Shimizu
- Department of Hematology, Nagano Red Cross Hospital.
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32
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Rashid R, Johnson RJ, Morris S, Dickinson H, Czyz J, O'Connor SJM, Owen RG. Intravascular large B-cell lymphoma associated with a near-tetraploid karyotype, rearrangement of BCL6, and a t(11;14)(q13;q32). ACTA ACUST UNITED AC 2006; 171:101-4. [PMID: 17116487 DOI: 10.1016/j.cancergencyto.2006.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 06/28/2006] [Accepted: 07/06/2006] [Indexed: 11/19/2022]
Abstract
Chromosome analysis of a patient with intravascular large B-cell lymphoma (IVL) revealed a complex, near-tetraploid karyotype with 83 chromosomes. Abnormalities included a t(11;14)(q13;q32), which was confirmed with both interphase fluorescence in situ hybridization (FISH) using an IGH/cyclin D1 dual-color, dual-fusion probe set and cyclin D1 immunohistochemical analysis. Abnormality of 3q was also evident. Interphase FISH analysis with a dual-color, break-apart probe set confirmed rearrangement of BCL6. To our knowledge, this is the first report of these abnormalities in IVL.
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MESH Headings
- Chromosomes, Human, Pair 11
- Chromosomes, Human, Pair 14
- DNA-Binding Proteins/genetics
- Female
- Humans
- Karyotyping
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Polyploidy
- Proto-Oncogene Proteins c-bcl-6
- Translocation, Genetic
- Tumor Cells, Cultured
- Vascular Neoplasms/genetics
- Vascular Neoplasms/pathology
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Affiliation(s)
- Rumana Rashid
- HMDS Laboratory, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, UK.
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33
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Cerretini R, Noriega MF, Narbaitz M, Slavutsky I. New chromosome abnormalities and lack of BCL-6 gene rearrangements in Argentinean diffuse large B-cell lymphomas. Eur J Haematol 2006; 76:284-93. [PMID: 16519699 DOI: 10.1111/j.1600-0609.2005.00616.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphomas. Cytogenetic studies have revealed a broad spectrum of clonal genetic abnormalities and complex karyotypes. The purpose of this study was to contribute to the understanding of the genomic alterations associated with this group of lymphomas. METHODS Cytogenetic, fluorescence in situ hybridization (FISH) and molecular analyses were performed in 30 cases with DLBCL: 20 de novo DLBCL (dn-DLBCL) and 10 DLBCL secondary to follicular lymphoma (S-DLBCL). RESULTS A total of 37 different structural chromosomal rearrangements were found: 27% translocations, 54% deletions, and 19% other alterations. Chromosomes 8, 6, 2, and 9 were the most commonly affected. Interestingly, translocation t(3;14)(q27;q32) and/or BCL-6 gene rearrangements were not observed either by cytogenetic studies or by FISH analysis. Fifteen novel cytogenetic alterations were detected, among them translocations t(2;21)(p11;q22) and t(8;18)(q24;p11.3) appeared as sole structural abnormalities. Translocation t(14;18)(q32;q21) and/or BCL-2-IGH gene rearrangements were the genomic alterations most frequently observed: 50% of S-DLBCL and 30% of dn-DLBCL. Deletions del(4)(q21), del(6)(q27), del(8)(q11), and del(9)(q11) were recurrent. The most common gains involved chromosome regions at 12q13-q24, 7q10-q32, and 17q22-qter; 6q was the most frequently deleted region, followed by losses at 2q35-qter, 7q32-qter, and 9q13-qter. Four novel regions of loss were identified: 5q13-q21, 2q35-qter (both recurrent in our series), 4p11-p12, and 17q11-q12. CONCLUSIONS These studies emphasize the value of combining conventional cytogenetics with FISH and molecular studies to allow a more accurate definition of the genomic aberrations involved in DLBCL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Argentina
- Chromosomes, Human/genetics
- DNA-Binding Proteins/genetics
- Female
- Humans
- In Situ Hybridization, Fluorescence/methods
- Karyotyping
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasms, Second Primary/genetics
- Neoplasms, Second Primary/pathology
- Proto-Oncogene Proteins c-bcl-6
- Sequence Deletion/genetics
- Translocation, Genetic/genetics
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Affiliation(s)
- Roxana Cerretini
- Departamento de Genética, Instituto de Investigaciones Hematológicas Mariano R. Castex, Academia Nacional de Medicina, Buenos Aires, Argentina.
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34
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Yamada N, Uchida R, Fuchida SI, Okano A, Okamoto M, Ochiai N, Iwasa H, Shimazaki C. CD5+ Epstein-Barr virus-positive intravascular large B-cell lymphoma in the uterus co-existing with huge myoma. Am J Hematol 2005; 78:221-4. [PMID: 15726593 DOI: 10.1002/ajh.20288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A 42-year-old female underwent hysterectomy because of a huge uterine mass. Histologically, she was diagnosed as having intravascular lymphoma co-existing with myoma uteri. Lymphoma cells were large in size and were positive for CD5, CD20, CD45, CD79a, lambda light chain, and EBV but were negative for CD3 and cyclin D1. No other organs except for the adjoining bilateral ovaries seemed to be affected by the lymphoma cells. She received the combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisolone) together with rituximab and has been well without definite disease progression. So far, this is the first case of CD5+ EBV+ intravascular large B-cell lymphoma (CD5+ EBV+ IVLBL) in the uterus of a patient who was incidentally diagnosed and successfully treated.
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Affiliation(s)
- Noriko Yamada
- Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
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35
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Yoshioka T, Miura I, Kume M, Takahashi N, Okamoto M, Ichinohasama R, Yoshino T, Yamaguchi M, Hirokawa M, Sawada KI, Nakamura S. Cytogenetic features of de novo CD5-positive diffuse large B-cell lymphoma: Chromosome aberrations affecting 8p21 and 11q13 constitute major subgroups with different overall survival. Genes Chromosomes Cancer 2005; 42:149-57. [PMID: 15543600 DOI: 10.1002/gcc.20127] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
De novo CD5-positive diffuse large B-cell lymphoma (CD5(+)DLBCL) is regarded as a different clinicopathological entity from CD5-negative DLBCL (CD5(-)DLBCL) and mantle cell lymphoma (MCL). Because only a few published cytogenetic studies of de novo CD5(+)DLBCL are available, we investigated chromosomal changes in 23 Japanese patients who had de novo CD5(+)DLBCL. A characteristic of cytogenetic abnormalities in de novo CD5(+)DLBCL was a high incidence of chromosomal aberrations affecting 8p21 and 11q13. Major chromosomal breakpoints were concentrated at 8p21, 11q13, and 3q27. Patients with 8p21 aberrations showed aggressive clinical features, including advanced stage of disease, elevated serum LDH level, poor performance status, and an inferior survival curve compared with patients who had 11q13 changes (P = .043). Chromosomal abnormalities of both 8p21 and 11q13 were not observed in the same patient, and each abnormality showed different chromosomal gains and losses. These results indicate that de novo CD5(+)DLBCL may occur in previously unidentified subgroups that differ in their chromosomal abnormalities. The conflicting results of previous studies on prognosis may thus be explained in part by the differences in chromosomal changes.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- CD5 Antigens/genetics
- Chromosome Aberrations
- Chromosome Breakage/genetics
- Chromosome Deletion
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 8/genetics
- Cytogenetics/methods
- Female
- Gene Amplification/genetics
- Humans
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Survival Rate
- Translocation, Genetic/genetics
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Affiliation(s)
- Tomoko Yoshioka
- Third Department of Internal Medicine, Akita University School of Medicine, Akita, Japan
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36
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Gomyo H, Shimoyama M, Minagawa K, Yakushijin K, Urahama N, Okamura A, Yamamoto K, Ito M, Chihara K, Matsui T. Effective anti-viral therapy for hemophagocytic syndrome associated with B-cell lymphoma. Leuk Lymphoma 2004; 44:1807-10. [PMID: 14692538 DOI: 10.1080/1042819031000103926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A rheumatoid arthritis (RA) patient treated with low-dose methotrexate (MTX) therapy suffered from hemophagocytic syndrome (HPS) associated with B-cell lymphoma (B-LAHS). Administration of acyclovir and intravenous immunoglobulin promptly resolved laboratory test abnormalities accompanied with HPS. Moreover, hemophagocytic histiocytes and lymphoma cells in the bone marrow disappeared without anti-cancer therapy. Two months after reintroduction of MTX for RA flare, lymphoma re-grew rapidly without bone marrow involvement and HPS. Two cycles of combination chemotherapy induced the lymphoma to a complete remission/unconfirmed (CRu), but then the chemotherapy was discontinued due to severe side effects. In this case, on the basis of RA and MTX induced immunosuppressive state, Epstein-Barr virus (EBV) infection was associated with the development of HPS and lymphoma. Anti-viral therapy alone was effective against HPS and lymphoma at initial presentation and improved her general condition. This case indicates that anti-cancer therapy should be preceded by anti-viral therapy and withdrawal of immunosuppressive therapy in patients under immunosuppressive therapy, as long as the clinical situation permits.
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Affiliation(s)
- Hiroshi Gomyo
- Hematology/Oncology, Department of Medicine, Kobe University School of Medicine, Chuo-ku, Kobe 650-0017, Japan.
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37
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Khoury H, Lestou VS, Gascoyne RD, Bruyere H, Li CH, Nantel SH, Dalal BI, Naiman SC, Horsman DE. Multicolor karyotyping and clinicopathological analysis of three intravascular lymphoma cases. Mod Pathol 2003; 16:716-24. [PMID: 12861069 DOI: 10.1097/01.mp.0000077515.68734.85] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intravascular lymphoma (IVL) is a rare neoplastic disease characterized by the presence of large malignant lymphoid cells in small vessels. It is often diagnosed at autopsy. Clinical manifestations are typically neurologic and dermatologic. Karyotypic abnormalities have been described in a small number of cases and have revealed complex alterations in the majority of cases. We have identified three cases of IVL with varied clinicopathological findings. Karyotypic analysis was undertaken by standard G-banding and supplemented by multi-colored karyotyping (M-FISH) to decipher the chromosomal content of marker chromosomes and undefined additions. M-FISH clarified the chromosomal abnormalities in two cases and unveiled cryptic translocations der(10)t(10;22), der(17)t(17;22), and balanced t(11;14). Comparison with previously published karyotypes revealed prominent involvement of chromosomes 1, 3, 6, 11, 14, and 18, similar to the pattern of clonal evolution in other B-cell lymphomas. The most frequent alterations seen were -6 or 6q- and +18 or dup(18q), with a minimally deleted region located at 6q21-q23 and a commonly amplified region located at 18q13-q23, respectively. Few differences between the classical and Asian variant of this disease were apparent at the karyotypic level. Cytogenetic analysis of additional cases supplemented by multicolor karyotyping may help identify the full spectrum of genetic alterations associated with IVL and assist in the delineation of the critical mutations associated with initiation and progression of this disease.
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Affiliation(s)
- Haytham Khoury
- Leukemia/BMT Program of British Columbia, Vancouver, British Columbia, Canada
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38
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Ohno T, Ueda Y, Nagai KI, Takahashi T, Konaka Y, Takamatsu T, Suzuki T, Sasada M, Uchiyama T. The serum cytokine profiles of lymphoma-associated hemophagocytic syndrome: a comparative analysis of B-cell and T-cell/natural killer cell lymphomas. Int J Hematol 2003; 77:286-94. [PMID: 12731674 DOI: 10.1007/bf02983788] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
To elucidate the differences in pathogenesis between lymphoma-associated hemophagocytic syndromes (LAHS) of the T-cell/ natural killer cell (T/NK) and B-cell (B) types, we comparatively analyzed the clinical features and serum cytokine profiles of 33 patients with LAHS registered in the Kyoto University Hematology/Oncology Study Group. The serum cytokine levels of each patient group (B-LAHS versus T/NK-LAHS) were expressed as the ratio of the median to the upper normal values of the respective cytokines and were as follows: 19.05 versus 13.99 for soluble interleukin 2 (IL-2) receptor, 0.67 versus 0.67 for granulocyte-macrophage colony-stimulating factor (GM-CSF), 0.64 versus 1.26 for G-CSF, 5.70 versus 3.61 for M-CSF, 1.54 versus 3.39 for interferon gamma (IFN-gamma), 13.17 versus 1.17 for IL-6, 6.88 versus 1.58 for tumor necrosis factor alpha (TNF-alpha), 0.71 versus 0.41 for IL-1beta, 1.99 versus 0.21 for IL-12, and 105.32 versus 29.65 for IL-10. The serum levels of IL-6, TNF-alpha, and IL-10 were significantly higher in the B-LAHS group, whereas those of IFN-y were significantly lower. These differences between the 2 groups may reflect a difference in the pathogenesis Higher serum levels of IL-6, TNF-alpha, and IL-10 may be derived at least partly from neoplastic B-cells themselves In addition, the extremely high serum levels of IL-10 suggest that a compensatory anti-inflammatory process may operate in both groups and give rise to a profound immunosuppressive state and a poor outcome.
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MESH Headings
- Adolescent
- Aged
- Aged, 80 and over
- Case-Control Studies
- Cytokines/blood
- Female
- Histiocytosis, Non-Langerhans-Cell/blood
- Histiocytosis, Non-Langerhans-Cell/etiology
- Histiocytosis, Non-Langerhans-Cell/pathology
- Humans
- Interleukin-10/blood
- Interleukin-6/blood
- Killer Cells, Natural/pathology
- Lymphoma, B-Cell/blood
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/immunology
- Lymphoma, T-Cell/blood
- Lymphoma, T-Cell/complications
- Lymphoma, T-Cell/immunology
- Male
- Middle Aged
- Tumor Necrosis Factor-alpha/analysis
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Affiliation(s)
- Tatsuharu Ohno
- Division of Hematology and Immunology, Department of Internal Medicine, Ohtsu Red Cross Hospital, Nagara, Ohtsu, Japan.
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39
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Ito M, Kim Y, Choi JW, Ozawa H, Fujino M. Prevalence of intravascular large B-cell lymphoma with bone marrow involvement at initial presentation. Int J Hematol 2003; 77:159-63. [PMID: 12627851 DOI: 10.1007/bf02983214] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We used immunohistochemical analysis to investigate 146 bone marrow (BM) clot specimens from patients with fever of unknown origin (FUO) (n = 124) or hemophagocytic syndrome (HPS) (n = 22). Intravascular lymphoma (IVL) primarily involving BM was detected in 12 (8.2%) of the 146 patients. Diagnosis was based on the presence of CD20+ and CD79a+ tumor cells confined within the lumina of sinuses and surrounded by CD34+ endothelial cells. Of the 12 IVL cases, 6 were CD5+; of these 6 CD5+ cases, 5 were positive for vimentin. The finding of a considerably high prevalence of IVL tumor cells in BM from patients with FUO or HPS suggests that immunohistochemical examination of BM may be helpful in the diagnosis of IVL in these patients. Vimentin coexpression in CD5+ IVL might be evidence of origin from a subset of prefollicular B-cells.
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Affiliation(s)
- Masafumi Ito
- Department of Pathology, Nagoya University Hospital, Nagoya, Japan.
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40
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Kojima K, Kaneda K, Yasukawa M, Tanaka K, Inoue T, Yamashita T, Dansako H, Sakugawa ST, Kozuka T, Hara M, Tanimoto M. Specificity of polymerase chain reaction-based clonality analysis of immunoglobulin heavy chain gene rearrangement for the detection of bone marrow infiltrate in B-cell lymphoma-associated haemophagocytic syndrome. Br J Haematol 2002; 119:616-21. [PMID: 12437634 DOI: 10.1046/j.1365-2141.2002.03866.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As a wide range of disorders underlie haemophagocytic syndrome, a rapid distinction between benign polyclonal and malignant monoclonal lymphoid proliferations is critical. We investigated whether polymerase chain reaction (PCR) amplification of immunoglobulin heavy chain gene rearrangement could efficiently detect clonal B-cell populations in non-diagnostic marrow for B-cell lymphoma-associated haemophagocytic syndrome (B-LAHS). On amplifying two DNA samples per biopsy, no reproducible monoclonal PCR result was found in reactive haemophagocytic marrows. In contrast, four out of nine assessable B-LAHS patients with histomorphologically and immunohistochemically lymphoma-free bone marrow showed a reproducible monoclonal immunoglobulin heavy chain gene rearrangement. At the molecular level, two B-LAHS patients had lymphoma-free marrow as demonstrated by patient-specific PCR, suggesting that haemophagocytic marrow is not always associated with lymphoma involvement. PCR-based demonstration of clonal B-cell populations in marrow would add an extra dimension to B-LAHS diagnosis.
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Affiliation(s)
- Kensuke Kojima
- Department of Medicine II, Okayama University Medical School, Okayama, Japan
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41
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Smadja NV, Bastard C, Brigaudeau C, Leroux D, Fruchart C. Hypodiploidy is a major prognostic factor in multiple myeloma. Blood 2001; 98:2229-38. [PMID: 11568011 DOI: 10.1182/blood.v98.7.2229] [Citation(s) in RCA: 297] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Conventional karyotypes performed before any treatment in 208 patients with multiple myeloma were reviewed by the Groupe Français de Cytogénétique Hématologique. A total of 138 patients displayed complex chromosomal abnormalities (CCAs). According to the chromosome number pattern, a first group of 75 patients had a hyperdiploid karyotype. A second group of 63 patients referred to as the hypodiploid group had either pseudodiploid, hypodiploid, or near-tetraploid karyotypes. Of 159 treated patients available for survival analysis, 116 had an abnormal karyotype. The comparison of overall survival (OS) between hyperdiploid and hypodiploid patients showed a highly significant difference (median OS 33.8 vs 12.6 months, respectively, P <.001). The presence of 14q32 rearrangements (36 of 116 patients) worsened the prognosis (median OS 17.6 vs 29.9 months, P <.02). The presence of chromosome 13q abnormalities (13qA, 63 patients) did not modify OS in CCA patients (median OS 20.6 vs 27.8 months, P <.59). However, taking into account the whole series including normal karyotypes, 13qA (63 of 159 patients) had a significant impact on OS (median 20.6 vs 37.1 months, P <.04). In the same way, the presence of a hypodiploid karyotype (52 of 159 patients) had a strong prognostic value (OS 12.8 vs 44.5 months, P <.000 01). A multivariate analysis including stage, beta2-microglobulin, bone marrow plasmocytosis, treatment type, 13qA, and hyperdiploidy and hypodiploidy showed that a hypodiploid karyotype was the first independent factor for OS (P <.001), followed by treatment approach. These results confirm that the chromosome number pattern of malignant plasma cells is a very powerful prognostic factor in newly diagnosed multiple myeloma patients.
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Affiliation(s)
- N V Smadja
- Research Cytogenetic Laboratory, Hôpital Saint-Antoine, Paris, France
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42
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Yamamoto K, Nakamura Y, Arai H, Aoyagi M, Saito K, Furusawa S, Mitani K. Translocation (14;19)(q32;q13) detected by spectral karyotyping and lack of BCL3 rearrangement in CD5-positive B-cell lymphoma associated with hemophagocytic syndrome. CANCER GENETICS AND CYTOGENETICS 2001; 130:38-41. [PMID: 11672772 DOI: 10.1016/s0165-4608(01)00466-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It has been shown that some cases of B-cell non-Hodgkin lymphoma associated with a hemophagocytic syndrome (B-LAHS) have chromosomal abnormalities at 14q32 or 19q13. We report here a 64-year-old woman with B-LAHS and a complex karyotype including add(14)(q32). We applied spectral karyotyping and revealed that the add(14)(q32) was derived from a der(14)t(14;19)(q32;q13). However, rearrangement of the BCL3 gene at 19q13 could not be detected by Southern blot analysis. Our results indicate that the translocation involving 19q13 may be one of the recurrent aberrations in B-LAHS and that the molecular mechanism of t(14;19)(q32;q13) in B-LAHS appear to be different from that observed in chronic lymphocytic leukemia.
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Affiliation(s)
- K Yamamoto
- Department of Hematology, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, 321-0293, Tochigi, Japan.
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43
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Allory Y, Challine D, Haioun C, Copie-Bergman C, Delfau-Larue MH, Boucher E, Charlotte F, Fabre M, Michel M, Gaulard P. Bone marrow involvement in lymphomas with hemophagocytic syndrome at presentation: a clinicopathologic study of 11 patients in a Western institution. Am J Surg Pathol 2001; 25:865-74. [PMID: 11420457 DOI: 10.1097/00000478-200107000-00004] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hemophagocytic syndrome (HPS) is a clinicopathologic syndrome that can reveal a non-Hodgkin's lymphoma. The pathologic features of lymphoma associated with HPS remain ill defined. We studied 11 lymphomas associated with HPS on initial bone marrow biopsies, consecutively diagnosed during a 6-year period in a Western institution. There were seven diffuse large B-cell lymphomas (DLBCLs), three T-cell lymphomas (one peripheral T-cell lymphoma unspecified, two hepatosplenic gammadelta T-cell lymphomas [HS gammadeltaTLs]), and one aggressive NK-cell lymphoma/leukemia (NKL). These lymphomas shared common clinicopathologic features with a systemic presentation, a poor outcome (nine patients died within 2 years), and a mild interstitial lymphoid infiltrate of the bone marrow at presentation in nine patients. This equivocal lymphoma infiltrate was blending with normal hematopoietic cells, and CD20 and CD3 immunolabelings were essential for its detection. A high number of reactive T (CD3+) cells, most often with a predominant cytotoxic (CD8+ TiA1+) phenotype, was present in all DLBCLs. By in situ hybridization, Epstein-Barr virus was detected in neoplastic cells of three cases (one DLBCL, one HS gammadeltaTL, and one NKL), which also showed serum viral DNA. Polymerase chain reaction studies disclosed HHV6 DNA sequences in tumor tissues of two DLBCLs, whereas HHV8 DNA was not detected. Because tumor mass indicative of lymphoma was not striking in most patients, bone marrow biopsy appears to be of great value for the diagnosis of an HPS-associated lymphoma, which may be, in Western patients, of B- as well as T- or NK-cell type. Immunostaining for CD3 and CD20 is essential to identify the common subtle lymphoma involvement. Together with a better understanding of the pathogenic processes, an early diagnosis may improve the prognosis of HPS-associated lymphoma.
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MESH Headings
- Adolescent
- Adult
- Aged
- Bone Marrow/pathology
- Female
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 6, Human/isolation & purification
- Herpesvirus 8, Human/isolation & purification
- Histiocytosis, Non-Langerhans-Cell/complications
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/virology
- Lymphoma, T-Cell/complications
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/virology
- Male
- Middle Aged
- Retrospective Studies
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Affiliation(s)
- Y Allory
- Département de Pathologie and EA 2348, Hôpital Henri Mondor, AP-HP, Créteil, France
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44
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Murase T, Nakamura S, Kawauchi K, Matsuzaki H, Sakai C, Inaba T, Nasu K, Tashiro K, Suchi T, Saito H. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 2001. [PMID: 11122144 DOI: 10.1111/j.1365-2141.2000.02426.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diffuse large B-cell lymphoma with haemophagocytic syndrome (BCL-HS) has been reported mainly in Asia and is regarded as a distinct variant of intravascular lymphoma (IVL). However, it is unclear whether all cases of BCL-HS fall within the framework of IVL and available clinical information is limited. We analysed 25 cases with BCL-HS, including 11 autopsied cases (median, 66 years; male-female ratio, 1.1:1). The patients presented with fever, anaemia, thrombocytopenia, hepatosplenomegaly, haemophagocytosis, bone marrow invasion, respiratory disturbance and disseminated intravascular coagulopathy, but usually lacked lymphadenopathy, mass formation, neurological abnormalities and skin lesions. The clinical course was aggressive with a median survival of 7 months. The morphological findings were uniform: large lymphoid cells infiltrated vessels and/or sinusoids of the liver, marrow, lung, kidney and other organs. They were positive for CD19, CD20, CD79a and HLA-DR, but negative for CD10, CD23 and CD30. CD5 was positive in five out of 17 cases. Our critical review indicates that BCL-HS is the equivalent of the Asian variant of IVL.
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Affiliation(s)
- T Murase
- Department of Pathology and Clinical Laboratories, Aichi Cancer Centre Hospital, Nagoya, Japan.
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45
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Hirai H, Shimazaki C, Hatsuse M, Okano A, Ashihara E, Inaba T, Murakami S, Saigo K, Nakagawa M. Autologous peripheral blood stem cell transplantation for adult patients with B-cell lymphoma-associated hemophagocytic syndrome. Leukemia 2001; 15:311-2. [PMID: 11236952 DOI: 10.1038/sj.leu.2402030] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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46
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Beschorner R, Schluesener HJ, Nguyen TD, Magdolen V, Luther T, Pedal I, Mattern R, Meyermann R, Schwab JM. Lesion-associated accumulation of uPAR/CD87- expressing infiltrating granulocytes, activated microglial cells/macrophages and upregulation by endothelial cells following TBI and FCI in humans. Neuropathol Appl Neurobiol 2000; 26:522-7. [PMID: 11123718 DOI: 10.1046/j.0305-1846.2000.287.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Urokinase-type plasminogen activator receptor (uPAR/CD87) together with its ligand, urokinase-type plasminogen activator (uPA), constitutes a proteolytic system associated with tissue remodelling and leucocyte infiltration. uPAR is a member of the glycosyl phosphatidyl inositol (GPI) anchored protein family. The functional role of uPAR comprises fibrinolysis by conversion of plasminogen to plasmin. In addition, uPAR promotes cell adhesion, migration, proliferation, re-organization of the actin cytoskeleton, and angiogenesis. Furthermore, uPAR is involved in prevention of scar formation and is chemoattractant to macrophages and leucocytes. In order to investigate the pathophysiological role of uPAR following human CNS injury we examined necrotic brain lesions resulting from traumatic brain injury (TBI; n = 28) and focal cerebral infarctions (FCI; n = 17) by immunohistochemistry. Numbers of uPAR+ cells and uPAR+ blood vessels were counted. Following brain damage, uPAR+ cells increased significantly within 12 h, reached a maximum after 3-4 days and remained elevated until later stages. uPAR was expressed by infiltrating granulocytes, activated microglia/macrophages and endothelial cells. Numbers of uPAR+ vessels increased in parallel subsiding earlier following FCI than post TBI. The restricted, lesion-associated accumulation of uPAR+ cells in the brain parenchyma and upregulated expression by endothelial cells suggests a crucial role for the influx of inflammatory cells and blood-brain barrier (BBB) disturbance. Through a failure in BBB function, uPAR participates in formation of brain oedema and thus contributes to secondary brain damage. In conclusion, the study defines the localization, kinetic course and cellular source of uPAR as a potential pharmacological target following human TBI and FCI.
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Affiliation(s)
- R Beschorner
- Institute of Brain Research, Eberhard-Karls-University, Tuebingen, Germany.
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47
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Murase T, Nakamura S, Kawauchi K, Matsuzaki H, Sakai C, Inaba T, Nasu K, Tashiro K, Suchi T, Saito H. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 2000. [DOI: 10.1046/j.1365-2141.2000.02426.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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48
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Inaba T, Shimazaki C, Sumikuma T, Okano A, Hatsuse M, Okamoto A, Takahashi R, Ashihara E, Hibi S, Sudo Y, Yamagata N, Murakami S, Rin K, Fujita N, Yoshimura M, Nakagawa M. Expression of T-cell-associated antigens in B-cell non-Hodgkin's lymphoma. Br J Haematol 2000; 109:592-9. [PMID: 10886209 DOI: 10.1046/j.1365-2141.2000.02006.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We performed the immunophenotyping of 101 patients with B-cell non-Hodgkin's lymphoma (B-NHL) using two-colour flow cytometry (FCM) and found that lymphoma cells coexpressed at least one kind of T-cell-associated antigen (T-Ag; CD2, CD5, CD7) in 25 patients (24. 8%). Among these three T-Ags, CD5 was the most frequently expressed, in 21 patients (20.8%), followed by CD7, expressed in five patients (5.0%), and CD2, which was expressed in two patients (2.0%). Two kinds of T-Ag were simultaneusly expressed in three patients (CD2/CD5, CD2/CD7, and CD5/CD7, each expressed in one patient). Concerning the expression pattern of T-Ag, there were no significant differences between lymph nodes and extranodal organs in the three patients with T-Ag-positive B-NHL (T-Ag(+) B-NHL) who were analysed. When comparing the clinical features between T-Ag(+) B-NHL and T-Ag-negative B-NHL (T-Ag(-) B-NHL), extranodal involvement and higher International Prognostic Index (H and H.I.) were significantly frequent in the former subgroup (P = 0.0119 and P = 0. 0302 respectively).
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Affiliation(s)
- T Inaba
- Department of Clinical Laboratory and Medicine, Kyoto Prefectural University of Medicine, Japan.
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Abstract
B-cell lymphoma-associated hemophagocytic syndrome (B-LAHS) is extremely rare in Western countries but has recently been increasingly reported in Asian countries, especially Japan. Here, we reviewed 25 previously reported Japanese cases of B-LAHS and summarized its clinicopathologic features and therapeutic outcome. The median age of onset was 63 years old with initial presentation of fever, hepatomegaly, and splenomegaly without associated lymphadenopathy. Laboratory findings showed increased levels of lactate dehydrogenase, C-reactive protein, ferritin and soluble interleukin-2 receptor. Histopathologically, hemophagocytosis was often seen in the bone marrow and spleen. Various percentages of lymphoma cells were seen in the bone marrow, positive for CD19, CD20 and surface immunoglobulin. and some were also positive for CD5. Cytogenetic analysis showed a complex structural abnormality including chromosome 14q32, 19q13 and deletion of the terminal part of 8p21. Some patients had histological features of intravascular lymphomatosis (IVL). The prognosis was poor with a median survival period of 9 months. We treated five patients using autologous peripheral blood stem cell transplantation (PBSCT), and four are still in complete remission nine to 24 months after PBSCT, suggesting that high-dose chemotherapy followed by PBSCT might improve the survival rate.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- CD5 Antigens/immunology
- Chromosome Aberrations
- Chromosome Disorders
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 8
- Combined Modality Therapy
- Female
- Hematopoietic Stem Cell Transplantation
- Histiocytosis, Non-Langerhans-Cell/etiology
- Histiocytosis, Non-Langerhans-Cell/genetics
- Histiocytosis, Non-Langerhans-Cell/immunology
- Histiocytosis, Non-Langerhans-Cell/therapy
- Humans
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/therapy
- Male
- Middle Aged
- Transplantation, Autologous
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Affiliation(s)
- C Shimazaki
- Second Department of Medicine, Kyoto Prefectural University of Medicine, Kamigyoku, Japan
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Yamamoto K, Nagata K, Hamaguchi H. Translocation (11;14)(q13;q32) in CD5-positive B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 1999; 106:1069-70. [PMID: 10520018 DOI: 10.1046/j.1365-2141.1999.01702.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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