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Fujimi A, Nagamachi Y, Yamauchi N, Onoyama N, Hayasaka N, Matsuno T, Koike K, Goto Y, Ihara K, Kato J, Nishisato T, Kawase H, Yano T, Kanaseki T, Sugita S, Kobune M. High-grade B-cell lymphoma, not otherwise specified, presenting as primary peritoneal lymphomatosis and successfully treated with dose-adjusted EPOCH-R. J Clin Exp Hematop 2024; 64:37-44. [PMID: 38281744 PMCID: PMC11079986 DOI: 10.3960/jslrt.23044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 01/30/2024] Open
Abstract
Peritoneal lymphomatosis (PL) is a rare lymphoma-associated condition defined as the dissemination of lymphoma cells in the peritoneum. An 82-year-old man presented with abdominal pain, heartburn, and high fever. Radiological findings, including positron emission tomography-computed tomography (PET-CT), and gastrointestinal fiberscopy, showed diffuse thickening of the peritoneum, omentum, and mesentery; however, no lymphadenopathy, hepatosplenomegaly, or gastrointestinal lesions were observed. Under suspicion of peritonitis carcinomatosa of unknown origin, exploratory laparoscopy was performed that revealed multiple white nodules and masses on the surfaces of the peritoneum, mesentery, and intestinal serosa. The histopathological and cytogenetic findings of the peritoneum revealed high-grade B-cell lymphoma, not otherwise specified, and a gain of MYC by fluorescence in-situ hybridization. The patient was treated with two cycles of R-CHOP therapy, followed by six cycles of dose-adjusted EPOCH-R therapy, and a complete metabolic response was confirmed by PET-CT. Since there are no specific radiological findings to confirm the diagnosis of PL, a histopathological diagnosis is usually required. Most PL exhibit an aggressive lymphoma phenotype and can be cured by appropriate chemotherapy. Therefore, early diagnosis and treatment are desirable.
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Feng B, Ma Q, Wang H, Zhao T, Tian Y, Dong Y, Zhao Q. A case of peritoneal Burkitt's lymphoma mimic of peritoneal tuberculosis. Respir Med Case Rep 2024; 47:101979. [PMID: 38292731 PMCID: PMC10825563 DOI: 10.1016/j.rmcr.2024.101979] [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: 08/24/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Peritoneal lymphomatosis is a rare presentation of lymphoma that can mimic peritoneal tuberculosis. The computed tomography findings in both conditions include omental caking, thickening, and nodularity. We report the case of a 41-year-old man who presented with intermittent abdominal pain and distension. Abdominal CT initially suggested peritoneal tuberculosis due to the thickening of the peritoneum and greater omentum with multiple nodules. However, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) images showed diffuse metabolic activity increase in the thickened peritoneum, omentum, and mesentery. An omental biopsy was performed under ultrasonography guidance, and histopathological examination revealed a high-grade Burkitt lymphoma. It is crucial to distinguish peritoneal lymphomatosis from tuberculosis, as the prognosis and management of the two conditions are vastly different.
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Affiliation(s)
- Bei Feng
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Qianfeng Ma
- Department of Ultrasound, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Huiwei Wang
- Department of Dermatology, The University of Hong Kong-Shenzhen Hospital, Haiyuan 1st Road, Futian District, Shenzhen, Guangdong, China
| | - Tingting Zhao
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Yaxin Tian
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Yiyuan Dong
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
| | - Qian Zhao
- Department of Nuclear Medicine, General Hospital of Ningxia Medical University, Shengli Street, Yinchuan, 750004, Ningxia, China
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3
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Miguez González J, Calaf Forn F, Pelegrí Martínez L, Lozano Arranz P, Oliveira Caiafa R, Català Forteza J, Palacio Arteaga LM, Losa Gaspà F, Ramos Bernadó I, Barrios Sánchez P, Ayuso Colella JR. Primary and secondary tumors of the peritoneum: key imaging features and differential diagnosis with surgical and pathological correlation. Insights Imaging 2023; 14:115. [PMID: 37395913 DOI: 10.1186/s13244-023-01417-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/30/2023] [Indexed: 07/04/2023] Open
Abstract
Peritoneal malignancies represent a diagnostic challenge for abdominal radiologists, oncologists, surgeons and pathologists in multidisciplinary teams, who must address their differential diagnosis, staging and treatment. In this article, we explain the pathophysiology of these processes and lay out the role of different imaging techniques in their evaluation. Then, we review the clinical and epidemiological aspects, the main radiological features and the therapeutic approaches for each primary and secondary peritoneal neoplasm, with surgical and pathological correlation. We further describe other rare peritoneal tumors of uncertain origin and a variety of entities that may mimic peritoneal malignancy. Finally, we summarize the key imaging findings of each peritoneal neoplasm to facilitate an accurate differential diagnosis that may impact patient management.Clinical relevance statementImaging plays an essential role in the evaluation of peritoneal malignancies, assessing their extension, detecting unfavorable sites of involvement and facilitating an accurate differential diagnosis, helping to choose the best therapeutic approach.
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Affiliation(s)
- Javier Miguez González
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain.
| | - Francesc Calaf Forn
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Laura Pelegrí Martínez
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Pilar Lozano Arranz
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Rafael Oliveira Caiafa
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Jordi Català Forteza
- Department of Radiology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Lina Maria Palacio Arteaga
- Department of Pathology, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Ferrán Losa Gaspà
- Department of Medical Oncology, Institut Català d'Oncologia Hospitalet, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Isabel Ramos Bernadó
- Peritoneal Surface Malignancies Unit, Department of Surgery, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
| | - Pedro Barrios Sánchez
- Former Director of the Peritoneal Carcinomatosis Program of Catalonia, Former Head of the Peritoneal Surface Malignancies Unit, Department of Surgery, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral, Sant Joan Despí, Barcelona, Spain
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Kim HB, Hong R, Na YS, Choi WY, Park SG, Lee HJ. Isolated peritoneal lymphomatosis defined as post-transplant lymphoproliferative disorder after a liver transplant: A case report. World J Clin Cases 2019; 7:4299-4306. [PMID: 31911911 PMCID: PMC6940333 DOI: 10.12998/wjcc.v7.i24.4299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 10/31/2019] [Accepted: 11/15/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a fatal complication of solid organ transplantation or allogenic hematopoietic stem cell transplantation that is associated with immunosuppressive therapy. Potential manifestations are diverse, ranging from reactive lymphoid hyperplasia to high-grade lymphoma. PTLD is usually of B-cell origin and associated with Epstein-Barr virus (EBV) infection. Herein, we describe a case of PTLD involving the peritoneal omentum. There has been only case of PTLD as a diffuse large B-cell lymphoma (DLBCL) in the peritoneum.
CASE SUMMARY The patient was a 62-year-old man who had been receiving immunosuppressive therapy with tacrolimus since undergoing a liver transplant 15 years prior. He reported that he had experienced abdominal discomfort and anorexia 1 month prior to the current admission. Abdominal pelvic computed tomography (CT) revealed peritoneal and omental mass-like lesions without bowel obstruction. Ultrasonography-guided biopsy was performed, and he was histologically diagnosed with EBV-negative DLBCL. Positron emission tomography (PET)-CT depicted peritoneum and omentum involvement only, without any lymphadenopathy or organ masses, including in the gastrointestinal tract. Six cycles of chemotherapy with a “R-CHOP“ regimen (rituximab-cyclophosphamide, doxorubicin, vincristine, prednisolone) were administered, and PET-CT performed thereafter indicated complete remission.
CONCLUSION This is the first report of isolated peritoneal lymphomatosis defined as PTLD in a liver transplant recipient.
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Affiliation(s)
- Hong Beum Kim
- Department of Premedical Course, Chosun University School of Medicine, Gwangju 501-717, South Korea
| | - Ran Hong
- Department of Pathology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, South Korea
| | - Yung Sub Na
- Department of Internal Medicine, Pulomonology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Woo Young Choi
- Department of Plastic and Reconstructive Surgery, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Sang Gon Park
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
| | - Hee Jeong Lee
- Department of Internal Medicine, Hemato-oncology, Chosun University Hospital, Gwangju 501-717, South Korea
- MD, PhD, Department of HematoOncology, Chosun University Hospital, 365 Pilmun-daero, Dong-gu, Gwangju 501-717, South Korea
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5
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Zaarour M, Busack C, Munker R. Obstructing Duodenal Diffuse Large B-cell Lymphoma with Peritoneal Lymphomatosis with Exceptional Response to R-CHOP. Cureus 2019; 11:e4621. [PMID: 31312548 PMCID: PMC6615582 DOI: 10.7759/cureus.4621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Primary small bowel tumors are uncommon and usually carry a poor prognosis. Adenocarcinoma is the predominant histological type while lymphoma is far less common. Small bowel diffuse large B-cell lymphoma (DLBCL) can mimic adenocarcinoma; thus, the distinction can be challenging before tissue examination is performed. Bowel obstruction, as well as peritoneal involvement, are often seen in gastrointestinal (GI) adenocarcinoma cases; however, these features are extremely uncommon with GI lymphomas. Herein, the authors report an unusual case of an obstructing duodenal mass with peritoneal involvement, which was highly suspicious for an advanced duodenal adenocarcinoma. Surprisingly, sampling of the tumor revealed a diffuse large B-cell lymphoma.
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Affiliation(s)
- Mazen Zaarour
- Hematology and Oncology, Tulane University School of Medicine, New Orleans, USA
| | - Christopher Busack
- Internal Medicine, Tulane University School of Medicine, New Orleans, USA
| | - Reinhold Munker
- Hematology and Oncology, Tulane University School of Medicine, New Orleans, USA
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Abstract
RATIONALE Lymphoma with an initial manifestation of ascites and peritoneal invasion is rare. PATIENT CONCERNS A 65-year-old woman presented to the emergency department with a 3-week history of abdominal distention, anorexia, and night sweating, and a 2-week history of melena. She was a silent hepatitis B virus carrier. Abdominal ultrasound showed massive ascites without cirrhosis. Abdominal computed tomography revealed ascites, infiltrative peritoneal lesions with omental cake appearance, and lymphadenopathies. DIAGNOSIS We performed paracentesis and the ascites cytology was obtained. The patient also underwent esophagogastroduodenoscopy, which showed ulcerative tumors in the stomach. Both ascites cytology and pathology of the gastric tumors confirmed the diagnosis of B-cell lymphoma. INTERVENTIONS This patient received 7 cycles of chemotherapy. OUTCOMES Follow-up imaging studies revealed partial remission of lymphoma, but an enlargement of residual tumors in omentum and mesentery, which resulted in intractable ascites and rapid deterioration of performance status. Despite a change of regimen of chemotherapy, this patient expired 10 months after diagnosis. LESSONS Lymphoma should be one of the differential diagnoses in patients with intractable ascites not attributable to other comorbidities.
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MESH Headings
- Aged
- Antineoplastic Agents/therapeutic use
- Ascites/etiology
- Diagnosis, Differential
- Endoscopy, Digestive System/methods
- Fatal Outcome
- Female
- Humans
- Hypertension, Portal/complications
- Hypertension, Portal/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Paracentesis
- Peritoneal Neoplasms/diagnosis
- Peritoneal Neoplasms/secondary
- Peritoneum/pathology
- Positron-Emission Tomography
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
| | - Jyh-Seng Wang
- Department of Pathology and Lab Medicine, Kaohsiung Veterans General Hospital
| | - Wen-Chi Yang
- Division of Hematology and Medical Oncology, Department of Internal Medicine, E-Da Hospital
- I-Shou University, Kaohsiung, Taiwan
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7
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Computed tomography imaging of ovarian peritoneal carcinomatosis: a pictorial review. Pol J Radiol 2018; 83:e500-e509. [PMID: 30655930 PMCID: PMC6334186 DOI: 10.5114/pjr.2018.80247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/24/2018] [Indexed: 01/29/2023] Open
Abstract
Gynaecological malignancies are the most common malignancies in women and also an important public health issue. In developing countries, there is a paucity of screening facilities and cancer awareness, so patients present at an advanced stage of disease, which severely limits the prognosis and clinical outcome. Among the gynaecological malignancies, ovarian malignancy has the second highest incidence in women according to the incidences. Ovarian malignancy is usually diagnosed at the advanced stages, and to improve the patient’s survival, debulking surgery is very important. Advanced-stage disease is treated with either debulking surgery followed by adjuvant chemotherapy or initial neoadjuvant chemotherapy followed by debulking surgery. Imaging is very important in patient selection, in determining who will benefit from neoadjuvant chemotherapy just before debulking surgery. This article highlights the role of computed tomography (CT) in the detection of patterns of spread of ovarian malignancy, important for staging and management.
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8
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Fei N, Shah N. Adult Sporadic Burkitt's Lymphoma Presenting with Rapid Development of Peritoneal Lymphomatosis. Case Rep Oncol Med 2017; 2017:4789706. [PMID: 29130007 PMCID: PMC5654332 DOI: 10.1155/2017/4789706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/29/2017] [Indexed: 01/20/2023] Open
Abstract
Sporadic Burkitt's Lymphoma (BL) is a highly aggressive form of non-Hodgkin's lymphoma which requires prompt diagnosis and treatment. Though usual presentation involves abdominal lymphadenopathy with possible solid organ involvement, sporadic BL can rarely present with peritoneal lymphomatosis. We present a unique case with rapid evolution of BL presenting as peritoneal and omental lymphomatosis with hepatic lesions and pelvic and pericardial adenopathy.
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Affiliation(s)
- Naomi Fei
- Department of Internal Medicine, West Virginia University Hospital, 1 Medical Center Dr, Morgantown, WV 26505, USA
| | - Nilay Shah
- Department of Internal Medicine, West Virginia University Hospital, 1 Medical Center Dr, Morgantown, WV 26505, USA
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9
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Rohena-Quinquilla IR, Lattin GE, Wolfman D. Imaging of Extranodal Genitourinary Lymphoma. Radiol Clin North Am 2017; 54:747-64. [PMID: 27265606 DOI: 10.1016/j.rcl.2016.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The genitourinary (GU) system is commonly affected by disseminated lymphoma. Rarely, lymphoma can originate from and remain localized to one of the GU organs and thus presents as primary extranodal disease. Up to 40% of lymphomas present as extranodal disease, with only 3% having the GU system as the primary site of involvement. This article describes and correlates the radiologic and pathologic features of extranodal lymphomatous disease affecting the GU system with specific focus on the kidneys, adrenal glands, testicles, and ovaries. Lymphoma of the uterine body and cervix, external female genitalia, urinary bladder, and prostate gland is briefly discussed.
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Affiliation(s)
- Iván R Rohena-Quinquilla
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Radiology, Martin Army Community Hospital, 6600 Van Aalst Boulevard, Fort Benning, GA 31905-5637, USA
| | - Grant E Lattin
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA
| | - Darcy Wolfman
- Department of Radiology and Radiological Sciences, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; American Institute for Radiologic Pathology, 1010 Wayne Avenue, Suite 320, Silver Spring, MD 20910, USA; Department of Radiology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814, USA.
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10
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Cunningham N, Ffrench-Constant S, Planche K, Gillmore R. Peritoneal lymphomatosis: a rare presentation of follicular lymphoma mimicking peritoneal carcinomatosis. BMJ Case Rep 2015; 2015:bcr-2014-207136. [PMID: 25694630 DOI: 10.1136/bcr-2014-207136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients presenting with ascites associated with peritoneal disease have a wide differential diagnosis including both malignant and non-malignant related causes. We present the unusual case of a patient, clinically deteriorating, whose malignant peritoneal disease was due to an underlying follicular lymphoma. An urgent staging CT scan followed by a peritoneal biopsy allowed the patient to start chemotherapy within days of acute presentation to the hospital. This case emphasises the importance of obtaining tissue diagnosis urgently in these patients to ensure that the correct treatment can be started in a timely manner.
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Affiliation(s)
| | | | | | - Roopinder Gillmore
- Department of Oncology, Royal Free London NHS Foundation Trust, London, UK
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11
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Yadav BS, George P, Sharma SC, Gorsi U, McClennan E, Martino MA, Chapman J, Chen LM, Prakash G, Malhotra P, Tantravahi SK, Glenn MJ, Werner TL, Baksh K, Sokol L, Morris GJ. Primary Non-Hodgkin Lymphoma of the Ovary. Semin Oncol 2014; 41:e19-30. [DOI: 10.1053/j.seminoncol.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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12
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NonHodgkin's Lymphoma with Peritoneal Localization. Case Rep Gastrointest Med 2014; 2014:723473. [PMID: 24711934 PMCID: PMC3970443 DOI: 10.1155/2014/723473] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 01/23/2014] [Indexed: 12/15/2022] Open
Abstract
The gastrointestinal tract is the most common extranodal site involved with lymphoma accounting for 5–20% of all cases. Lymphoma can occur at any site of the body, but diffuse and extensive involvement of the peritoneal cavity is unusual and rare. We report a case of diffuse large B-cell lymphoma in a 57-year-old female infiltrating the peritoneum and omentum and presenting with ascites and pleural effusion. The performed examinations did not discover any pathological findings affecting the digestive tract or parenchymal organs, except for diffuse thickening of the peritoneum and omentum. Peripheral, mediastinal, or retroperitoneal lymphadenopathy was not registered. The blood count revealed only elevated leukocytes and on examination there were no immature blood cells in the peripheral blood. The cytology from the ascites and pleural effusion did not detect any malignant cells. Due to the rapid disease progression the patient died after twenty-two days of admission. The diagnosis was discovered postmortem with the histological examination and immunohistochemical study of the material taken during the surgical laparoscopy performed four days before the lethal outcome. Although cytology is diagnostic in most cases, laparoscopy with peritoneal biopsy is the only procedure which can establish the definitive diagnosis of peritoneal lymphomatosis.
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13
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Abstract
Invasive peritoneal disease includes more than just peritoneal carcinomatosis. Although this is the most common aetiology, especially when a primary is found, other conditions may be responsible for peritoneal invasion. A rigorous analysis of CT features taken together with the clinical and biological context usually allows the main differential diagnoses, which entail different types of management, to be drawn out. Pseudomyxoma peritonei, peritoneal lymphomatosis, tuberculosis, peritoneal mesothelioma, diffuse peritoneal leiomyomatosis, and benign splenosis are the main differential diagnoses.
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14
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Abstract
OBJECTIVE The purpose of this article is to review the imaging features, particularly on MR images, useful in identifying primary gynecologic lymphoma. CONCLUSION Primary gynecologic lymphoma is rare. Nonetheless, the distinction between primary and secondary involvement is important because of critical differences in prognosis and treatment. The prospective diagnosis of primary gynecologic lymphoma enables immediate chemotherapy or radiation therapy and avoids unnecessary surgery, which delays treatment. Diagnostic imaging can be key in differentiating lymphoma from the far more common pelvic malignancies.
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Abstract
Peritoneal carcinomatosis is a term used to describe widespread metastases of cancerous tumors in the peritoneal cavity. It is most common in carcinomas of the gastrointestinal tract (GIT) and ovaries, and must be considered to be the main diagnosis even when the primary is not known. A wide variety of disease processes mimic peritoneal carcinomatosis. Precise diagnosis based on imaging alone is often difficult and very often the final diagnosis is only obtained after appropriate histopathology or microbiology.
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Affiliation(s)
- S Smiti
- Department of Radio-diagnosis and Imaging, Kasturba Medical College, Manipal, Karnataka, India
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16
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Kim YG, Baek JY, Kim SY, Lee DH, Park WS, Kwon Y, Kim MJ, Kang J, Lee JM. Peritoneal lymphomatosis confounded by prior history of colon cancer: a case report. BMC Cancer 2011; 11:276. [PMID: 21708008 PMCID: PMC3141780 DOI: 10.1186/1471-2407-11-276] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Accepted: 06/27/2011] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is well known that carcinomas of the gastrointestinal tract are frequently associated with peritoneal carcinomatosis. In contrast to that entity extensive involvement of the peritoneal cavity with malignant lymphoma is rare. CASE PRESENTATION This is the first case reporting coexistence of peritoneal lymphomatosis and a previous history of colon cancer, which is a highly challenging clinical situation. CONCLUSIONS If not aware of this unusual condition medical history, radiologic finding and laboratory data alone can lead to wrong diagnosis as in this case.
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Affiliation(s)
- Yun Gi Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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17
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Lim Y, Kim TY, Choi IS, Kim BS, Lee TS, Kim JE, Chang MS, Kim KH. Diffuse Large B-Cell Lymphoma With Germinal Center B-Cell Phenotype Mimicking Primary Effusion Lymphoma. J Clin Oncol 2011; 29:e271-3. [DOI: 10.1200/jco.2010.32.5258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Yoojoo Lim
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Tae-Yong Kim
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Sil Choi
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Byung-Su Kim
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Taek Sang Lee
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ji Eun Kim
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Mee Soo Chang
- Seoul National University Boramae Medical Center, Seoul, Korea
| | - Ki Hwan Kim
- Seoul National University Boramae Medical Center, Seoul, Korea
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18
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Bihari C, Bhatia V, Rastogi A, Bhardwaj V, Jain D, Thapar S. T-cell lymphoma with raised serum glycoprotein-125(CA-125) and raised ascitic fluid adenosinedeaminase levels initially presenting as ascites: a case report and review of literature. Diagn Cytopathol 2010; 39:770-4. [PMID: 20890997 DOI: 10.1002/dc.21551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2010] [Accepted: 08/19/2010] [Indexed: 12/13/2022]
Abstract
We report a case of T-cell lymphoma presenting as ascites, omental thickening, and raised serum glycoprotein-125 (CA-125) and high-ascitic fluid adenosinedeaminase levels. This case was clinically suspected to be peritoneal carcinomatosis or peritoneal tuberculosis based on clinical, biochemical, and radiological features. However, effusion cytology, cell block, and immunohistochemistry confirmed this case as T-cell lymphoma. This revealed the role of effusion cytology and cell-block preparation with imunohistochemistry in the diagnosis.
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Affiliation(s)
- Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary sciences (ILBS), New Delhi, India
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19
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Park EK, Lee SR, Kim YC, Oh SY, Choe JG. Peritoneal Lymphomatosis Imaged by F-18 FDG PET/CT. Nucl Med Mol Imaging 2010; 44:159-60. [PMID: 25013531 DOI: 10.1007/s13139-010-0018-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/28/2009] [Accepted: 01/18/2010] [Indexed: 12/13/2022] Open
Abstract
Peritoneal lymphomatosis is uncommon, but when encountered is associated with aggressive histological subtypes of high-grade lymphoma, such as small-cell, large-cell, mixed large and small cell, non-cleaved, lymphoblastic Burkitt-like, and diffuse large B cell lymphomas. The CT findings of peritoneal lymphomatosis are linear or nodular peritoneal thickening, retroperitoneal lymphadenopathy, omental and mesenteric involvement with streak-like infiltrations or a bulky mass, bowel wall thickening, hepatosplenomegaly, and ascites. The authors report the first FDG PET/CT images of diffuse large B-cell lymphoma of small bowel origin associated with peritoneal lymphomatosis in a 69-year-old man. The lesions demonstrated intense FDG uptake in PET/CT images.
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Affiliation(s)
- Eun Kyung Park
- Department of Nuclear Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705 Korea
| | - Se Ryeon Lee
- Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Chul Kim
- Department of Nuclear Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705 Korea
| | - Sun Young Oh
- Department of Nuclear Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705 Korea
| | - Jae Gol Choe
- Department of Nuclear Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705 Korea
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20
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Fasih N, Galwa RP, Macdonald DB, Fraser-Hill MA, McInnes M, Khalili K. Thinking beyond peritoneal carcinomatosis: imaging spectrum of unusual disseminated peritoneal entities. Can Assoc Radiol J 2010; 62:125-34. [PMID: 20452173 DOI: 10.1016/j.carj.2010.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/07/2010] [Accepted: 03/08/2010] [Indexed: 11/16/2022] Open
Abstract
Although peritoneal carcinomatosis is the most common entity involving the peritoneum diffusely, a vast array of unusual diseases may affect the peritoneal surfaces. These entities can be further categorized into infectious, neoplastic, and miscellaneous, and miscellaneous conditions. Cross-sectional imaging, including computed tomography and magnetic resonance imaging are excellent modalities for further characterization of these unusual diseases. For some of the conditions, imaging-specific is achievable. For others, the diagnosis can be favored when clinical and/or cross-sectional features coexist.
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Affiliation(s)
- Najla Fasih
- Division of Abdominal Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Canada.
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21
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Martínez Baena D, Díaz Gómez D, Parra Membrives P, Brox Jiménez A. [Diagnostic value of laparoscopy in peritoneal lymphomatosis]. Cir Esp 2009; 88:202-3. [PMID: 19863952 DOI: 10.1016/j.ciresp.2009.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/06/2009] [Accepted: 07/07/2009] [Indexed: 11/26/2022]
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22
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Aslam MB. Peritoneal lymphomatosis, a morphological look alike to peritoneal carcinomatosis: an autopsy report. J Clin Pathol 2009; 62:480. [PMID: 19398600 DOI: 10.1136/jcp.2008.061671] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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23
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Wong S, Sanchez TRS, Swischuk LE, Huang FS. Diffuse peritoneal lymphomatosis: atypical presentation of Burkitt lymphoma. Pediatr Radiol 2009; 39:274-6. [PMID: 19020870 DOI: 10.1007/s00247-008-1063-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 10/14/2008] [Accepted: 10/23/2008] [Indexed: 11/24/2022]
Abstract
Burkitt lymphoma presenting as a peritoneal and small thickening problem mimicking carcinomatosis is very rare. We present a previously healthy 7-year-old boy with a 1-week history of worsening abdominal distention, vomiting and melena. He demonstrated liver nodules, but no pathologic chest or abdominal adenopathy was present. It was finally determined that he was suffering from Burkitt lymphoma. We present this case because it is such a rare but very significant manifestation of Burkitt lymphoma.
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Affiliation(s)
- Stephen Wong
- Department of Radiology, The University of Texas Medical Branch, 301 University Blvd., Galveston, TX, 77555-0365, USA
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24
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Ba-Ssalamah A, Uffmann M, Bastati N, Schima W. [Diseases of the peritoneum and mesenterium]. Radiologe 2009; 49:637-51; quiz 652-4. [PMID: 19224192 DOI: 10.1007/s00117-008-1766-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Peritoneal diseases can be seen in the different imaging modalities either as fluid collections or solid tumors along the ligaments, mesenteries, and spaces of the peritoneal cavity. The broad spectrum of different abnormalities includes inflammatory, infectious, traumatic, and neoplastic diseases. In this article, a large variety of peritoneal abnormalities such as ascites, peritonitis, intraperitoneal hemorrhage, and both primary and secondary peritoneal tumors are discussed. The different imaging modalities, characteristic radiological features, and typical pathways of anatomic spread are explained.
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Affiliation(s)
- A Ba-Ssalamah
- Universitätsklinik für Radiodiagnostik, Medizinische Universität, A-1090 Wien, Osterreich.
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25
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Abstract
Multiple intra-abdominal organ infiltration or disseminated peritoneal lymphoma receives much less attention than peritoneal carcinomatosis in clinical practice. This may be due to its relatively infrequent occurrence. In this report, an 89-year-old woman was diagnosed with disseminated peritoneal lymphoma with gastric and rectal involvement and marked ascites. Flow cytometry of the surface markers for ascites showed positive results for CD19, CD20 and CD45. Biopsy of the stomach and rectum were all reported to show diffuse large B-cell lymphoma. The cytology of ascites is a simple and effective method for making a diagnosis from adequate samples with time limitations. The management of this disease depends on the individual case. It must be kept in mind that differential diagnosis from other pathologic entities with similar imaging features or high ascitic fluid adenosine deaminase levels is difficult because of considerable overlap of clinical features. To prolong the survival of patients with peritoneal lymphomatosis, diagnosis should be made as early as possible.
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Affiliation(s)
- Shuo-Chun Weng
- Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C
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26
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Abstract
The gastrointestinal (GI) tract contains the largest collection of lymphocytes anywhere in the body. GI lymphoma may arise at any site in the GI tract but typically involves the stomach and small bowel in cases of systemic disease. Most cases are non-Hodgkin B-cell type. Enteropathy-associated T cell lymphoma can complicate celiac disease. Less commonly, lymphoma may originate in the GI tract without systemic involvement. This sometimes occurs in response to chronic infections. This article discusses the role of imaging in detecting and staging GI tract lymphomas, using fluoroscopy and cross-sectional imaging, primarily CT.
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Affiliation(s)
- Marc J Gollub
- Weill Medical College of Cornell University, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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27
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Antonarakis ES, Fradin JM, Petronis JD, Couzi RJ. Not what it seems. Am J Med 2007; 120:408-11. [PMID: 17466648 DOI: 10.1016/j.amjmed.2006.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2006] [Revised: 11/09/2006] [Accepted: 11/10/2006] [Indexed: 10/23/2022]
MESH Headings
- Aged
- Ascitic Fluid/chemistry
- Breast Neoplasms/secondary
- CA-125 Antigen/analysis
- Comorbidity
- Female
- Flow Cytometry
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/epidemiology
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/epidemiology
- Lymphoma, Follicular/pathology
- Mesentery/pathology
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/pathology
- Paracentesis
- Peritoneal Neoplasms/diagnosis
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/epidemiology
- Peritoneal Neoplasms/pathology
- Peritoneum/pathology
- Positron-Emission Tomography
- Pulmonary Embolism/diagnostic imaging
- Pulmonary Embolism/epidemiology
- Tomography, X-Ray Computed
- Venous Thrombosis/epidemiology
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Affiliation(s)
- Emmanuel S Antonarakis
- Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Md 21224, USA.
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28
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Abstract
AIM: To assess CT manifestations and its diagnostic value for lymphoma in the abdominal lymph nodes (LALN).
METHODS: CT findings in 52 cases of LALN proved by surgery or biopsy, including Hodgkin’s disease (HD) in 16 cases and non-Hodgkin’s lymphoma (NHL) in 36 cases, were retrospectively analyzed.
RESULTS: (1) CT manifestations based on distribution of the lesions of LALN: Solitary mass type was found in 10 cases, including solitary, round, uniform-density, enlarged lymph nodes in 3 cases; and multiple, enlarged lymph nodes fusing into singular lobular mass in 7 cases. Thirty-four cases of multiple-nodular type showed multiple, round, enlarged lymph nodes with uniform density and clear margins. Vessels-embedded signs, including mesenteric vessels, renal vessels, abdominal aorta or inferior vena cava, were seen in 6 cases, and duodenum-embedded signs were seen in 2 cases. Eight cases of diffuse type showed characteristic “cobblestone signs”. (2) CT manifestations correlated with pathological type: CT manifestations of 12 cases of HD were different from those of 40 cases of NHL in distribution, size, quantity and fused lesion of enlarged lymph nodes. (3) Twenty-eight cases of 52 patients were accompanied with extra-nodal lymphoma in the abdomen, especially gastrointestinal lymphoma, which had characteristic CT findings. (4) In follow-up examinations, CT images showed uniform, heterogeneous or rim enhancement in 15 cases, and occasional calcifications accompanied with reduction of the lesion size and quantity in 12 cases, whereas the lesions disappeared in 3 cases after treatment.
CONCLUSION: CT images show many characteristic manifestations valuable for qualitative diagnosis of LALN, and it is also helpful for pathological classification of LALN and therapeutic evaluation in follow-up of patients.
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Affiliation(s)
- Ri-Sheng Yu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University, School of Medicine, Hangzhou 310009, Zhejiang Province, China
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