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Lewis CS, Joy G, Jensen P, Barraclough A, Franco N, Talaulikar D, Hawkes EA, El-Galaly TC, Villa D, Dickinson M, Seymour JF, Cheah CY. Primary gastric diffuse large B-cell lymphoma: A multicentre retrospective study. Br J Haematol 2024; 205:534-541. [PMID: 38632873 DOI: 10.1111/bjh.19470] [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: 02/03/2024] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
Primary gastric diffuse large B-cell lymphoma (PG-DLBCL) accounts for the majority of extra-nodal DLBCL. Even so, literature is lacking on early, localised presentations. We studied a cohort of patients with stage I disease, diagnosed between 2006 and 2018, from six centres between Australia, Canada and Denmark. Our goal was to characterise outcomes, review treatment and investigate the role of interim positron emission tomography (iPET). Thirty-seven eligible patients were identified. The median duration of follow-up was 42.2 months. All received chemoimmunotherapy with 91.9% (n = 34) given rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP). 35.1% (n = 13) underwent consolidative radiotherapy. Eighteen patients were H. pylori positive and 11 had the documentation of H. pylori eradication therapy. The 4-year progression-free survival and overall survival of R-CHOP was 88% (95% CI: 71-95) and 91% (95% CI: 75-97) respectively. All patients who achieved a partial metabolic response or complete metabolic response on iPET went on to achieve complete response at the end of treatment. R-CHOP-based therapy with iPET assessment appears to offer favourable outcomes, with radiotherapy and H. pylori eradication therapy implemented on a case-by-case basis.
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Affiliation(s)
- Cameron S Lewis
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Greta Joy
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Paw Jensen
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Allison Barraclough
- Department of Haematology, Austin Health, Melbourne, Victoria, Australia
- Department of Haematology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Nunzio Franco
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
| | - Dipti Talaulikar
- Department of Haematology, ACT Pathology, Canberra Health Services, Canberra, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Eliza A Hawkes
- Department of Haematology, Austin Health, Melbourne, Victoria, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tarec Christoffer El-Galaly
- Department of Hematology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Hematology, Odense University Hospital, Odense, Denmark
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Diego Villa
- Centre for Lymphoid Cancer, British Columbia Cancer, Vancouver, British Columbia, Canada
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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2
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Ge DF, Wang YK, Li SL, Zou XF, Kong LC, Deng WY, Wang SN. Histopathological staging and differential diagnosis of marginal zone lymphoma of gastric mucosa-associated lymphoid tissue. Eur J Gastroenterol Hepatol 2024; 36:720-727. [PMID: 38625832 DOI: 10.1097/meg.0000000000002770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
The purpose of this study was to explore the histopathological staging and differential diagnosis of marginal zone lymphoma in gastric mucosa-associated lymphoid tissue (MALT lymphoma). We performed detailed histomorphology and immunohistochemistry investigations as well as genetic testing on endoscopic biopsy and endoscopic mucosal resection specimens from 18 patients with gastric MALT lymphoma. We found that gastric MALT lymphoma typically begins as a small, isolated area outside the lymphoid follicular mantle zone or proliferates in a multifocal, patchy manner, gradually spreads to the interfollicular zone, forming diffuse proliferation, invades the gastric mucosal glands, and infiltrates or proliferates into the center of peripheral reactive lymphoid follicles. Abnormally proliferating lymphocytes invade the surrounding lymphoid follicles, resulting in damage, atrophy, and disappearance of their normal follicles as well as of the gastric mucosa glands, forming diffuse proliferation. Redifferentiation and proliferation lead to the transformation of lymphocytes; that is, MALT transitions into highly invasive lymphoma. Based on our findings in this study, we propose the following five stages in the process of development and progression of gastric MALT lymphoma: the stage of cell proliferation outside the lymphoid follicular mantle zone; the stage of heterogeneous proliferative lymphoepithelial lesion; the stage of reactive lymphoid follicular implantation; the stage of lymphoid follicular clonal proliferation; and the stage of MALT transforming into highly invasive lymphoma. We examined the differential diagnosis of histopathological features at each stage. The clinicopathological staging of gastric MALT lymphoma can help clinicians provide accurate treatment and track malignant cell transformation, thus playing a significant role in controlling its development and progression.
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Affiliation(s)
- Dong-Feng Ge
- Department of Pathology, The First Affiliated Hospital of Henan University of Science and Technology, Luoyang
| | - Yang-Kun Wang
- Department of Pathology, The Fourth People's Hospital of Longgang District
| | - Shen-Lin Li
- Department of Pathology, The Fourth People's Hospital of Longgang District
| | - Xiong-Fei Zou
- Department of Pathology, The Fourth People's Hospital of Longgang District
| | - Ling-Chao Kong
- Department of Pathology, Shenzhen Bao'an District Central Hospital
| | - Wei-Yi Deng
- Department of Pathology, Shenzhen Hospital of Southern Medical University
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3
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Albano D, Calabrò A, Dondi F, Bagnasco S, Tucci A, Bertagna F. The role of baseline 2-[ 18 F]-FDG-PET/CT metrics and radiomics features in predicting primary gastric lymphoma diagnosis. Hematol Oncol 2024; 42:e3266. [PMID: 38444261 DOI: 10.1002/hon.3266] [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: 12/14/2023] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/07/2024]
Abstract
Diffuse Large B-Cell Lymphomas (DLCBL) and mucosa-associated lymphoid tissue (MALT) are the two most common primary gastric lymphomas (PGLs), but have strongly different features. DLBCL is more aggressive, is frequently diagnosed at an advanced stage and has a poorer prognosis. The aim of this retrospective study was to explore the role of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (2-[18 F]-FDG-PET/CT) and radiomics features (RFs) in predicting the final diagnosis of patients with PGLs. Ninety-one patients with newly diagnosed PGLs who underwent pre-treatment 2-[18 F]-FDG-PET/CT were included. PET images were qualitatively and semi-quantitatively analyzed by deriving maximum standardized uptake value body weight (SUVbw), maximum standardized uptake value lean body mass (SUVlbm), maximum standardized uptake value body surface area (SUVbsa), lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume (gMTV) and total lesion glycolysis of gastric lesion (gTLG), total MTV (tMTV), TLG, and first-order RFs (histogram-related and shape related). Receiver-operating characteristic (ROC) curve analyses were performed to determine the differential diagnostic values of PET parameters. The final diagnosis was DLBCL in 54 (59%) cases and MALT in 37 cases (41%). PGLs showed FDG avidity in 83 cases (90%), 54/54 of DLBCL and 29/37 of MALT. All PET/CT metabolic features, such as stage of disease and tumor size, were significantly higher in DLBCL than MALT; while the presence of H. Pylori infection was more common in MALT. At univariate analysis, all PET/CT metrics were significantly higher in DLBCL than MALT lymphomas, while among RFs only Shape volume_vx and Shape sphericity showed a significant difference between the two groups. In conclusion we demonstrated that 2-[18 F]-FDG-PET/CT parameters can potentially discriminate between DLBCL and MALT lymphomas with high accuracy. Among first-order RFs, only Shape volume_vx and Shape sphericity helped in the differential diagnosis.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Anna Calabrò
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Francesco Dondi
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Samuele Bagnasco
- Division of Hematology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Alessandra Tucci
- Division of Hematology, ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
- Nuclear Medicine, University of Brescia, Brescia, Italy
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Sharobim M, Matkovic E, Schwalbe M, Matkowskyj KA. Pathologic Features of Miscellaneous Foregut Malignancies. Cancer Treat Res 2024; 192:49-66. [PMID: 39212915 DOI: 10.1007/978-3-031-61238-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Neuroendocrine neoplasms are a heterogeneous group of tumors that can occur in almost any organ and share a common neuroendocrine phenotype.
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Affiliation(s)
- Mark Sharobim
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Eduard Matkovic
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
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Mainland N, Ranabothu A, Ranabothu M, Waack A, Vattipally V. Case report of rare primary gastric large B-cell lymphoma. Radiol Case Rep 2024; 19:246-249. [PMID: 38028283 PMCID: PMC10630762 DOI: 10.1016/j.radcr.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
Gastric large B-cell lymphoma is rare and can be challenging to diagnose due to its nonspecific presentation. Primary gastric large B-cell lymphoma is rare, especially compared to systemic disease with gastric involvement. In this case, an 85-year-old female was brought to the ER with abdominal pain, as well as a history of nausea, constipation, and weight loss. CT imaging showed thickening of the anterior wall of the stomach accompanied by inflammatory changes. Esophagogastroduodenoscopy revealed a 7-8 cm "half circumferential necrotic" ulcer suggestive of malignancy. Biopsy confirmed this to be gastric large B-cell lymphoma. Subsequent PET-CT showed no metastasis. This case illustrates the value of imaging in diagnosing this unusual condition.
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Affiliation(s)
- Natalie Mainland
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Akash Ranabothu
- Grand Valley State University College of Liberal Arts and Sciences, Allendale, MI
| | - Meghana Ranabothu
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| | - Andrew Waack
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
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Aslanian HR, Muniraj T, Nagar A, Parsons D. Endoscopic Ultrasound in Cancer Staging. Gastrointest Endosc Clin N Am 2024; 34:37-49. [PMID: 37973230 DOI: 10.1016/j.giec.2023.09.009] [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] [Indexed: 11/19/2023]
Abstract
The authors review the role of endoscopic ultrasound (EUS) in the staging of cancers throughout the gastrointestinal tract. EUS offers an advantage over cross-sectional imaging in locoregional tumor staging but is less sensitive in identifying distant metastasis. The addition of FNA increases diagnostic accuracy and provides a tissue diagnosis. EUS combined with cross-sectional imaging is important in accurately staging GI tumors and thereby reducing unnecessary procedures and health care costs.
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Affiliation(s)
- Harry R Aslanian
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA.
| | - Thiruvengadam Muniraj
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Anil Nagar
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - David Parsons
- Department of Medicine, Section Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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7
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Ma'koseh M, Farfoura H, Abufara A, Elmusa R, Hushki A, Faqeer N, Ghatasheh H, Shahin O, Alawabdeh T, Al-Rwashdeh M, Halahleh K, Al-Ibraheem A, Alrabi K. Outcome and patterns of relapse in primary gastric diffuse large B cell lymphoma treated with RCHOP. Hematology 2023; 28:2198898. [PMID: 37114663 DOI: 10.1080/16078454.2023.2198898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES Patterns and predictors of relapse in primary gastric diffuse large B cell lymphoma (DLBCL) were variably reported. Our study aims to evaluate the patterns and predictors of relapse in early-stage gastric DLBCL treated with Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone (RCHOP). METHODS From 2005 to 2019, the medical records of 72 patients with stage I or stage II gastric DLBCL treated with six cycles of RCHOP without radiotherapy were reviewed. Different variables were correlated with progression free survival (PFS), overall survival (OS), and local relapse free survival (LRFS). RESULTS 64 (88.1%) patients achieved a complete response (CR), while 8 (11.9%) had refractory disease. After CR, 9 (14%) patients relapsed; 7 (78%) relapses were loco-regional. Abnormal LDH (p = 0.028), H. pylori negative (p = 0.032) and, stage adjusted international prognostic index (sa-IPI) > 1 (p = 0.013) correlated with loco-regional failure. The 5-year PFS, OS, and LRFS were 74.8%, 75.3%, and 87.5%, respectively, after a median follow-up of 58 (range: 6-185) months. The median time to progression or relapse was 9 months (range: 5-54 months). In multivariate analysis, a sa-IPI >1 (HR: 3.56, CI: 1.35-8.8, p = 0.01) was associated with PFS while low albumin (HR: 8.85, CI: 1.09-71.4, p = 0.041) was associated with worse OS. None of the variables were associated with LRFS. CONCLUSION Treatment of primary gastric DLBCL with RCHOP results in a high CR rate. The majority of treatment failures were loco-regional. Sa-IPI and H. pylori status may be used to identify patients who may benefit from combined modality treatment.
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Affiliation(s)
- Mohammad Ma'koseh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Hebah Farfoura
- Department of Radiology, King Hussein Cancer Center, Amman, Jordan
| | - Alaa Abufara
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Reem Elmusa
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Ahmad Hushki
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Nour Faqeer
- Department of Pharmacy, King Hussein Cancer Center, Amman, Jordan
| | - Hamza Ghatasheh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Omar Shahin
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Tala Alawabdeh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | | | - Khalid Halahleh
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Kamal Alrabi
- Department of Internal Medicine, King Hussein Cancer Center, Amman, Jordan
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8
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Shi M, Yao Y, Ding H, Yang J, Zhang C, Wu Y, Guo T. The Effect of Surgery on the Prognosis of Gastric Lymphoma: A Meta-analysis. Am Surg 2023; 89:6147-6156. [PMID: 37309604 DOI: 10.1177/00031348231183126] [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] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Surgery is an effective clinical approach that has been used for the treatment of gastric lymphoma. However, its specific effect on the prognosis of patients with gastric lymphoma remains largely unknown. The current meta-analysis aimed to identify the effect of surgery on the prognosis of gastric lymphoma. METHODS We searched the MEDLINE, Embase, and Cochrane Central databases to obtain relevant studies investigating the influence of surgery on overall survival (OS) and relapse-free survival (RFS). We extracted the hazard ratios (HRs) and associated 95% confidence intervals (CIs) of each included report for pooled analysis. We assessed heterogeneity (I2 statistic) and funnel plots to select the data models and evaluate publication bias. RESULTS Ultimately, we included 12 studies containing 26 comparisons in the current quantitative meta-analysis. The analysis revealed that surgery had no significant effect on OS (HR .83, P = .13) or RFS (HR .78, P = .08). However, subgroup analysis revealed that the effect of surgery on OS differed significantly between the surgery plus conservative therapy subgroup and the conservative therapy alone groups, with HR = .69 (P = .01). No significant publication bias was detected regarding the main outcomes. CONCLUSION Surgery had a limited effect on the prognosis of patients with gastric lymphoma. However, the use of surgery as an additional therapy may confer potential benefits. This was an interesting research direction, and additional high-quality, large-scale randomized controlled trials should be conducted.
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Affiliation(s)
- Min Shi
- Department of Pathophysiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, China
| | - Yao Yao
- School of Medicine, Huanggang Polytechnic College, Huanggang, China
| | - Haifeng Ding
- School of Medicine, Huanggang Polytechnic College, Huanggang, China
| | - Jian Yang
- School of Nursing, Huanggang Polytechnic College, Huanggang, China
| | - Cong Zhang
- School of Medicine, Huanggang Polytechnic College, Huanggang, China
| | - Ying Wu
- Liuzhou Key Laboratory of Infection Disease and Immunology, Guangxi Health Commission Key Laboratory of Clinical Biotechnology, Liuzhou People's Hospital Affiliated to Guangxi Medical University, Liuzhou, China
| | - Tao Guo
- Department of Pathophysiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, China
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9
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Feng Y, Duan TJ, Huang Q, Li ZY, Liu YP, Luo MS, Lu GF, Shi W, Zhang ZY, Li HX. The clinicopathological characteristics of gastric cancer and precancerous conditions in gastric DLBCL and MALT lymphoma patients: a multi-center retrospective study. Ann Med 2023; 55:2193423. [PMID: 37183786 DOI: 10.1080/07853890.2023.2193423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVE The objective of this study is to explore the clinicopathological characteristics of gastric cancer and precancerous conditions in patients with primary gastric lymphoma. METHODS We analyzed 474 cases of primary gastric lymphoma, mainly DLBCL and MALT, from three clinical centres retrospectively, and compared the clinicopathological parameters of primary gastric lymphoma patients complicated with gastric cancer, precancerous conditions, or with no complications. RESULTS A total of 5.1% of the patients with primary gastric lymphoma were diagnosed with gastric cancer, including metachronous gastric adenocarcinoma (3.2%) and synchronous gastric adenocarcinoma (1.9%). Of the patients with gastric lymphoma, 14.6% had precancerous conditions including atrophy (14.6%), intestinal metaplasia (8.9%), and low-grade intraepithelial neoplasia (1.9%). Primary gastric lymphoma patients with an ulcerative type (p = 0.009) and Lugano classification stage IIE + IV (p < 0.001) lymphoma had a higher risk of complicating with gastric cancers or precancerous conditions. The rate of infection of Helicobacter pylori (Hp) was 68.4% in patients with primary gastric lymphoma, which was higher in patients with MALT lymphoma (p < 0.001), Lugano classification stage I + II (p < 0.001), and patients complicated with precancerous conditions and gastric cancer (p < 0.001), especially gastric cancer of the intestinal type (p = 0.04). Gastric cancer (95.8%) and precancerous conditions (91.3%) occurred mostly in Hp-infected primary gastric lymphoma patients, with a minor subset of Hp-eradicated patients. Primary gastric lymphoma patients had a higher detection rate of early gastric cancer (25.0%) and a five-year survival rate (40.0%) than the general Chinese population. CONCLUSIONS Patients with primary gastric lymphoma have a high risk of developing gastric cancer and precancerous conditions, and this risk may be related to Helicobacter pylori infection. Follow-up of primary gastric lymphoma provides an opportunity for the detection of early gastric cancer.Key messages5.1% of the patients with primary gastric lymphoma were diagnosed with gastric cancer.14.6% of the patients with gastric lymphoma had premalignant lesions including atrophy (14.6%), intestinal metaplasia (8.9%), and low-grade intraepithelial neoplasia (1.9%).Primary gastric lymphoma patients complicating with gastric cancer had a higher infection rate of Helicobacter pylori (100.0%), a detection rate of early gastric cancer (25.0%) and a five-year survival rate (40.0%) than the general Chinese population.
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Affiliation(s)
- Yun Feng
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Tian-Jiao Duan
- Department of Gastroenterology, Shaanxi Provincial People's Hospital, Xi'an, People's Republic of China
| | - Qing Huang
- Department of Gastroenterology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, People's Republic of China
| | - Zhi-Yi Li
- Department of Hematology, The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Ya-Ping Liu
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Miao-Sha Luo
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Gui-Fang Lu
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Wen Shi
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Zhi-Yong Zhang
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
| | - Hong-Xia Li
- The First Affiliated Hospital of Xi'an Jiao Tong University, Xi'an, People's Republic of China
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10
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Huang W, Tao Z, Younis MH, Cai W, Kang L. Nuclear medicine radiomics in digestive system tumors: Concept, applications, challenges, and future perspectives. VIEW 2023; 4:20230032. [PMID: 38179181 PMCID: PMC10766416 DOI: 10.1002/viw.20230032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/20/2023] [Indexed: 01/06/2024] Open
Abstract
Radiomics aims to develop novel biomarkers and provide relevant deeper subvisual information about pathology, immunophenotype, and tumor microenvironment. It uses automated or semiautomated quantitative analysis of high-dimensional images to improve characterization, diagnosis, and prognosis. Recent years have seen a rapid increase in radiomics applications in nuclear medicine, leading to some promising research results in digestive system oncology, which have been driven by big data analysis and the development of artificial intelligence. Although radiomics advances one step further toward the non-invasive precision medical analysis, it is still a step away from clinical application and faces many challenges. This review article summarizes the available literature on digestive system tumors regarding radiomics in nuclear medicine. First, we describe the workflow and steps involved in radiomics analysis. Subsequently, we discuss the progress in clinical application regarding the utilization of radiomics for distinguishing between various diseases and evaluating their prognosis, and demonstrate how radiomics advances this field. Finally, we offer our viewpoint on how the field can progress by addressing the challenges facing clinical implementation.
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Affiliation(s)
- Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Zihao Tao
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
| | - Muhsin H. Younis
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Weibo Cai
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing, China
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11
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Alvi AT, Shankar M. A Rare Case of Primary Extra-Nodal Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue (MALT) in the Rectum. Cureus 2023; 15:e49447. [PMID: 38149148 PMCID: PMC10751178 DOI: 10.7759/cureus.49447] [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: 11/26/2023] [Indexed: 12/28/2023] Open
Abstract
Mucosa-associated lymphoid tissue (MALT) is a unique clinical condition that can manifest in different anatomic locations. In the gastrointestinal tract, it is typically seen in the stomach but is less commonly found in other sites. There have been a few cases in the literature in which primary MALT lymphoma is found in the rectum. We describe a case of a 63-year-old male who presented with rectal pain and bleeding. Colonoscopy revealed a rectal mass, which was excised with a trans-anal approach. Histopathological examination of the biopsy specimen was significant for MALT lymphoma. Therefore, the patient underwent radiation therapy followed by repeat colonoscopies to monitor disease recurrence.
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Affiliation(s)
- Ali Tariq Alvi
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Murali Shankar
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
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12
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Tian FY, Wang JX, Huang G, An W, Ai LS, Wang S, Wang PZ, Yu YB, Zuo XL, Li YQ. Clinical and endoscopic features of primary small bowel lymphoma: a single-center experience from mainland China. Front Oncol 2023; 13:1142133. [PMID: 37397371 PMCID: PMC10313208 DOI: 10.3389/fonc.2023.1142133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The worldwide incidence of primary small intestinal lymphoma (PSIL) is increasing. However, little is known about the clinical and endoscopic characteristics of this disease. The aim of this study was to investigate the clinical and endoscopic data of patients with PSIL, with the goal of enhancing our understanding of the disease, improving diagnostic accuracy, and facilitating more accurate prognosis estimation. Methods Ninety-four patients diagnosed with PSIL were retrospectively studied at Qilu Hospital of Shandong University between 2012 and 2021. The clinical data, enteroscopy findings, treatment modalities, and survival times were collected and analyzed. Results Ninety-four patients (52 males) with PSIL were included in this study. The median age of onset was 58.5 years (range: 19-80 years). Diffuse large B-cell lymphoma (n=37) was the most common pathological type. Abdominal pain (n=59) was the most frequent clinical presentation. The ileocecal region (n=32) was the most commonly affected site, and 11.7% of patients had multiple lesions. At the time of diagnosis, the majority of patients (n=68) were in stages I-II. A new endoscopic classification of PSIL was developed, including hypertrophic type, exophytic type, follicular/polypoid type, ulcerative type, and diffusion type. Surgery did not show a significant increase in overall survival; chemotherapy was the most commonly administered treatment. T-cell lymphoma, stages III-IV, "B" symptoms, and ulcerative type were associated with poor prognosis. Conclusion This study provides a comprehensive analysis of the clinical and endoscopic features of PSIL in 94 patients. This highlights the importance of considering clinical and endoscopic characteristics for accurate diagnosis and prognosis estimation during small bowel enteroscopy. Early detection and treatment of PSIL is associated with a favorable prognosis. Our findings also suggest that certain risk factors, such as pathological type, "B" symptoms, and endoscopic type, may affect the survival of PSIL patients. These results underscore the need for careful consideration of these factors in the diagnosis and treatment of PSIL.
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Affiliation(s)
- Feng-Yu Tian
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jue-Xin Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Gang Huang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Wen An
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Li-Si Ai
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Sui Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Pei-Zhu Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan-Bo Yu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
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O'Neill TJ, Tofaute MJ, Krappmann D. Function and targeting of MALT1 paracaspase in cancer. Cancer Treat Rev 2023; 117:102568. [PMID: 37126937 DOI: 10.1016/j.ctrv.2023.102568] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/03/2023]
Abstract
The paracaspase MALT1 has emerged as a key regulator of immune signaling, which also promotes tumor development by both cancer cell-intrinsic and -extrinsic mechanisms. As an integral subunit of the CARD11-BCL10-MALT1 (CBM) signaling complex, MALT1 has an intriguing dual function in lymphocytes. MALT1 acts as a scaffolding protein to drive activation of NF-κB transcription factors and as a protease to modulate signaling and immune activation by cleavage of distinct substrates. Aberrant MALT1 activity is critical for NF-κB-dependent survival and proliferation of malignant cancer cells, which is fostered by paracaspase-catalyzed inactivation of negative regulators of the canonical NF-κB pathway like A20, CYLD and RelB. Specifically, B cell receptor-addicted lymphomas rely strongly on this cancer cell-intrinsic MALT1 protease function, but also survival, proliferation and metastasis of certain solid cancers is sensitive to MALT1 inhibition. Beyond this, MALT1 protease exercises a cancer cell-extrinsic role by maintaining the immune-suppressive function of regulatory T (Treg) cells in the tumor microenvironment (TME). MALT1 inhibition is able to convert immune-suppressive to pro-inflammatory Treg cells in the TME of solid cancers, thereby eliciting a robust anti-tumor immunity that can augment the effects of checkpoint inhibitors. Therefore, the cancer cell-intrinsic and -extrinsic tumor promoting MALT1 protease functions offer unique therapeutic opportunities, which has motivated the development of potent and selective MALT1 inhibitors currently under pre-clinical and clinical evaluation.
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Affiliation(s)
- Thomas J O'Neill
- Research Unit Signaling and Translation, Group Signaling and Immunity, Molecular Targets and Therapeutics Center, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Marie J Tofaute
- Research Unit Signaling and Translation, Group Signaling and Immunity, Molecular Targets and Therapeutics Center, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
| | - Daniel Krappmann
- Research Unit Signaling and Translation, Group Signaling and Immunity, Molecular Targets and Therapeutics Center, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
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Wang D, Shi XL, Xu W, Shi RH. Nomogram model predicting the overall survival for patients with primary gastric mucosa-associated lymphoid tissue lymphoma. World J Gastrointest Oncol 2023; 15:533-545. [PMID: 37009322 PMCID: PMC10052661 DOI: 10.4251/wjgo.v15.i3.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Increasingly extranodal marginal B-cell lymphoma of mucosa-associated lymphoid tissue, known as mucosa-associated lymphoid tissue (MALT) lymphoma, is a type of non-Hodgkin’s lymphoma. The prognosis of primary gastric MALT (GML) patients can be affected by many factors. Clinical risk factors, including age, type of therapy, sex, stage and family hematologic malignancy history, also have significant effects on the development of the disease. The available data are mainly focused on epidemiology; in contrast, few studies have investigated the prognostic variables for overall survival (OS) in patients with primary GML. Based on the realities above, we searched a large amount of data on patients diagnosed with primary GML in the Surveillance, Epidemiology and End Results (SEER) database. The aim was to develop and verify a survival nomogram model that can predict the overall survival prognosis of primary GML by combining prognostic and determinant variables.
AIM To create an effective survival nomogram for patients with primary gastric GML.
METHODS All data of patients with primary GML from 2004 to 2015 were collected from the SEER database. The primary endpoint was OS. Based on the LASSO and COX regression, we created and further verified the accuracy and effectiveness of the survival nomogram model by the concordance index (C-index), calibration curve and time-dependent receiver operating characteristic (td-ROC) curves.
RESULTS A total of 2604 patients diagnosed with primary GML were selected for this study. A total of 1823 and 781 people were randomly distributed into the training and testing sets at a ratio of 7:3. The median follow-up of all patients was 71 mo, and the 3- and 5-year OS rates were 87.2% and 79.8%, respectively. Age, sex, race, Ann Arbor stage and radiation were independent risk factors for OS of primary GML (all P < 0.05). The C-index values of the nomogram were 0.751 (95%CI: 0.729-0.773) and 0.718 (95%CI: 0.680-0.757) in the training and testing cohorts, respectively, showing the good discrimination ability of the nomogram model. Td-ROC curves and calibration plots also indicated satisfactory predictive power and good agreement of the model. Overall, the nomogram shows favorable performance in discriminating and predicting the OS of patients with primary GML.
CONCLUSION A nomogram was developed and validated to have good survival predictive performance based on five clinical independent risk factors for OS for patients with primary GML. Nomograms are a low-cost and convenient clinical tool in assessing individualized prognosis and treatment for patients with primary GML.
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Affiliation(s)
- Dan Wang
- Medical School, Southeast University, Nanjing 210009, Jiangsu Province, China
- Department of Gastroenterology, Zhongda Hospital, Affiliated Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
- Laboratory of Gastroenterology, Medical School of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Xin-Lin Shi
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Yangzhou University, Yangzhou 225001, Jiangsu Province, China
| | - Wei Xu
- Department of Gastroenterology, Zhongda Hospital, Affiliated Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
- Laboratory of Gastroenterology, Medical School of Southeast University, Nanjing 210009, Jiangsu Province, China
| | - Rui-Hua Shi
- Department of Gastroenterology, Zhongda Hospital, Affiliated Hospital of Southeast University, Nanjing 210009, Jiangsu Province, China
- Laboratory of Gastroenterology, Medical School of Southeast University, Nanjing 210009, Jiangsu Province, China
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15
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Nahhat F, Zabad K, Najjar H, Doyya M, Khazeam N. Gastric Diffuse Large B-Cell Lymphoma in an Adolescent: A Case Report. Case Rep Oncol 2023; 16:69-73. [PMID: 36785741 PMCID: PMC9918866 DOI: 10.1159/000529181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
Non-Hodgkin lymphoma (NHL) is the 11th most common cancer worldwide and the 4th most common pediatric cancer. The GI tract is the most common extranodal site of NHL, making up about 30-40% of extranodal cases. The median age at diagnosis for gastrointestinal NHL (gNHL) is around 61. On the other hand, gNHL is very rare in the pediatric population. Herein, we report the case of a 15-year-old girl who complained of abdominal pain and vomiting after meals, with severe B symptoms (fever, night chills, and severe weight loss). Esophagogastroduodenoscopy showed a mass in the lesser curvature of the stomach. Subsequent biopsy and immunostaining of the sample confirmed the diagnosis of diffuse large B-cell lymphoma. CT and PET-CT scans indicated the involvement of mesenteric and lesser omental lymph nodes. Later on, the patient started an R-CHOP chemotherapy regimen. In this report, we aim to shine the light on such a rare disease in this age group.
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Affiliation(s)
- Fouad Nahhat
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Kareem Zabad
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Hasan Najjar
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Modar Doyya
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Nisreen Khazeam
- Faculty of Medicine, Damascus University, Damascus, Syria
- Head of Oncology Department, Albairouni University Hospital, Damascus, Syria
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16
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Wang C, Yang Y, He Z, Wei X, Zhang S, Song J. High-grade B-cell lymphoma with gastroduodenal involvement showing paraneoplastic cerebellar degeneration: a case report. Transl Cancer Res 2022; 11:4441-4447. [PMID: 36644173 PMCID: PMC9834590 DOI: 10.21037/tcr-22-1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022]
Abstract
Background Paraneoplastic cerebellar degeneration (PCD), which displays ataxia and other cerebellar symptoms, is the most common paraneoplastic neurological syndrome (PNS). PCD is more likely to occur in individuals with small cell lung cancer (SCLC), gynecological malignancies, and Hodgkin disease, but it is rarely associated with non-Hodgkin lymphoma (NHL). Case Description We report a case of PCD accompanying high-grade B-cell lymphoma embedded in an individual's stomach and duodenum, who also presented with acute onset of gait ataxia and slurred speech. The results of the common laboratory tests for neurological disorders, including the paraneoplastic antibody test, were negative. The key to the accurate diagnosis was the positron emission tomography/computed tomography findings. The final diagnosis of high-grade B-cell lymphoma was unclear until the performance of repeated esophagogastroscopy with multipoint deep excavation biopsies. After standard chemotherapy, the patient's gastric tumor was significantly alleviated and cerebellar syndrome was significantly improved. Conclusions This case highlights the challenges of diagnosing PNS associated with occult malignancy. PNS patients may present with a variety of neurological disorders; Thus, if any unexplained neurological symptoms appear after a series of specific laboratory and imaging tests, a diagnosis of PNS should be taken into consideration in the differential diagnosis list, as it may help clinicians identify asymptomatic malignancies and ensure patients receive correct treatments in a timely manner. A high-quality endoscopic biopsy is essential, as it helps hematologists make an accurate diagnosis of lymphoma with gastroduodenal involvement based on pathology.
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Affiliation(s)
- Chunsaier Wang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yi Yang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhen He
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuejing Wei
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shutian Zhang
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jiugang Song
- Department of Gastroenterology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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17
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Liu J, Wei J, Jiang X, Yu W, Tong H, Jin J, Yan S, Xu W. Prognostic effects of clinical parameters, genetic abnormalities, and subtypes in primary gastric diffuse large B-cell lymphoma: a cohort analysis of 146 patients. Leuk Lymphoma 2022; 63:3362-3369. [PMID: 36148555 DOI: 10.1080/10428194.2022.2126279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This study included 146 primary gastric diffuse large B-cell lymphoma patients. Next-generation RNA sequencing and fluorescent in situ hybridization were performed on tumors from 27 and 38 patients, respectively. Five-year and 10-year overall survival (OS) rates were 77% and 57%, respectively. Lugano and TNM clinical stage were independent survival factors. Tier I mutation was found in 21 patients. The genetic subtypes were A53 (n = 3), MCD (n = 5), BN2 (n = 5), N1 (n = 5), EZB (n = 1), and NOS (n = 8). OS was significantly shorter in high-risk genetic subtypes (A53, MCD, and N1) than low-risk subtypes (BN2, EZB, and NOS). Frequencies of high-risk genetic subtypes were higher in patients with Lugano stage II/IV and TNM clinical stage III + IV than in those with Lugano stage I and TNM clinical stage I + II. Although genetic testing was performed in only a small number of cases, the results suggested that high-risk genetic subtypes were associated with advanced clinical stages and shorter survival.
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Affiliation(s)
- Junqing Liu
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Juying Wei
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Clinical Research Center For Hematological Disorders, Hangzhou, PR China
| | - Xue Jiang
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Wenjuan Yu
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Clinical Research Center For Hematological Disorders, Hangzhou, PR China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Clinical Research Center For Hematological Disorders, Hangzhou, PR China.,School of Medicine, MDS Center, The First Affiliated Hospital, Zhejiang University, Hangzhou, PR China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Clinical Research Center For Hematological Disorders, Hangzhou, PR China
| | - Senxiang Yan
- Department of Radiation Oncology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China
| | - Weilai Xu
- Department of Hematology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, PR China.,Zhejiang Provincial Clinical Research Center For Hematological Disorders, Hangzhou, PR China
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18
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Muacevic A, Adler JR, Mohamed A, Baddoura W, Cavanagh Y. A Case of Multifocal Burkitt Lymphoma in an Immunocompromised Patient. Cureus 2022; 14:e32183. [PMID: 36620831 PMCID: PMC9810485 DOI: 10.7759/cureus.32183] [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: 12/04/2022] [Indexed: 12/11/2022] Open
Abstract
Non-Hodgkin lymphoma is made from the B-cell lineage and includes extra-nodal marginal lymphomas, follicular lymphomas, mantle cell lymphoma, diffuse large B-cell lymphoma, and Burkitt lymphoma. Burkitt lymphoma is associated with Epstein Barr Virus and Human Immunodeficiency Virus. Although it is common for other B-cell lymphomas to develop in the stomach, it is less common for Burkitt lymphoma tumors to manifest there. Additionally, primary and/or secondary involvement of the duodenum, pancreas, and intestines is very rare in Burkitt lymphoma. Herein, we present a male diagnosed with extensive Burkitt lymphoma of the bone, lymph nodes, pancreas, small intestine, duodenum, and stomach.
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Erkut M, Erkut N, Bektaş Ö, Fidan S, Coşar AM, Sönmez M, Sonmez M. Effect of Clinical, Endoscopic, Radiological Findings, and Complications on Survival in Patients with Primary Gastrointestinal Lymphoma. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2022; 33:909-917. [PMID: 36262100 PMCID: PMC9797772 DOI: 10.5152/tjg.2022.211003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical, endoscopic, and radiological characteristics, complications, survival outcomes, and prognostic factors of patients with primary gastrointestinal lymphoma. METHODS This study retrospectively analyzed the demographic, laboratory, endoscopic, and radiological characteristics and treatment outcomes of 43 patients with newly diagnosed primary gastrointestinal lymphoma. RESULTS The median age was 62 years (range: 26-83). The primary lesion location was the gastric in 33 (77%) patients and the intestinal in 10 (23%) patients. The most common lesions were the corpus (33%) and corpus+antrum (24%) in primary gastric lymphoma and the ileum (60%) in primary intestinal lymphoma. The most common endoscopic findings were diffuse infiltrative lesion (23%) and massforming (33%), while the most common computed tomography finding was wall thickening (53%). Wall thickening and mass-forming at computed tomography were greater in primary intestinal lymphoma than in primary gastric lymphoma (P = .034). Complications were observed in 9 (21%) patients and 13 (31%) patients who underwent surgery. Complication and surgery rates were higher in primary intestinal lymphoma than in primary gastric lymphoma (P = .003 and P = .014, respectively). Five-year overall survival and 5-year eventfree survival rates were 75% and 72%, respectively. Univariate analysis showed that intestinal involvement, advanced clinical stage, a high International Prognostic Index score, mass-forming and wall thickening at computed tomography, extranodal involvement, and complication were found to adversely affect survival. Multivariate analysis revealed that intestinal involvement and a high International Prognostic Index score were independent prognostic factors for overall survival and event-free survival. CONCLUSION Patients with primary gastrointestinal lymphoma with intestinal involvement and high International Prognostic Index score should be followed closely.
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Affiliation(s)
- Murat Erkut
- Department of Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon,Corresponding author: Murat Erkut, e-mail:
| | - Nergiz Erkut
- Department of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon,Corresponding author: Murat Erkut, e-mail:
| | - Özlen Bektaş
- Department of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Sami Fidan
- Department of Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Arif Mansur Coşar
- Department of Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Mehmet Sönmez
- Department of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon
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20
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Wu FZ, Chen XX, Chen WY, Wu QH, Mao JT, Zhao ZW. Multiple primary malignancies – hepatocellular carcinoma combined with splenic lymphoma: A case report. World J Clin Cases 2022; 10:10130-10135. [PMID: 36246796 PMCID: PMC9561559 DOI: 10.12998/wjcc.v10.i28.10130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/09/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary liver cancer is one of the most common malignant tumours, while primary splenic lymphoma is a rare malignancy. Thus, cases of hepatocellular carcinoma (HCC) combined with splenic lymphoma are extremely rare.
CASE SUMMARY We present a 62-year-old woman who was admitted to the Interventional Radiology Department with a lump in the spleen and liver as well as multiple enlarged lymph nodes visible by ultrasound. Contrast-enhanced computed of the abdomen revealed a circular, low-density, shallow mass (approximately 2.6 cm in diameter) in the left intrahepatic lobe and multiple round, low-density shadows in the spleen with clear boundaries (maximum diameter 7.6 cm). Based on the characteristic clinical symptoms and explicit radiological findings, the clinical diagnosis was HCC with metastasis to the liver portal, retroperitoneal lymph nodes, and spleen. After transcatheter arterial chemoembolization and sequential radiofrequency ablation, the -fetoprotein level returned to the normal range, and the hepatitis B cirrhosis improved. In addition, splenic tumour biopsy confirmed the diagnosis of primary malignant lymphoma, which went into remission after chemotherapy.
CONCLUSION HCC with primary splenic non-Hodgkin lymphoma is extremely rare and easily misdiagnosed. Better understanding would facilitate early diagnosis, treatment and prognosis.
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Affiliation(s)
- Fa-Zong Wu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Xiao-Xiao Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Wei-Yue Chen
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Qiao-Hong Wu
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Jian-Ting Mao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
| | - Zhong-Wei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui 323000, Zhejiang Province, China
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Liu X, Cao D, Liu H, Ke D, Ke X, Xu X. Clinical Features Analysis and Survival Nomogram of Primary Small Intestinal Diffuse Large B-Cell Lymphoma. Cancer Manag Res 2022; 14:2639-2648. [PMID: 36090469 PMCID: PMC9462437 DOI: 10.2147/cmar.s369086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to analyze the clinical features and survival of primary small intestinal diffuse large B-cell lymphoma (PsI-DLBCL), and establish and independently validate a prognostic nomogram for individual risk prediction. Patients and methods Data for 24 patients from the Renmin Hospital of Wuhan University were used as an independent validation cohort, data for 1144 patients with PsI-DLBCL from the SEER database were randomly assigned to training (N=817) and internal validation (N=327) sets. The survival nomogram was constructed with the most significant factors associated with OS using Univariate and multivariate analyses on the training set. Decision curve analysis (DCA) was conducted. Internal validation was SEER validation set. Our cancer center cohort was used as an external validation set to further verify the survival nomogram. Results Five clinicopathological feature factors associated with OS of the training set yielded (age, marital status, Ann Arbor stage, surgery for primary site and chemotherapy), which were used to create a survival nomogram. Additionally, the calibration curves of the prognostic nomogram revealed good agreement between the predicted survival probabilities and the ground truth values. The stability of our survival nomogram was explained by internal and external validation data. Conclusion Our nomogram proposes the clinical and therapeutic factors affecting OS for patients with PsI-DLBCL. It shows that chemotherapy and surgery are beneficial to patients in the choice of treatment options. These results suggest that a survival nomogram may be better at predicting OS for PsI-DLBCL patients.
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Affiliation(s)
- Xiaohong Liu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Dedong Cao
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Hui Liu
- Department of Hematology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Dong Ke
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Xiaokang Ke
- Department of Pathology; Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Ximing Xu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
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Rahman SH, Chaudhry AW, Raoof S, Khan N, Khan AH. Helicobacter pylori-Negative Gastric Mucosa-Associated Lymphoid Tissue Lymphoma Presenting as Massive Gastrointestinal Bleed. Cureus 2022; 14:e29125. [PMID: 36258947 PMCID: PMC9559925 DOI: 10.7759/cureus.29125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2022] [Indexed: 11/21/2022] Open
Abstract
This case reports a patient that represents the minority of patients with gastric mucosa-associated lymphoid tissue (MALT) lymphoma who do not have underlying Helicobacter pylori gastritis. Gastric MALT lymphoma is a type of primary gastric lymphoma (PGL), which are extremely rare gastric malignancies characterized by proliferation of B-cells and infiltration of lymphoid tissue leading to destruction of gastric glands. Development of gastric MALT lymphoma is associated with H. pylori gastritis. Patients typically present with a wide range of symptoms including but not limited to epigastric pain, weight loss, gastrointestinal bleeding and gastric wall perforation. Gastric MALT lymphoma presenting as a massive gastrointestinal bleed is quite rare and only a few cases have been documented. Our case demonstrates that it is important to recognize that acute presentations of this disease may also occur.
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Tao Y, Nan Q, Lei Z, Miao YL, Niu JK. Rare primary rectal mucosa-associated lymphoid tissue lymphoma with curative resection by endoscopic submucosal dissection: A case report and review of literature. World J Clin Cases 2022; 10:7599-7608. [PMID: 36158004 PMCID: PMC9353914 DOI: 10.12998/wjcc.v10.i21.7599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/19/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) occurs in approximately 9% of non-Hodgkin B-cell lymphomas. The gastrointestinal tract is the most commonly affected site of the extranodal forms of primary non-Hodgkin’s lymphomas. However, it rarely occurs within the rectum, and at present, there is no consensus on its diagnosis and treatment at this site.
CASE SUMMARY We report a rare laterally spreading tumour-like rectal MALT lymphoma case in which the diagnosis and the depth of infiltration were determined by magnifying endoscopy and ultrasonic endoscopy. Then, the lesion was en bloc resected by endoscopic submucosal dissection (ESD) alone. The lesion was confirmed as MALT lymphoma by haematoxylin and eosin staining, immunohistochemical staining and gene arrangement analysis. Surveillance exams have indicated a 2-year disease-free survival for this patient.
CONCLUSION We report a rare primary rectal MALT lymphoma that was curable with resection by ESD. ESD is a safe and effective therapeutic option for rectal MALT lymphoma.
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Affiliation(s)
- Yan Tao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Qiong Nan
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Zi Lei
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
| | - Ying-Lei Miao
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
| | - Jun-Kun Niu
- Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University; Yunnan Province Clinical Research Center for Digestive Diseases, Kunming 650032, Yunnan Province, China
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Intelligent Reconstruction Algorithm-Based Computed Tomography Images for Automatic Detection of Gastric Tumor. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8179766. [PMID: 35799664 PMCID: PMC9256342 DOI: 10.1155/2022/8179766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/17/2022]
Abstract
The aim of this study was to explore the application of computed tomography (CT) images in the diagnosis of gastric tumor under the intelligent reconstruction algorithm (IRA). 120 patients with gastric cancer were selected and all the patients underwent CT scanning, and CT images were analyzed based on the Feldkamp-Davis-Kress algorithm (FDK algorithm) to evaluate the imaging features of gastric lesions. According to biopsy or surgical pathology, the detection rate of CT images was calculated. The results showed that there were three pathological types of benign tumors (polyps, leiomyomas, and mesenchymomas) and three pathological types of malignant tumors (mesenchymomas, adenomas, and lymphomas). In addition, the detection rates of CT scans were different, reaching 94.2% on different orientations of the stomach, 90.7% of benign tumors, and 90.9% of malignant tumors, so the detection rate of different orientations was relatively high. CT images based on the FDK IRA could realize a high detection rate in diagnosis, accurately locate the lesion, and display the characteristics of the lesion and the metastasis of surrounding tissues; there were significant differences between benign and malignant gastric tumors in CT images, and the detection effect was obvious, which is worthy of clinical application and promotion.
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Kaddu-Mulindwa D, Thurner L, Christofyllakis K, Bewarder M, Kos IA. Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives. Cancers (Basel) 2022; 14:cancers14123019. [PMID: 35740684 PMCID: PMC9220961 DOI: 10.3390/cancers14123019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/04/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Extranodal marginal zone lymphoma distinguishes itself from other indolent lymphomas due to its unique pathophysiology and natural history. This is reflected in its management, where next to traditional treatment strategies such as observation, radiotherapy or chemotherapy, eradication of the causal agent and even surgery represent important aspects of therapy. This review focuses on the particular aspects of this indolent lymphoma that affect management and summarizes the current evidence and different guidelines. Abstract Extranodal marginal zone lymphoma (EMZL) encompasses a subgroup of non-Hodgkin lymphomas that often present with localized involvement and may manifest in a diversity of organs and tissues. EMZL pathogenesis is in some cases linked to chronic inflammation/infection, which may impose additional diagnostic and clinical challenges. The most studied and established connection is the presence of Helicobacter pylori in gastric EMZL. Due to its heterogeneity of presentation and intricate pathological features, treatment can be complex, and staging systems are decisive for the choice of therapy. Nevertheless, there is no consensus regarding the most suitable staging system, and recommendations vary among different countries. As a rule of thumb, in limited stages, a local therapy with surgery or radiation is the preferred option, and it is potentially curative. Of note, eradicating the causal agent may be an important step of treatment, especially in gastric EMZL, in which Helicobacter pylori eradication remains the first-line therapy for the majority of patients. In patients with more advanced stages, watch-and-wait is a valuable option, especially amongst those without clear indications for systemic therapy, and it may be carried on for several years. If watch-and-wait is not an option, systemic therapy may be needed. Even though several agents have been tested as monotherapy or in combination in recent years, there is no consensus regarding the first-line therapy, and decisions can vary depending on individual factors, such as age, clinical performance and stage. This review aims to discuss the several aspects of EMZL, including genetic milieu, pathogenesis and staging systems, that may influence the choice of therapy. In addition, we present a summary of evidence of several systemic therapies, compare different recommendations worldwide and discuss future perspectives and novelties in its therapy.
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Calomino N, Fusario D, Cencini E, Lazzi S. Two secondary localisation of non-Hodgkin's lymphomas in the upper gastrointestinal tract. BMJ Case Rep 2022; 15:e247607. [PMID: 35584861 PMCID: PMC9119136 DOI: 10.1136/bcr-2021-247607] [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] [Accepted: 05/05/2022] [Indexed: 11/03/2022] Open
Abstract
Extranodal non-Hodgkin's lymphomas of the gastrointestinal tract represent 30%-40% of all extranodal lymphomas. Gastric lymphomas are increasingly described in the literature due to the development of diagnostic techniques and the increased incidence, together with the reduced incidence of gastric solid neoplasms. Significant diagnostic difficulties are determined by the non-specificity of the symptoms, which are mostly chronic, characterised by a slow progression. Localisation in the small intestine often appears as surgical urgency, due to the development of an intestinal obstruction or enterorrhagia. We present two cases of extranodal diffuse large B-cell lymphoma localisation, presented as a secondary lesion localised in the first one in the stomach, and in the second one in the first duodenal portion.
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Affiliation(s)
- Natale Calomino
- Department of Medicine, Surgery and Neuroscience, University of SIena, Siena, Italy
| | - Daniele Fusario
- Department of Medicine, Surgery and Neuroscience, University of SIena, Siena, Italy
| | - Emanuele Cencini
- Unit of Hematology, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Stefano Lazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
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王 竹, 谢 亚, 李 雅, 杨 锦, 谢 艳. [Analysis and Treatment Experience of 25 Cases of Primary Gastric Lymphoma with Acute Upper Gastrointestinal Bleeding as the Primary Manifestation]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:404-408. [PMID: 35642146 PMCID: PMC10409412 DOI: 10.12182/20220560204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Indexed: 06/15/2023]
Abstract
Objective To summarize the clinical characteristics and treatment experience of gastric primary lymphoma with acute upper gastrointestinal bleeding as the primary manifestation, and to provide support for clinical treatment. Methods Information on gastric primary lymphoma patients admitted to the Department of Gastroenterology, West China Hospital of Sichuan University between January 2010 and March 2021 for acute upper gastrointestinal bleeding was retrospectively collected. Data on endoscopic morphology, tumor staging, pathology typing, severity of bleeding, risks of rebleeding, treatment and inhospital prognosis were documented and analyzed. Results A total of 25 patients with a mean age of 57.2 years were included in the study, all of whom presented clinically with melena (100%), 9 (36%) had hematemesis, and 6 (24%) was accompanied with abdominal pain. Twenty, or 80%, of the gastric lymphoma patients with bleeding as the primary manifestation showed endoscopically a tumor-forming phenotype (Yao Classification), mostly involving the middle and lower parts of the gastric body (44% and 32%, respectively). After conservative treatment with medication, rebleeding occurred in 4 patients during hospitalization. One of them required endoscopic hemostasis, two required surgical resection to stop the bleeding, and one decided not to undergo any further treatment. Only one patient died from infection and no death resulted directly from severe bleeding. Conclusion Gastric primary lymphoma presenting acute upper gastrointestinal bleeding as the sole clinical manifestation rarely occurs, but when the condition does occur, it shows a wide range of endoscopic involvement. It has a higher risk of rebleeding, and endoscopic or surgical treatment may be attempted when conservative medication treatment for acute upper gastrointestinal bleeding fails.
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Affiliation(s)
- 竹 王
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan Univeristy, Chengdu 610041, China
| | - 亚文 谢
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan Univeristy, Chengdu 610041, China
| | - 雅茹 李
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan Univeristy, Chengdu 610041, China
| | - 锦林 杨
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan Univeristy, Chengdu 610041, China
| | - 艳 谢
- 四川大学华西医院 消化内科 (成都 610041)Department of Gastroenterology, West China Hospital, Sichuan Univeristy, Chengdu 610041, China
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Ahn JY. Gastrointestinal Tract Lymphoma. THE KOREAN JOURNAL OF HELICOBACTER AND UPPER GASTROINTESTINAL RESEARCH 2022. [DOI: 10.7704/kjhugr.2021.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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29
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Feng B, Huang L, Liu Y, Chen Y, Zhou H, Yu T, Xue H, Chen Q, Zhou T, Kuang Q, Yang Z, Chen X, Chen X, Peng Z, Long W. A Transfer Learning Radiomics Nomogram for Preoperative Prediction of Borrmann Type IV Gastric Cancer From Primary Gastric Lymphoma. Front Oncol 2022; 11:802205. [PMID: 35087761 PMCID: PMC8789309 DOI: 10.3389/fonc.2021.802205] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Objective This study aims to differentiate preoperative Borrmann type IV gastric cancer (GC) from primary gastric lymphoma (PGL) by transfer learning radiomics nomogram (TLRN) with whole slide images of GC as source domain data. Materials and Methods This study retrospectively enrolled 438 patients with histopathologic diagnoses of Borrmann type IV GC and PGL. They received CT examinations from three hospitals. Quantitative transfer learning features were extracted by the proposed transfer learning radiopathomic network and used to construct transfer learning radiomics signatures (TLRS). A TLRN, which integrates TLRS, clinical factors, and CT subjective findings, was developed by multivariate logistic regression. The diagnostic TLRN performance was assessed by clinical usefulness in the independent validation set. Results The TLRN was built by TLRS and a high enhanced serosa sign, which showed good agreement by the calibration curve. The TLRN performance was superior to the clinical model and TLRS. Its areas under the curve (AUC) were 0.958 (95% confidence interval [CI], 0.883–0.991), 0.867 (95% CI, 0.794–0.922), and 0.921 (95% CI, 0.860–0.960) in the internal and two external validation cohorts, respectively. Decision curve analysis (DCA) showed that the TLRN was better than any other model. TLRN has potential generalization ability, as shown in the stratification analysis. Conclusions The proposed TLRN based on gastric WSIs may help preoperatively differentiate PGL from Borrmann type IV GC. Borrmann type IV gastric cancer, primary gastric lymphoma, transfer learning, whole slide image, deep learning.
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Affiliation(s)
- Bao Feng
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China.,School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, China
| | - Liebin Huang
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Yu Liu
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, China
| | - Yehang Chen
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, China
| | - Haoyang Zhou
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, China
| | - Tianyou Yu
- School of Automation Science and Engineering, South China University of Technology, Guangzhou, China
| | - Huimin Xue
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Qinxian Chen
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Tao Zhou
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Qionglian Kuang
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
| | - Zhiqi Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
| | - Xiangguang Chen
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
| | - Xiaofeng Chen
- Department of Radiology, Meizhou People's Hospital, Meizhou, China
| | - Zhenpeng Peng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wansheng Long
- Department of Radiology, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, China
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Deng Y, Su W, Zhu J, Ji H, Zhou X, Geng J, Zhu J, Zhang Q. Helicobacter pylori infection disturbs the tumor immune microenvironment and is associated with a discrepant prognosis in gastric de novo diffuse large B-cell lymphoma. J Immunother Cancer 2021; 9:jitc-2021-002947. [PMID: 34645670 PMCID: PMC8515460 DOI: 10.1136/jitc-2021-002947] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastric diffuse large B-cell lymphoma (gDLBCL) related to Helicobacter pylori infection exhibits a wide spectrum of prognosis, and the tumor immune microenvironment (TIME) affects tumor progression. However, there are few studies on the correlation between prognosis and changes of TIME induced by H. pylori infection in de novo gDLBCL. METHODS A retrospective study was performed to determine the prognostic value of TIME related to H. pylori infection in de novo gDLBCL. A total of 252 patients were included and have been treated with standard rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy or other similar regimens in addition to H. pylori eradication (HPE). All patients were stratified by H. pylori infection, HPE efficacy, and preliminary TIME evaluation using conventional criteria. Statistical analyses were conducted. To assess the mechanism, 30 subjects were assessed for H. pylori infection. The components and spatial distributions of TIME were analyzed. RESULTS The median follow-up of the 252 patients was 66.6 months (range 0.7-119.2), and the 5-year overall survival (OS) was 78.0%. A total of 109 H. pylori-positive cases with pathological complete remission and high tumor-infiltrating T lymphocytes (cohort 1) had significantly higher 5-year progression-free survival (88.1% vs 70.5%, p<0.001) and OS (89.2% vs 76.6%, p<0.001) than the other 143 patients (cohort 2). Among 30 patients, 19 were cytotoxin-associated gene A-marked as the cohort 1 subset. Compared with cohort 2, cohort 1 exhibited increased inflammatory factors (tumor necrosis factor-α, interferon γ, etc) and decreased immunosuppressive components (PD-L1, PD-1, IL-10, etc). There was reduced NF-kB activation. Cancer-promoting immune cells (PD-1hiTim-3+ CTL, Tregs, M2-like macrophages, etc) occupied a minor spatial distribution, while the antitumor subtypes increased, corresponding to favorable survival. CONCLUSION H. pylori-evoked inflammatory responses disturb the TIME, causing a differential prognosis in de novo gDLBCL, which can be used to identify patients who could benefit from HPE and immunochemotherapy.
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Affiliation(s)
- Yuwei Deng
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Wenjia Su
- Department of Hematology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Junwen Zhu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Hongfei Ji
- Institute of Cancer Prevention and Treatment, Heilongjiang Academy of Medical Sciences, Harbin Medical University, Harbin, Heilongjiang, People's Republic of China
| | - Xiaoping Zhou
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Jingshu Geng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Jiayu Zhu
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
| | - Qingyuan Zhang
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang, People's Republic of China
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Bai Z, Zhou Y. A systematic review of primary gastric diffuse large B-cell lymphoma: Clinical diagnosis, staging, treatment and prognostic factors. Leuk Res 2021; 111:106716. [PMID: 34627052 DOI: 10.1016/j.leukres.2021.106716] [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: 04/14/2021] [Revised: 08/19/2021] [Accepted: 09/26/2021] [Indexed: 01/05/2023]
Abstract
Primary gastric lymphoma (PGL) is a rare clinical entity accounting for the majority of extra-nodal non-Hodgkin lymphoma (EN-NHL). The most common histological subtype is the primary gastric diffuse large B-cell lymphoma (PG-DLBCL) with a media age of 50-60 years old, mostly in male. Pathogenesis is often related to some bacterial infection such as Helicobacter pylori (H. pylori) infection. However, due to various available staging system, there is still no consensus on the staging of PG-DLBCL. The international prognostic index (IPI) is the most valuable used for the stratification of almost all subtype of NHL and as well as for PG-DLBCL. As for treatment strategies, surgery, chemotherapy, radiation therapy and antibiotic therapy in various combinations have been applied in clinical treatment. There are a few well-known prognostic factors and some of them may constitute prognostic models. Due to the increasing incidence of this neoplasm, it is necessary for clinicians to make deep insight of the diagnosis, staging, treatment and prognostic factors of PG-DLBCL.
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Affiliation(s)
- Zhimin Bai
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Yong Zhou
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Diamantidis MD, Papaioannou M, Hatjiharissi E. Primary gastric non-Hodgkin lymphomas: Recent advances regarding disease pathogenesis and treatment. World J Gastroenterol 2021; 27:5932-5945. [PMID: 34629810 PMCID: PMC8475005 DOI: 10.3748/wjg.v27.i35.5932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/27/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
Primary gastric lymphomas (PGLs) are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly. Their main histological types are diffuse large B-cell lymphoma (DLBCL) or mucosa-associated lymphoma tissue. PGL has been one of the main fields of clinical research of our group in recent years. Although gastric DLBCLs are frequent, sufficient data to guide optimal care are scarce. Until today, a multidisciplinary approach has been applied, including chemotherapy, surgery, radiotherapy or a combination of these treatments. In this minireview article, we provide an overview of the clinical manifestations, diagnosis and staging of these diseases, along with their molecular pathogenesis and the most important related clinical published series. We then discuss the scientific gaps, perils and pitfalls that exist regarding the aforementioned studies, in parallel with the unmet need for future research and comment on the proper methodology for such retrospective studies. Aiming to fill this gap, we retrospectively evaluated the trends in clinical presentation, management and outcome among 165 patients with DLBCL PGL who were seen in our institutions in 1980-2014. The study cohort was divided into two subgroups, comparing the main 2 therapeutic options [cyclophosphamide doxorubicin vincristine prednisone (CHOP) vs rituximab-CHOP (R-CHOP)]. A better outcome with immunochemotherapy (R-CHOP) was observed. In the next 2 mo, we will present the update of our study with the same basic conclusion.
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Affiliation(s)
- Michael D Diamantidis
- Department of Hematology, Thalassemia and Sickle Cell Disease Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | - Maria Papaioannou
- Division of Hematology, First Department of Internal Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Evdoxia Hatjiharissi
- Division of Hematology, First Department of Internal Medicine, AHEPA General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
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Qian Z, Chen L, Wang X, Kan Y, Wang Y, Yu Y, Wang X, Zhao Z, Yang H, Ge P, Ding T, Zhai Q, Zhao H. Increased MALAT1 expression predicts poor prognosis in primary gastrointestinal diffuse large B-cell lymphoma. Clin Exp Med 2021; 22:183-191. [PMID: 34427833 DOI: 10.1007/s10238-021-00748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022]
Abstract
Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) is involved in the pathogenesis and progression of several cancers. However, the potential effect of MALAT1 in primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) has not been elucidated. This study aimed to explore the prognostic value of MALAT1 in patients with PGI-DLBCL. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to determine the expression of MALAT1 in 90 patients with PGI-DLBCL. MALAT1 was remarkably upregulated in PGI-DLBCL tissues compared to paired adjacent non-tumor tissues (P < 0.001), and the area under the receiver operating characteristic (ROC) curve (AUC) was 0.838. MALAT1 expression was further increased in the non-germinal center B-cell-like (non-GCB), advanced stage (stages IIE-IV) and International Prognostic Index (IPI) score (3-5) groups (P = 0.01, P < 0.001 and P < 0.001, respectively). Furthermore, Kaplan-Meier analysis showed that elevated MALAT1 expression correlated with inferior overall survival (OS) and progression-free survival in PGI-DLBCL patients (P < 0.001 and P < 0.001, respectively), and our multivariate analysis results suggested that upregulation of MALAT1 and high IPI score (3-5) were two unfavorable prognostic factors for PGI-DLBCL. In conclusion, our results demonstrate that MALAT1 may serve as a novel prognostic biomarker and an ideal therapeutic target for patients with PGI-DLBCL.
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Affiliation(s)
- Zhengzi Qian
- Key Laboratory of Cancer Prevention and Therapy, Department of Lymphoma, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Leiyuan Chen
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Xinyuan Wang
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Yutian Kan
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Yafei Wang
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Yong Yu
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Xiaofang Wang
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Zhigang Zhao
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Hongliang Yang
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China
| | - Peng Ge
- Key Laboratory of Cancer Prevention and Therapy, Department of Laboratory, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Tingting Ding
- Key Laboratory of Cancer Prevention and Therapy, Department of Pathology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Qiongli Zhai
- Key Laboratory of Cancer Prevention and Therapy, Department of Pathology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, People's Republic of China
| | - Haifeng Zhao
- Key Laboratory of Cancer Prevention and Therapy, Department of Hematology, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, 300060, People's Republic of China.
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Wagner VP, Rodrigues-Fernandes CI, Carvalho MVR, Dos Santos JN, Barra MB, Hunter KD, Aguirre-Urizar JM, van Heerden WFP, Vargas PA, Fonseca FP, Martins MD. Mantle cell lymphoma, malt lymphoma, small lymphocytic lymphoma, and follicular lymphoma of the oral cavity: An update. J Oral Pathol Med 2021; 50:622-630. [PMID: 34101256 DOI: 10.1111/jop.13214] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although uncommon, mature small B-cell lymphomas may arise in the oral/maxillofacial area and oral pathologists must be aware of the key characteristics of these neoplasms to perform an accurate diagnosis. In this manuscript, we attempted to integrate the currently available data on the clinicopathological features of follicular lymphoma (FL), mantle cell lymphoma (MCL), extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT-L), and chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL) affecting these anatomical regions. METHODS An updated descriptive literature review was carried out and a detailed electronic search was done in multiple databases to gather all cases affecting the oral/maxillofacial region and palatine tonsils. RESULTS We observed that MALT-L was the most frequently reported subtype, followed by FL, MCL, and CLL/SLL. The palate was affected in a high proportion of cases and the most usual clinical presentation was an asymptomatic swelling. MALT-L and CLL/SLL neoplastic cells were strongly associated with small salivary glands. FL showed no gender preference, while MCL and CLL/SLL were more prevalent in males and MALT-L in females. Overall, cases were more common in elderly individuals. Patients' treatment and outcome varied, with MCL being the most aggressive neoplasm with a dismal prognosis in comparison to FL and MALT-L. CONCLUSION Despite the poor documentation in many of the cases available, especially regarding the microscopic and molecular features of tumors, this review demonstrated that the oral mature small B-cell lymphomas investigated share similar clinical presentation, but carry different prognostic significance, demanding an accurate diagnosis.
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Affiliation(s)
- Vivian Petersen Wagner
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | | | - Jean Nunes Dos Santos
- Department of Oral Pathology, School of Dentistry, Federal University of Bahia, Salvador, Brazil
| | | | - Keith D Hunter
- Academic Unit of Oral and Maxillofacial Medicine and Pathology, Department of Clinical Dentistry, University of Sheffield, Sheffield, UK.,Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Jose Manuel Aguirre-Urizar
- Unit of Oral Pathology and Medicine, Department of Stomatology II, University of the Basque Country/EHU, Leioa, Spain
| | - Willie F P van Heerden
- Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Biology and Pathology, School of Dentistry, University of Pretoria, Pretoria, South Africa.,Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Manoela Domingues Martins
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Prognostic Impact of Pretreatment 2-[ 18F]-FDG PET/CT Parameters in Primary Gastric DLBCL. ACTA ACUST UNITED AC 2021; 57:medicina57050498. [PMID: 34069203 PMCID: PMC8156603 DOI: 10.3390/medicina57050498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 01/12/2023]
Abstract
Background and Objectives: Primary gastric diffuse large-B cell lymphoma (DLBCL) is an aggressive lymphoma subtype with high 18F-FDG avidity but unclear criteria for 2-[18F]-FDG PET/CT in the evaluation of treatment response and prognostication. Our aim was to investigate whether the pretreatment 2-[18F]-FDG PET/CT variables may predict treatment response (at end of first-line therapy) and prognosis in primary gastric DLBCL. Materials and Methods: we included 57 patients with a diagnosis of primary gastric DLBCL and a baseline 2-[18F]-FDG PET/CT and an end of treatment PET/CT after 6 cycles of R-CHOP chemotherapy. We analyzed PET images qualitatively and semi-quantitatively by deriving the maximum standardized uptake value body weight (SUVbw), the maximum standardized uptake value lean body mass (SUVlbm), the maximum standardized uptake value body surface area (SUVbsa), lesion to liver SUVmax ratio (L-L SUV R), lesion to blood-pool SUVmax ratio (L-BP SUV R), metabolic tumor volume and total lesion glycolysis of gastric lesion (gMTV and gTLG), and total MTV (tMTV) and TLG. Survival curves were plotted according to the Kaplan–Meier analysis. Results: at a median follow up of 80 months, the median PFS and OS were 69 and 80 months. Baseline gMTV, gTLG, tMTV, and TLG were significantly higher in patients with incomplete response (partial response and progression) compared to complete response group. tMTV and TLG were confirmed to be independent prognostic factors both for PFS (p = 0.023 and p = 0.038) and OS (p = 0.038 and p = 0.026); instead, the other metabolic parameters were not related to outcome survival. Conclusions: high tMTV and TLG were significantly correlated with shorter survival (PFS and OS) and may predict incomplete response after therapy.
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Molina-Valencia JL, Delgado-López CA. Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El linfoma puede afectar el tracto gastrointestinal de manera primaria o secundaria, y representa hasta el 2 % de todas las neoplasias malignas del intestino delgado y colon. El tracto gastrointestinal es la ubicación extraganglionar primaria más común en el linfoma no Hodgkin.
Métodos. Se realizó una búsqueda de la literatura en las principales bases de datos académicas, con revisión de textos publicados sobre el tema en los últimos 5 años.
Discusión. La presentación clínica del linfoma con compromiso gastrointestinal es inespecífica y, hasta en la mitad de los pacientes, se puede presentar de manera inicial con complicaciones que requieran manejo quirúrgico. Entre las principales se encuentran la perforación intestinal, el sangrado digestivo y la obstrucción intestinal.
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Alvarez-Lesmes J, Chapman JR, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery EA, Lossos IS, Sussman D, Poveda J. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 2021; 145:1585-1596. [PMID: 33836528 DOI: 10.5858/arpa.2020-0661-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The gastrointestinal (GI) tract is the most common site of extranodal non-Hodgkin lymphoma, accounting for 20% to 40% of all extranodal lymphomas. The majority of these are systemic processes secondarily involving the GI tract. Primary GI lymphomas are less common, accounting for approximately 10% to 15% of all non-Hodgkin lymphoma. Most non-Hodgkin lymphoma involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. OBJECTIVE.— To review the lymphoproliferative neoplasms of B-cell and T-cell lineage involving the luminal GI tract according to the most prevalent subtypes at each anatomic site. DATA SOURCE.— Systematic search of the PubMed database for updated literature on GI lymphomas epidemiology, subtypes, clinical, endoscopic, and genetic findings. Histologic images are derived from our collection of clinical cases. CONCLUSIONS.— The GI tract is the most common site of extranodal lymphoproliferative neoplasms. Recognition of the most frequently encountered GI lymphomas is imperative for patient management and treatment.
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Affiliation(s)
- Jessica Alvarez-Lesmes
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Jennifer R Chapman
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Daniel Cassidy
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Yi Zhou
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Monica Garcia-Buitrago
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Elizabeth A Montgomery
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Izidore S Lossos
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida (Lossos).,Department of Molecular and Cellular Pharmacology (Lossos), University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Sussman
- Division of Digestive Health and Liver Diseases (Sussman), University of Miami Miller School of Medicine, Miami, Florida
| | - Julio Poveda
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
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Ju JY, Stelow EB, Courville EL. Normal gastrointestinal tract inflammatory cells and review of select benign hematolymphoid proliferations. Semin Diagn Pathol 2021; 38:6-13. [PMID: 33726961 DOI: 10.1053/j.semdp.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/10/2021] [Accepted: 02/22/2021] [Indexed: 11/11/2022]
Abstract
The luminal gastrointestinal tract can be a site of robust immune response in which reactive lymphoproliferative processes can sometimes be difficult to distinguish from lymphoma. In this article, we review gastrointestinal tract normal resident inflammatory cells and common nonneoplastic lymphoproliferative responses with emphasis on their differential and links to lymphoma. Topics that are covered include lymphocytic esophagitis, gastric chronic inflammation, mucosa-associated lymphoid tissue, and ulceration, small intestinal lymphoid hyperplasia, celiac disease, microscopic colitis, inflammatory bowel disease, primary immunodeficiency, graft-versus-host disease, and anti-programmed cell death protein-1 effect. We additionally present the less common differential of histiocytic processes within the gastrointestinal tract. The aim of this paper is to serve as a reference for practicing pathologists facing lymphoid, lymphoplasmacytic, or histiocytic processes in the luminal gastrointestinal tract. We hope to help the practicing pathologist distinguish benign from malignant entities and identify features requiring further workup.
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Affiliation(s)
- Jennifer Y Ju
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 NE Pacific St, Box 357470, Seattle, WA, United States
| | - Edward B Stelow
- Department of Pathology, University of Virginia, 1215 Lee Street, Box 800214, Charlottesville, VA, United States
| | - Elizabeth L Courville
- Department of Pathology, University of Virginia, 1215 Lee Street, Box 800214, Charlottesville, VA, United States.
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Couto ME, Oliveira I, Domingues N, Viterbo L, Martins Â, Moreira I, Espírito-Santo A, Chacim S, Moreira C, Pereira D, Henrique R, Mariz J. Gastric Diffuse Large B-Cell Lymphoma: A Single-Center 9-Year Experience. Indian J Hematol Blood Transfus 2021; 37:492-496. [PMID: 33424149 PMCID: PMC7778395 DOI: 10.1007/s12288-020-01391-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/27/2020] [Indexed: 12/11/2022] Open
Abstract
Gastric diffuse large B cell lymphoma (DLBCL) represents the majority of all gastric lymphomas. We report a series of gastric DLBCL diagnosed and treated in a single center, between 2010 and 2018 (included). We retrospectively analyzed the population demographic features, treatment outcomes and survival. One-hundred-and-one patients were studied, 50.5% males and median age of 64 years [23–94]. Lugano staging was I in 16.8%, II1 in 20.8%, II2 in 10.9%, IIE in 13.9% and IV in 34.7% of cases. Twenty percent had Helicobacter pylori infection. R-CHOP-like therapy was used as first line in 96.9% of the patients. A complete response was achieved in 80% after first line therapy. At 3-years of follow-up (FU), 54% were in complete remission. The mean FU time was 73.6 months. Median overall survival and median progression free survival were not reached. We identified seven factors with negative impact in survival: age above 65 years-old (p < 0.01), ECOG 2–3 (p < 0.01), B symptoms (p = 0.001), bulky disease (p = 0.003), IPI 3–4 (p = 0.001), more than 3 treatment lines (p < 0.01), absence of response to first line treatment (p < 0.01). This study demonstrates that gastric DLBCL is a potentially curable disease with R-CHOP-like therapy, entailing long term survival and comparing well with other published series.
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Affiliation(s)
- Maria Eduarda Couto
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Isabel Oliveira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Nelson Domingues
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Luísa Viterbo
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ângelo Martins
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ilídia Moreira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Ana Espírito-Santo
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Sérgio Chacim
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Cláudia Moreira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Dulcineia Pereira
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
| | - Rui Henrique
- Department of Pathology and Cancer Biology and Epigenetics Group - Research Centre (CI-IPOP), Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal.,Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - José Mariz
- Department of Onco-hematology, Portuguese Oncology Institute of Porto (IPO-Porto), Porto, Portugal
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Harbron RW, Pasqual E. Ionising radiation as a risk factor for lymphoma: a review. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2020; 40:R151-R185. [PMID: 33017815 DOI: 10.1088/1361-6498/abbe37] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/05/2020] [Indexed: 06/11/2023]
Abstract
The ability of ionising radiation to induce lymphoma is unclear. Here, we present a narrative review of epidemiological evidence of the risk of lymphoma, including chronic lymphocytic leukaemia (CLL) and multiple myeloma (MM), among various exposed populations including atomic bombing survivors, industrial and medical radiation workers, and individuals exposed for medical purposes. Overall, there is a suggestion of a positive dose-dependent association between radiation exposure and lymphoma. The magnitude of this association is highly imprecise, however, with wide confidence intervals frequently including zero risk. External comparisons tend to show similar incidence and mortality rates to the general population. Currently, there is insufficient information on the impact of age at exposure, high versus low linear energy transfer radiation, external versus internal or acute versus chronic exposures. Associations are stronger for males than females, and stronger for non-Hodgkin lymphoma and MM than for Hodgkin lymphoma, while the risk of radiation-induced CLL may be non-existent. This broad grouping of diverse diseases could potentially obscure stronger associations for certain subtypes, each with a different cell of origin. Additionally, the classification of malignancies as leukaemia or lymphoma may result in similar diseases being analysed separately, while distinct diseases are analysed in the same category. Uncertainty in cell of origin means the appropriate organ for dose response analysis is unclear. Further uncertainties arise from potential confounding or bias due to infectious causes and immunosuppression. The potential interaction between radiation and other risk factors is unknown. Combined, these uncertainties make lymphoma perhaps the most challenging malignancy to study in radiation epidemiology.
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Affiliation(s)
- Richard W Harbron
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Health Protection Research Unit in Chemical and Radiation Threats and Hazards, Newcastle University, United Kingdom
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elisa Pasqual
- Barcelona Institute for Global Health, (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Differentiating gastric cancer and gastric lymphoma using texture analysis (TA) of positron emission tomography (PET). Chin Med J (Engl) 2020; 134:439-447. [PMID: 33230019 PMCID: PMC7909296 DOI: 10.1097/cm9.0000000000001206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background: Texture analysis (TA) can quantify intra-tumor heterogeneity using standard medical images. The present study aimed to assess the application of positron emission tomography (PET) TA in the differential diagnosis of gastric cancer and gastric lymphoma. Methods: The pre-treatment PET images of 79 patients (45 gastric cancer, 34 gastric lymphoma) between January 2013 and February 2018 were retrospectively reviewed. Standard uptake values (SUVs), first-order texture features, and second-order texture features of the grey-level co-occurrence matrix (GLCM) were analyzed. The differences in features among different groups were analyzed by the two-way Mann-Whitney test, and receiver operating characteristic (ROC) analysis was used to estimate the diagnostic efficacy. Results: InertiaGLCM was significantly lower in gastric cancer than that in gastric lymphoma (4975.61 vs. 11,425.30, z = −3.238, P = 0.001), and it was found to be the most discriminating texture feature in differentiating gastric lymphoma and gastric cancer. The area under the curve (AUC) of inertiaGLCM was higher than the AUCs of SUVmax and SUVmean (0.714 vs. 0.649 and 0.666, respectively). SUVmax and SUVmean were significantly lower in low-grade gastric lymphoma than those in high grade gastric lymphoma (3.30 vs. 11.80, 2.40 vs. 7.50, z = −2.792 and −3.007, P = 0.005 and 0.003, respectively). SUVs and first-order grey-level intensity features were not significantly different between low-grade gastric lymphoma and gastric cancer. EntropyGLCM12 was significantly lower in low-grade gastric lymphoma than that in gastric cancer (6.95 vs. 9.14, z = −2.542, P = 0.011) and had an AUC of 0.770 in the ROC analysis of differentiating low-grade gastric lymphoma and gastric cancer. Conclusions: InertiaGLCM and entropyGLCM were the most discriminating features in differentiating gastric lymphoma from gastric cancer and low-grade gastric lymphoma from gastric cancer, respectively. PET TA can improve the differential diagnosis of gastric neoplasms, especially in tumors with similar degrees of fluorodeoxyglucose uptake.
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Ren Y, Liu J, Wang L, Luo Y, Ding X, Shi A, Liu J. Multiple metabolic parameters and visual assessment of 18F-FDG uptake heterogeneity of PET/CT in advanced gastric cancer and primary gastric lymphoma. Abdom Radiol (NY) 2020; 45:3569-3580. [PMID: 32274551 DOI: 10.1007/s00261-020-02503-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Advanced gastric cancer (AGC) and primary gastric lymphoma (PGL) are the two most common malignant tumors of the stomach. Conventional imaging examinations have difficulty distinguishing the two. This study explored the values of multiple parameters and visual assessment of 18F-fluorodeoxyglucose(18F-FDG) uptake heterogeneity of positron emission tomography/computed tomography(PET/CT) for differentiating between AGC and PGL. METHODS This retrospective study included 70 AGC and 26 PGL patients, all of whom had undergone 18F-FDG PET/CT before treatment. We analyzed the differences between AGC and PGL in the distribution of metastatic lesions and multiple metabolic parameters, including the maximum standardized uptake value (SUVmax), SUVmax/maximal thickness(THKmax), metabolic tumor volume and total lesion glycolysis (TLG). In addition, 18F-FDG uptake heterogeneity was visually assessed using a visual scoring method and a method of measuring SUVmax differences (SUVmax-d). RESULTS The most common metastasis of AGC patients were liver, bone, peritoneal and proximal lymph nodes; PGL patients had fewer peritoneal metastases and lymph node metastasis could appeared to be "skip metastasis." The metabolic parameters-SUVmax, SUVmax/THKmax and TLG-were higher in patients who had PGL, especially in diffuse large B-cell lymphoma (DLBCL). In the visual assessment of 18F-FDG uptake heterogeneity, the measurements of SUVmax-d in PGL were significantly higher than in AGC. Receiver operating characteristics curve analysis suggested that SUVmax has the highest comprehensive diagnostic efficiency due to having the highest value of area under the curve and the highest accuracy (77.2%). CONCLUSION 18F-FDG PET/CT had a high diagnostic efficiency for discrimination of AGC and PGL, especially between DLBCL and other pathological subtypes. Visual assessment used to evaluate 18F-FDG uptake heterogeneity could help to distinguish the two types of tumors. In addition, our innovative method of measuring the heterogeneity of 18F-FDG uptake-namely, SUVmax-d-could contribute to identification of the two tumor types and should have its significance clarified by future studies.
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Abstract
Hematologic malignancies include several lymphoproliferative and myeloproliferative disorders, many of which are frequently encountered in current health care settings. These malignancies frequently affect the gastrointestinal (GI) tract, either by secondary extranodal or extramedullary extension to the GI tract, or as a primary process arising in the GI tract. In fact, the GI tract may represent the most common extranodal site of involvement in many of them, such as lymphoma. Furthermore, in the current era of improved cancer treatment and advanced transplant procedures with increased survival, it has been quite common to encounter GI involvement by these malignancies through the disease course. Post-transplant lymphoproliferative disorder following kidney transplantation, for example, very commonly involves the GI tract. Other conditions that can involve the GI tract include multiple myeloma, plasmacytoma, myeloid sarcoma, mastocytosis, and Castleman disease. Imaging diagnosis of these malignancies can be challenging, since they are much less common than primary GI cancers and both share many common imaging features as well. However, certain imaging features, particularly in combination with a matching clinical scenario, play a pivotal role in diagnosing these conditions and directing further evaluation. In this article, we review common and rare hematologic malignancies of the GI tract and discuss their pathophysiologic, clinical, and imaging features.
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Pattern of failure and optimal treatment strategy for primary gastric diffuse large B-cell lymphoma treated with R-CHOP chemotherapy. PLoS One 2020; 15:e0238807. [PMID: 32960887 PMCID: PMC7508390 DOI: 10.1371/journal.pone.0238807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 08/24/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The optimal treatment for primary gastric diffuse large B-cell lymphoma (PG-DLBCL) is still unknown. We evaluated unfavorable prognostic factors and pattern of failure in PG-DLBCL to determine the optimal treatment strategy. METHODS Between April 2001 and November 2018, 120 patients with complete remission following rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy were retrospectively reviewed. According to the Lugano staging system, 80 patients (66.7%) had localized disease and 40 patients (33.3%) had advanced disease. A total of 93 (77.5%) patients had single gastric lesion and 27 (22.5%) patients had multiple gastric lesions. Ninety patients (75%) were treated with R-CHOP chemotherapy alone and 30 patients (25%) received R-CHOP chemotherapy with additional local treatment for gastric lesions. RESULTS The 5-year locoregional failure-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) rates in patients treated with R-CHOP chemotherapy with local treatment were 100%, 100%, and 100%, respectively, whereas the LRFS, PFS, and OS rates in patients treated with R-CHOP chemotherapy alone were 86.3%, 78.2%, and 87.4%, respectively (p = 0.031, p = 0.095, and p = 0.025, respectively). During the follow-up period, 17 patients (14.2%) had disease recurrence. Only 3 of the 17 patients had relapse in a completely new site without relapse in the initial involved site. All, except 2, cases of local recurrence included gastric failure. In the multivariate analysis, performance status and number of gastric lesions were independent prognostic factors for treatment outcome. CONCLUSIONS Patients with complete remission following R-CHOP chemotherapy showed a good prognosis. The main pattern of failure in patients with PG-DLBCL was local recurrence, especially in the stomach. Patients who received local treatment for gastric lesions showed improved gastric control. Therefore, in patients with unfavorable prognostic factors, we recommend R-CHOP chemotherapy with additional local treatment for gastric lesions.
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45
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Choi KH, Lee HH, Jung SE, Park KS, O JH, Jeon YW, Choi BO, Cho SG. Analysis of the response time to involved-field radiotherapy in primary gastrointestinal low-grade B-cell lymphoma. Radiat Oncol 2020; 15:210. [PMID: 32867796 PMCID: PMC7457476 DOI: 10.1186/s13014-020-01649-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Early-stage primary gastrointestinal (GI) low-grade B-cell lymphoma shows good therapeutic response to primary radiotherapy. However, there is no clear guideline for the evaluation of response to radiation therapy currently. The aim of this study was to analyze the relationship between the best response time and the clinical course after radiotherapy. METHODS Patients who underwent radiotherapy for treatment of primary GI low-grade B-cell lymphoma from September 2007 to December 2018 at Seoul St. Mary's Hospital were included. Early responders were defined by best response within 6 months after radiotherapy, and delayed responders after 6 months. Clinical and pathological factors associated with delayed response and survival analyses were performed to investigate the recurrence and survival during follow-up. RESULTS A total of 43 patients were evaluated and the number of gastric mucosa-associated lymphoid tissue and duodenal follicular lymphoma was 36 and 7, respectively. All of 43 patients showed complete remission to radiotherapy and the best response time after radiotherapy was a median of 3 months. There were 8 delayed responders with a median duration of 8.9 months. Early and delayed responders were characterized by a significant difference in depth of invasion beyond the mucosal layer. CONCLUSIONS Delayed responders did not show differences in oncological outcomes compared with early responders. They were allowed to watch and wait for an additional 6 to 12 months without further treatment.
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Affiliation(s)
- Kyu Hye Choi
- Department of Radiation Oncology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Han Hee Lee
- Department of Gastroenterology, Catholic University Lymphoma Group, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Eun Jung
- Department of Radiology, Catholic University Lymphoma Group, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Sin Park
- Department of Pathology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joo-Hyun O
- Department of Nuclear Medicine, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Woo Jeon
- Department of Hematology, Catholic University Lymphoma Group, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Ock Choi
- Department of Radiation Oncology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Seok-Goo Cho
- Department of Hematology, Catholic University Lymphoma Group, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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46
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Chichirau BE, Scheidt T, Diechler S, Neuper T, Horejs-Hoeck J, Huber CG, Posselt G, Wessler S. Dissecting the Helicobacter pylori-regulated transcriptome of B cells. Pathog Dis 2020; 78:5899724. [DOI: 10.1093/femspd/ftaa049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 08/27/2020] [Indexed: 12/21/2022] Open
Abstract
ABSTRACT
Persistent infections with the bacterial group-I carcinogen Helicobacter pylori (H. pylori) have been associated with a broad range of gastric disorders, including gastritis, ulceration, gastric cancer or mucosa-associated lymphoid tissue (MALT) lymphoma. Pathogenesis of H. pylori requires a balance between immune tolerance and defense. Although H. pylori induces inflammatory responses, the immune system cannot eliminate the pathogen. The detailed molecular mechanisms of how H. pylori interferes with cells of the immune system, in particular infiltrated B cells, are not well investigated. Previously, it was shown that the bacterial effector and oncoprotein cytotoxin-associated gene A (CagA) is delivered into B cells followed by its tyrosine-phosphorylation. To investigate the functional consequences in B cells colonized by CagA-positive H. pylori, we analyzed the global transcriptome of H. pylori-infected Mec-1 cells by RNA sequencing. We found 889 differentially expressed genes (DEGs) and validated JUN, FOSL2, HSPA1B, SRC, CXCR3, TLR-4, TNF-α, CXCL8, CCL2, CCL4, MHC class I and MHC class II molecules by qPCR, western blot, flow cytometry and ELISA assays. The H. pylori-specific mRNA expression signature reveals a downregulation of inflammation- and migration-associated genes, whereas central signal transduction regulators of cell survival and death are upregulated.
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Affiliation(s)
- Bianca E Chichirau
- Department of Biosciences, Division of Microbiology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Tamara Scheidt
- Department of Biosciences, Bioanalytical Research Labs, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Sebastian Diechler
- Department of Biosciences, Division of Microbiology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Theresa Neuper
- Department of Biosciences, Division of Molecular Immunology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Jutta Horejs-Hoeck
- Department of Biosciences, Division of Molecular Immunology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Christian G Huber
- Department of Biosciences, Bioanalytical Research Labs, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Gernot Posselt
- Department of Biosciences, Division of Microbiology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
| | - Silja Wessler
- Department of Biosciences, Division of Microbiology, Paris-Lodron University of Salzburg, 5020 Salzburg, Austria
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47
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Lu S, Zhou G, Chen M, Liu W, Zhao S. Monomorphic Epitheliotropic Intestinal T-cell Lymphoma of the Stomach: Two Case Reports and a Literature Review. Int J Surg Pathol 2020; 29:410-419. [PMID: 32856508 DOI: 10.1177/1066896920953906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We describe the clinicopathologic and molecular features of 2 cases of gastric monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), which were first diagnosed from gastric biopsies, one was primary whereas the other was gastric involvement by MEITL. Both cases were older men with stomach ulcers. Case 1 was admitted for a hemorrhage in the upper digestive tract and case 2 for edema. Histology of both cases showed infiltrated monomorphic and medium-sized lymphocytes with lymphoid epithelial phenomenon. An inflammatory background and vascular hyperplasia were also observed likely due to the ulceration. Neoplastic cells expressed CD2, CD3, CD7, CD8, CD56, TIA-1, and MYC, not CD5, CD4, Granzyme B, CD20, CD30, TdT, or EBER. Both lymphomas showed TCRG gene rearrangement and c-MYC gains. Moreover, we first affirmed polysomy of chromosome 8 in case 2. For correct diagnosis of this rare tumor at the rare location, it is important that pathologists raise the possibility and exclude other differential diagnoses.
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Affiliation(s)
- Susu Lu
- West China Hospital, 34753Sichuan University, Chengdu, China
| | - Gang Zhou
- 462489Dachuan District People's Hospital, Dazhou, China
| | - Min Chen
- West China Hospital, 34753Sichuan University, Chengdu, China
| | - Weiping Liu
- West China Hospital, 34753Sichuan University, Chengdu, China
| | - Sha Zhao
- West China Hospital, 34753Sichuan University, Chengdu, China
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48
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Clinicopathological Characteristics and Incidence of Gastric Cancer in Eastern India: A Retrospective Study. J Gastrointest Cancer 2020; 52:863-871. [PMID: 32809138 DOI: 10.1007/s12029-020-00478-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To study the association of gastric cancer with various clinicopathological traits in eastern India which can be used as an important factor for further analysis, understanding of the diseases and amelioration of patients. METHODS The retrospective study includes the patients who underwent subtotal or total gastrectomy from surgical oncology department of Chittaranjan National Cancer Institute (hospital) of West Bengal, India between 2014 and 2018. The study includes 751 gastric cancer patients from Chittaranjan National Cancer Institute. We used electronic hospital records to collect data on various clinical parameters and other information. We used Microsoft Office Excel 2007 spreadsheets for the statistical analyses. RESULTS Incidence of gastric cancer is associated with mid age (40-59 years) group male patients and lymph node metastasis. Frequency of gastric cancer is highest in the antrum (42.21%). Of the mid age group gastric cancer patients, 35.02% were having much high risk of developing diffused type of adenocarcinoma (P < 0.00001). Tobacco intake in form of smoking was found as an important risk factor in gastric cancer development with risk ratio and odds ratio of 1.18 and 3.14 respectively. CONCLUSION Collectively, the results of the present study confirm that incidence of diffused type of gastric cancer is increasing as an alarming rate in mid age group male patients and tobacco intake in the form of smoking as an independent risk factor for this type of cancer in eastern India. This result can be used to manage gastric carcinoma in future prospective clinical studies and in patient's improvement.
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Chen L, Kan Y, Wang X, Ge P, Ding T, Zhai Q, Wang Y, Yu Y, Wang X, Zhao Z, Yang H, Liu X, Li L, Qiu L, Zhang H, Qian Z, Zhao H. Overexpression of microRNA-130a predicts adverse prognosis of primary gastrointestinal diffuse large B-cell lymphoma. Oncol Lett 2020; 20:93. [PMID: 32831912 PMCID: PMC7439117 DOI: 10.3892/ol.2020.11954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/22/2020] [Indexed: 12/15/2022] Open
Abstract
Primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) is a highly heterogeneous type of non-Hodgkin lymphoma. A number of studies have demonstrated that microRNA-130a (miR-130a) serves a role in the tumorigenesis and prognosis of numerous human tumors. However, to the best of our knowledge, the prognostic significance of miR-130a in PGI-DLBCL remains unknown. The present study explored the association between miR-130a and the clinical outcomes of PGI-DLBCL. Relative miR-130a expression was assessed by reverse transcription-quantitative PCR. Immunohistochemistry was used to detect expression levels of BCL-2, c-MYC, neprilysin, B-cell lymphoma 6 protein, PWWP domain-containing DNA repair factor 3A and proliferation marker protein Ki-67. A receiver operating characteristic curve was constructed to analyze the specificity and sensitivity of microRNA levels in the diagnosis of PGI-DLBCL. Survival curves were constructed using the Kaplan-Meier method. In the present study, miR-130a expression was notably higher in patients with PGI-DLBCL compared with in the controls (P<0.0001). miR-130a overexpression was closely associated with a high International Prognostic Index score (3–5) and drug resistance (P=0.017 and P=0.044, respectively). No significant difference in other clinical features was observed. Patients with increased expression levels of miR-130a had lower overall survival [hazard ratio (HR), 2.998; 95% CI, 1.347-6.673; P=0.007] and progression-free survival (HR, 3.325; 95% CI, 1.488-7.429; P=0.003) compared with patients who had lower expression levels of miR-130a. Furthermore, multivariate Cox regression analysis suggested that miR-130a was a negative prognostic parameter in PGI-DLBCL. Therefore, upregulation of miR-130a could become a potential prognostic marker for PGI-DLBCL. Additionally, further study of these results may have important guiding significance for the prognosis of patients with PGI-DLBCL in the clinical setting.
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Affiliation(s)
- Leiyuan Chen
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Yutian Kan
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Xinyuan Wang
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Peng Ge
- Department of Laboratory, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Tingting Ding
- Department of Pathology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Qiongli Zhai
- Department of Pathology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Yafei Wang
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Yong Yu
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Xiaofang Wang
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Zhigang Zhao
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Hongliang Yang
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Xianming Liu
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Lanfang Li
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Lihua Qiu
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Huilai Zhang
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Zhengzi Qian
- Department of Lymphoma, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
| | - Haifeng Zhao
- Department of Hematology and Oncology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin Clinical Research Center for Cancer, Tianjin 300060, P.R. China
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50
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Nezu N, Usui Y, Asakage M, Shimizu H, Tsubota K, Narimatsu A, Umazume K, Yamakawa N, Ohno SI, Takanashi M, Kuroda M, Goto H. Distinctive Tissue and Serum MicroRNA Profile of IgG4-Related Ophthalmic Disease and MALT Lymphoma. J Clin Med 2020; 9:jcm9082530. [PMID: 32764512 PMCID: PMC7464164 DOI: 10.3390/jcm9082530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 12/24/2022] Open
Abstract
The molecular pathogenesis of orbital lymphoproliferative disorders, such as immunoglobulin G4-related ophthalmic disease (IgG4-ROD) and orbital mucosa-associated lymphoid tissue (MALT) lymphoma, remains essentially unknown. Differentiation between the two disorders, which is important since the work-up and treatment can vary greatly, is often challenging due to the lack of specific biomarkers. Although miRNAs play an important role in the regulation of carcinogenesis and inflammation, the relationship between miRNA and orbital lymphoproliferative diseases remains unknown. We performed a comprehensive analysis of 2565 miRNAs from biopsy and serum specimens of 17 cases with IgG4-ROD, where 21 cases with orbital MALT lymphoma were performed. We identified specific miRNA signatures and their miRNA target pathways, as well as the network analysis for IgG4-ROD and orbital MALT lymphoma. Machine-learning analysis identified miR-202-3p and miR-7112-3p as the best discriminators of IgG4-ROD and orbital MALT lymphoma, respectively. Enrichment analyses of biological pathways showed that the longevity-regulating pathway in IgG4-ROD and the mitogen-activated protein kinase (MAPK) signaling pathway in orbital MALT lymphoma was most enriched by target genes of downregulated miRNAs. This is the first evidence of miRNA profiles of biopsy and serum specimens of patients with IgG4-ROD and orbital MALT lymphoma. These data will be useful for developing diagnostic and therapeutic interventions, as well as elucidating the pathogenesis of these disorders.
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Affiliation(s)
- Naoya Nezu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Yoshihiko Usui
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
- Correspondence: ; Tel.: +81-3-3342-6111
| | - Masaki Asakage
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Hiroyuki Shimizu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Kinya Tsubota
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Akitomo Narimatsu
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Kazuhiko Umazume
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Naoyuki Yamakawa
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
| | - Shin-ichiro Ohno
- Department of Molecular Pathology, Tokyo Medical University, Tokyo 160-8402, Japan; (S.-i.O.); (M.T.); (M.K.)
| | - Masakatsu Takanashi
- Department of Molecular Pathology, Tokyo Medical University, Tokyo 160-8402, Japan; (S.-i.O.); (M.T.); (M.K.)
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, Tokyo 160-8402, Japan; (S.-i.O.); (M.T.); (M.K.)
| | - Hiroshi Goto
- Department of Ophthalmology, Tokyo Medical University, Tokyo 160-0023, Japan; (N.N.); (M.A.); (H.S.); (K.T.); (A.N.); (K.U.); (N.Y.); (H.G.)
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