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Paquin AR, Oyogoa E, McMurry HS, Kartika T, West M, Shatzel JJ. The diagnosis and management of suspected lymphoma in general practice. Eur J Haematol 2023; 110:3-13. [PMID: 36093749 PMCID: PMC10042228 DOI: 10.1111/ejh.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
With rapid advancements in diagnosis and treatment of malignancies, the gap between generalists and subspecialists continues to widen, particularly in cancers like lymphoma where the spectrum of disease varies from indolent to rapidly progressive. Prior to establishing with a hematologist/oncologist, patients must be accurately and comprehensively diagnosed and managed for lymphoma in the generalist setting. In the following manuscript, we review the common clinical presentations in which should raise concern for lymphoma. We summarize the literature regarding the role of laboratory studies including complete blood count and peripheral blood flow cytometry, the recommendations for lymph node sampling, the role and selection of imaging modalities, and ideal patient monitoring for high-risk clinical syndromes that may be encountered in lymphoma.
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Affiliation(s)
- Ashley R. Paquin
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Emmanuella Oyogoa
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Hannah Stowe McMurry
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Kartika
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Malinda West
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J. Shatzel
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
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Li C, Wang W, Xu L, Zheng D, Zhang M, Zhang Q, Wu X, Yao Y, Huang W, Li X, Ying P, Wang X, Shang L, Feng Y. Multiple osteolytic primary peripheral T-cell bone lymphoma: the first case report. J Int Med Res 2021; 49:3000605211052229. [PMID: 34657512 PMCID: PMC8524712 DOI: 10.1177/03000605211052229] [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] [Indexed: 11/17/2022] Open
Abstract
Peripheral T-cell lymphoma accounts for about 10% of all cases of non-Hodgkin’s lymphoma. However, less than 5% of patients with non-Hodgkin’s lymphoma present with hypercalcaemia as the initial symptom, and less than 1% present with primary bone lesions. We herein describe a 76-year-old Chinese man who was diagnosed with primary bone adult T-cell lymphoma with extensive osteolysis, including bone loss in the radius, as the initial manifestation. He had developed severe generalised bone pain and an inability to raise his arms. X-ray examination revealed osteolytic destruction of the forearm with loss of the radial diaphysis. The patient was diagnosed with peripheral T-cell lymphoma based on his immunohistochemical results. He began treatment with the CHOPE chemotherapy regimen, which resulted in significant improvement of his bone pain.
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Affiliation(s)
- Chen Li
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Weiguo Wang
- Department of Clinical Laboratory, Fuyang People's Hospital, Fuyang City, Anhui Province, China
| | - Lingyun Xu
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Dingyun Zheng
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Miao Zhang
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Qin Zhang
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Xiaoqian Wu
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Yue Yao
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Wenyue Huang
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Xue Li
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Peipei Ying
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Xiuxiu Wang
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Liu Shang
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
| | - Yuhu Feng
- Department of Hematology, Fuyang People's Hospital (The Affiliated Fuyang People's Hospital of Anhui Medical University), Fuyang City, Anhui Province, China
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Barcellini W, Giannotta JA, Fattizzo B. Autoimmune Complications in Hematologic Neoplasms. Cancers (Basel) 2021; 13:cancers13071532. [PMID: 33810369 PMCID: PMC8037071 DOI: 10.3390/cancers13071532] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
Autoimmune cytopenias (AICy) and autoimmune diseases (AID) can complicate both lymphoid and myeloid neoplasms, and often represent a diagnostic and therapeutic challenge. While autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP) are well known, other rarer AICy (autoimmune neutropenia, aplastic anemia, and pure red cell aplasia) and AID (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, thyroiditis, and others) are poorly recognized. This review analyses the available literature of the last 30 years regarding the occurrence of AICy/AID in different onco-hematologic conditions. The latter include chronic lymphocytic leukemia (CLL), lymphomas, multiple myeloma, myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMML), myeloproliferative neoplasms, and acute leukemias. On the whole, AICy are observed in up to 10% of CLL and with higher frequencies in certain subtypes of non-Hodgkin lymphoma, whilst they occur in less than 1% of low-risk MDS and CMML. AID are described in up to 30% of myeloid and lymphoid patients, including immune-mediated hemostatic disorders (acquired hemophilia, thrombotic thrombocytopenic purpura, and anti-phospholipid syndrome) that may be severe and fatal. Additionally, AICy/AID are found in about 10% of patients receiving hematopoietic stem cell transplant or treatment with new checkpoint inhibitors. Besides the diagnostic difficulties, these AICy/AID may complicate the clinical management of already immunocompromised patients.
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Affiliation(s)
- Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (J.A.G.); (B.F.)
- Correspondence: ; Tel.: +39-025-503-3256
| | - Juri Alessandro Giannotta
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (J.A.G.); (B.F.)
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (J.A.G.); (B.F.)
- Department of Oncology and Oncohematology, University of Milan, 20122 Milan, Italy
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