Extranodal nasal-type natural killer/T-cell lymphoma with penile involvement: a case report and review of the literature

Advanced penile lymphoma: Case report and review of the literature

Primary penile lymphomas are extremely rare. They are aggressive neoplasms that can present as double-or triple-hit lymphomas, and because the associate with a high risk of central nervous system dissemination, treatment consists of high-dose chemotherapy regimens plus intrathecal prophylaxis. Pathology can be confused with squamous cell carcinoma of the penis, leading to inappropriate treatments and unnecessary amputations. We report the case of a patient diagnosed with clinical Stage IV penile non-Hodgkin lymphoma that was treated with a complete and durable response. In addition, we review the available literature on penile lymphoma.

Types of T-cell lymphoma-a cytogenetic perspective

T cell lymphoma, a type of non-Hodgkin lymphomas is a rare form of malignancy with poor outcomes. TCLS are a heterogeneous group of lymphoid malignancies that occur in nodal and extranodal sites. There are two main types of TCLs namely T-lymphoblastic lymphoma/leukemia and Peripheral T-cell lymphomas classified based on clinical manifestations and cytogenetic mutations. The use of advance technology like karyotyping, fluorescent in situ hybridization (FISH), comparative genomic hybridization (CGH) has allowed us to study TCLs in detail and to observe a different biochemical change that occurs in different TCLs allowing us to classify and treat them differently. This review focuses on the different mutations occurring in different TCLs and how they help us distinguish one type from another.

Penile Ulcer as the Unusual Initial Presentation of Nasal NK/T Cell Lymphoma

Extranodal natural killer (NK)/T cell lymphoma is a highly aggressive non-Hodgkin lymphoma that predominantly affects the upper aerodigestive tract. The nasal type accounts for ∼80% of cases of NK/T cell lymphomas. In advanced stages, the disease can disseminate to various sites such as skin, testis, eyes, gastrointestinal tract, and soft tissue. NK/T cell lymphoma presenting as lesion in penis is extremely rare. While reviewing the published literature, we found only three reported cases of NK/T cell lymphoma involving the penis. Among them, none was primary NK/T cell lymphoma of penis. We report a 60-year-old NK/T cell lymphoma patient who presented with destructive penile ulcer as the initial presenting symptom, who subsequently was found to have a nasal mass also with features of NK/T cell lymphoma. He underwent partial penectomy elsewhere and chemotherapy with steroid, methotrexate, ifosfamide, L-asparaginase, and etoposide protocol was given.

Combination of Gemcitabine and Thymosin alpha 1 exhibit a better anti-tumor effect on nasal natural killer/T-cell lymphoma

BACKGROUND

Nasal natural killer/T-cell lymphoma (NNKTL) is an aggressive and poor prognostic malignant tumor along with high-level infection of Epstein-Barr virus (EBV). Gemcitabine (Gem) and Thymosin alpha 1 (Tα1) exert an anti-tumor effect in various cancers. However, the effect of the combination of Gem and Tα1 in NNKTL remains unknown.

METHODS

SNK6 cells were treated with Gem, Tα1 and Gem plus Tα1 for 48 h. The expression levels of EBV and inflammatory factors were measured by qRT-PCR assay. The effect of Gem and Tα1 on cell viability, proliferation, apoptosis, autophagy was detected by CCK-8, colony formation, flow cytometry, autophagic flux measurement, respectively. Western blot was used to evaluate the expression of proteins related to epithelial-mesenchymal transition (EMT), apoptosis and autophagy. In vivo xenograft models were used to further verify the roles of Gem and Tα1. Tumors were removed for weight measurement, H&E and IHC staining.

RESULTS

We identified that the half maximal inhibitory concentration (IC50) of Gem and Tα1 was 116.5 μmol/ml and 1.334 μmol/ml. Alone or combined administration of Gem and Tα1 dramatically attenuated the EBV viral load and promoted inflammatory factors expression in SNK6 cells, among which the combination of Gem and Tα1 treatment showed the most significant effect. Besides, combination treatment with Gem and Tα1 markedly inhibited cell growth and EMT progress, and enhanced apoptosis and autophagy. Similarly, Gem combined with Tα1 suppressed tumor growth, promoted apoptosis and autophagy in vivo. Additionally, combination treatment with Gem and Tα1 inhibited PI3K/AKT/mTOR pathway.

CONCLUSION

In summary, combination administration of Gem and Tα1 suppressed the progression of NNKTL in vivo and in vitro. Our study provided an effective therapeutic strategy potentially for the clinical treatment of NNKTL.

Extranodal NK/T-cell lymphoma, nasal type with extensive cardiopulmonary involvement

Extranodal NK/T-cell lymphoma, nasal type (ENKTL-NT) is a rare type of Non-Hodgkin’s lymphoma, which usually presents with extranodal involvement and affects the nasal/upper aerodigestive tract in the classical presentation. Herein, we report the case of a 31-year-old, previously healthy, male patient diagnosed with ENKTL-NT with the involvement of the lung parenchyma and heart. Unfortunately, due to the rapid disease progression, the diagnosis was performed only at the autopsy. The authors highlight the rare clinical presentation of this type of lymphoma, as well as the challenging anatomopathological diagnosis in necrotic samples.

Secondary NK/T cell lymphoma after radiotherapy for non-HPV-related squamous cell carcinoma of the penis: an early warning event and literature review

Squamous cell carcinoma is the most common malignant tumor of the penis. The new World Health Organization (WHO) classifies it into two types: non-HPV-related and HPV-related. There is a certain proportion of recurrence and metastasis after the first operation on the tumor. Radiotherapy is one of the effective methods to improve prognosis, but there is a risk of secondary primary malignant tumor. Primary NK/T cell lymphoma of the penis is rare, and secondary primary NK/T cell lymphoma of penile stump after radiotherapy for penile cancer has not been reported. Here we report a case of a 75-year-old man who was diagnosed with primary non-HPV-related squamous cell carcinoma of the penis five years after the operation of gastric adenocarcinoma. One year after the first penile operation, penile cancer recurred with multiple metastases in the left inguinal lymph nodes, and radiotherapy was performed after re-operation. Secondary primary penile NK/T cell lymphoma was induced 16 months after radiotherapy. Secondary lymphoma after radiotherapy for penile cancer is an accidental event, and the efficacy and risk of postoperative radiotherapy need to be further evaluated.