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Rumney S, Rajesh A, Brigmon E. Primary Gastrointestinal Diffuse Large B-cell Lymphoma Presenting as Ileal Perforation. Cureus 2023; 15:e37341. [PMID: 37182022 PMCID: PMC10169252 DOI: 10.7759/cureus.37341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common form of non-Hodgkin's lymphoma and can rarely present as a primary gastrointestinal malignancy. Primary gastrointestinal lymphoma (PGIL) is associated with a significant risk of perforation and peritonitis, with high rates of mortality. Here we describe a case of a newly diagnosed PGIL in a previously healthy 22-year-old male presenting for new-onset abdominal pain with diarrhea. Early hospital course was characterized by peritonitis and severe septic shock. Despite multiple surgical interventions and resuscitative efforts, the patient's condition continued to deteriorate until cardiac arrest and death on hospital day five. A diagnosis of DLBCL of the terminal ileum and cecum was made by pathology post-mortem. The prognosis for these patients can be improved through early intervention with chemotherapy regimens and surgical resection of the malignant tissue. This report highlights DLBCL as a rare cause of gastrointestinal perforation that can culminate in precipitous multiorgan failure and death.
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Affiliation(s)
- Sean Rumney
- General Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Aashish Rajesh
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
| | - Erika Brigmon
- Surgery, University of Texas Health Science Center at San Antonio, San Antonio, USA
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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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