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Xie R, Mao Z, Xu X, Sun T. Epidemiological features and a survival nomogram for primary lymphoma of the male genital tract. Ann Hematol 2024; 103:1687-1695. [PMID: 38424302 DOI: 10.1007/s00277-024-05668-1] [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: 10/26/2023] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
Primary lymphoma of the male genital tract (PLMGT) is rare, and data on its epidemiology and prognosis are lacking. Our study aimed to estimate the incidence and develop a predictive nomogram for PLMGT. We pooled the incidence and survival data of PLMGT over the last 20 years from the Surveillance, Epidemiology, and End Results (SEER) database. Incidence rates were calculated by year of diagnosis, age, race, and histology. Independent prognostic factors selected by Cox regression analysis were used to develop a nomogram for predicting overall survival (OS). Our study enrolled 1312 patients with PLMGT. The overall incidence rate of PLMGT was 0.437/1,000,000 during 2000-2019. OS was associated with age, marital status, histological subtype, Ann Arbor stage, and therapeutic strategy, which were used to construct nomograms to predict 1-, 3-, and 5-year OS rates. Receiver operating characteristic curves, calibration plots, and decision curve analysis showed good performance of the nomogram. Based on the total score of each patient from the nomogram, the patients were clustered into three risk groups, and the risk stratification model was more successful in predicting clinical outcomes than the traditional Ann Arbor staging system. The incidence rate of PLMGT has remained relatively stable over the past two decades. For the OS of patients with PLMGT, we established a novel predictive nomogram involving all independent risk factors obtained from the SEER database and developed a corresponding risk classification system that showed better predictive performance than the Ann Arbor staging system.
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Affiliation(s)
- Rongli Xie
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Zekai Mao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiaojun Xu
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Tiantian Sun
- Department of Hematology, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China.
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2
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Yang S, Chang W, Zhang B, Shang P. What factors are associated with the prognosis of primary testicular diffuse large B-cell lymphoma? A study based on the SEER database. J Cancer Res Clin Oncol 2023; 149:10269-10278. [PMID: 37270733 DOI: 10.1007/s00432-023-04907-8] [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: 04/20/2023] [Accepted: 05/20/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is a relatively rare urological tumor with a high degree of malignancy and a poor prognosis. This study aimed to investigate the prognostic risk factors for survival of patients with PT-DLBCL, and then to construct a predictive model and verify its reliability. METHODS First, we selected subjects from the SEER database (2000-2018) and analyzed the survival of PT-DLBCL patients by Kaplan-Meier test. Then, we analyzed prognostic factors by Cox regression. Finally, the data from the training cohort were used to construct a prediction model and represented with a nomogram. We evaluated the nomogram using the consistency index (C-index), decision curve analysis (DCA), and the area under the subject operating characteristic curve (ROC). In addition, calibration curves were plotted to assess the agreement between the column plot model and the actual model. RESULTS We identified five independent risk factors for patient prognosis affecting OS and CSS in patients with PT-DLBCL by univariate and multivariate analysis, including age, transversality, Ann Arbor staging, chemotherapy, and radiotherapy. According to the above factors, we constructed prognostic nomograms, and found that age contributed the most to the survival of patients with PT-DLBCL. The C-indexes for the nomogram of OS and CSS in the training cohort were 0.758 (0.716-0.799) and 0.763 (0.714-0.812), and in the validation cohort were OS and CSS 0.756 (0.697-0.815) and 0.748 (0.679-0.817). CONCLUSION We produced the first nomogram of PT-DLBCL, and it can be used to evaluate the CSS and OS of patients to determine the prognosis of patients.
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Affiliation(s)
- Shujun Yang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Wei Chang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Bin Zhang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China
| | - Panfeng Shang
- Department of Urology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, Gansu, China.
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Lee YP, Yoon SE, Cho J, Ko YH, Oh D, Ahn YC, Kim WS, Kim SJ. Real-World Data Analysis of Survival Outcomes and Central Nervous System Relapses in Testicular Diffuse Large B Cell Lymphoma. Cancer Manag Res 2023; 15:463-474. [PMID: 37304895 PMCID: PMC10252944 DOI: 10.2147/cmar.s407837] [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: 02/09/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023] Open
Abstract
Background Primary testicular lymphoma is a rare type of non-Hodgkin lymphoma, mostly of the diffuse large B cell lymphoma (DLBCL). Although a consensus on standard treatment has been established, unresolved issues remain, such as recurrence in the central nervous system (CNS). Methods We retrospectively analyzed the clinical characteristics and survival outcomes of 65 testicular DLBCL patients according to clinical settings and treatment modalities. Results The median age of the patients in our study was 65 years, and two-thirds of them had disease limited to one testis. There was no right or left lateralization of testicular involvement. Over a median follow-up of 53.9 months (95% confidence interval 34.0-73.7 months), patients with stage I disease and a low international prognostic index score showed better survival outcomes than those in other categories. Orchiectomy, six cycles of chemotherapy, and radiation therapy (RT) to the contralateral testis demonstrated survival benefits, whereas CNS prophylaxis therapy did not reduce CNS recurrence. During the follow-up period, the survival curves showed continuous decline, mostly due to disease progression. CNS recurrence was observed in 15% of patients, and parenchymal involvement was dominant. However, no factors were associated with CNS recurrence in our analyses. Although our molecular analyses were performed in a small number of patients, MYD88, CD79B, and PIM1 mutations were frequent. Conclusion In our study, treatment with orchiectomy, six cycles of immunochemotherapy, and contralateral RT was effective. However, because CNS prophylaxis is an essential part of testicular DLBCL management, better treatment strategies than intrathecal therapy are required.
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Affiliation(s)
- Yong-Pyo Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Junhun Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Dahbi Z, Elmejjabar R, Alami R, Kouhen F. Testicular Radiotherapy: A Challenging Irradiation Site. Cureus 2023; 15:e37638. [PMID: 37200663 PMCID: PMC10187590 DOI: 10.7759/cureus.37638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/20/2023] Open
Abstract
Testicular radiation therapy is a crucial component of the overall treatment of certain neoplasms. Yet, it remains challenging due to the unique anatomic location of the testicles, their specific radiation tolerance, and the lack of a standardized treatment workflow. In this article, we present the case of a 78-year-old patient with primary testicular lymphoma and describe the technical aspects of his radiation therapy. The challenge was to achieve a comfortable, reproducible, and effective treatment position while protecting the penis and covering the superficial layers of the scrotum. We used a total body restraint system and performed a second simulated CT scan with a bolus. The entire scrotum was delineated as the clinical target volume, with an additional 1 cm margin to obtain the planning target volume. This case highlights the importance of careful planning and personalized treatment approaches in testicular irradiation and underscores the need for further research and standardization in this complex irradiation site.
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Affiliation(s)
- Zineb Dahbi
- Radiotherapy, International University Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Reyzane Elmejjabar
- Radiotherapy, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Rim Alami
- Radiotherapy, Mohammed VI University of Health Sciences, Casablanca, MAR
| | - Fadila Kouhen
- Radiation Oncology, Mohammed VI University of Health Sciences, Casablanca, MAR
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Berjaoui MB, Herrera-Caceres JO, Li T, Qaoud Y, Tiwari R, Ma D, Khondker A, Naidu S, Ajaj R, Lajkosz K, Kenk M, Ajib K, Chandraseka T, Goldberg H, Fleshner N. Age related differences in primary testicular lymphoma: A population based cohort study. Urol Oncol 2023; 41:151.e1-151.e10. [PMID: 36702705 DOI: 10.1016/j.urolonc.2022.10.032] [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: 02/21/2022] [Revised: 07/16/2022] [Accepted: 10/30/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Primary testicular non-Hodgkin's lymphoma (PTL) is a very rare disease, comprising 1% of all non-Hodgkin's lymphoma and <5% of all cases of testicular tumors. With a median age at diagnosis of 67 years, PTL is the most common testicular malignancy in men aged >60 years. There is limited published data on PTL incidence and outcomes in younger patients. The aim of this study is to compare the clinical parameters and survival outcomes between the patients older and younger than 50. METHODS The SEER database was queried for all patients diagnosed with PTL between 1983 and 2017. Data collected consisted of demographic, and clinical parameters, including staging, pathological assessments, and survival data. Patients were stratified according to their age and compared. RESULTS There was a total of 1,581 patients diagnosed with PTL between the year 2000 and 2017, of whom 215 (13.6%) were younger than 50 years old. The median age at diagnosis was 41 (interquartile range [IQR] 1-50), and 72 (IQR 51-95) years old for patients ≤50 and patients > 50 years of age, respectively. Comparison of younger and older patients detected similarities in disease laterality (92% vs. 94%, P = 0.38) and Ann Arbor stage I to II at diagnosis (76% vs. 75%, P = 0.59). The most common diffuse large B-cell lymphoma (DLBCL) subtype was more common in older patients (61% vs. 87%, P < 0.001). Radical orchiectomy (71% vs. 79%, P = 0.004) and radiation treatment (40% vs. 37%, P = 0.49) rates were comparable between both groups. However, a higher proportion of younger patients underwent chemotherapy (83% vs. 72%, P < 0.001). Patients ≤50 and >50 years old had a hazard ratio (HR) of 0.63 (95% CI: 0.57-0.71) and 0.34 (95% CI: 0.31-0.37), respectively, for 10-year OS with a median survival time for patients >50 of 5.75 years (95% CI: 5.25-6.33), P < 0.001. Patients ≤50 years old had a HR of 0.33 (95% CI: 0.26-0.40) compared to HR of 0.40 (95% CI: 0.37-0.43) in patients >50 years old for cumulative disease-specific mortality (DSM, P = 0.0204). Age >50 years was associated with worse DSM with a HR of 1.39 (95% CI: 1.05- 1.86, P = 0.024). Ann Arbor stage II and higher was also associated with worse DSM, while undergoing surgery, radiotherapy, and chemotherapy were associated with improved DSM. CONCLUSIONS PTL is the most common testicular malignancy in men older than 60 years of age, but more than a quarter of the patients are younger than 60 and more than 13% are ≤50 years. Younger patients are more likely to receive chemotherapy and radiation, and overall do better in terms of DSM. Being younger, having a lower Ann Arbor stage and being treated with chemotherapy and radiotherapy increase the chances of survival.
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Affiliation(s)
- Mohamad B Berjaoui
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Jaime O Herrera-Caceres
- Division of Urology, Department of Surgery, Princess Maraget Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Tiange Li
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Yazan Qaoud
- Division of Urology, Department of Surgery, Princess Maraget Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Raj Tiwari
- Division of Urology, Department of Surgery, Princess Maraget Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Danny Ma
- University of Toronto, Toronto, ON, Canada
| | | | | | - Ran Ajaj
- University of Toronto, Toronto, ON, Canada
| | - Katherine Lajkosz
- Division of Urology, Department of Surgery, Princess Maraget Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Miran Kenk
- Division of Urology, Department of Surgery, Princess Maraget Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Khaled Ajib
- Division of Urology, Medical College of Georgia at Augusta University, Albany, GA
| | | | - Hanan Goldberg
- Urology Department, SUNY Upstate Medical University, Syracuse, NY
| | - Neil Fleshner
- Division of Urology, Department of Surgery, Princess Maraget Cancer Centre, University Health Network, Toronto, ON, Canada
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Sun Y, Yan X, Zhao H, Cui Z, Wang Y, Sun S, Ning X, Xu H. Characteristic features of primary testicular lymphoma and survival trends: a multicenter clinical study. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:1019-1025. [PMID: 36066282 DOI: 10.1080/16078454.2022.2119345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To retrospectively investigate the clinical characteristics, prognosis, treatment, and therapy outcome of Chinese patients with primary testicular lymphoma (PTL). METHODS we collected data of 49 PTL patients from four hospitals over 13 years. The median age was 63 years old. We described the clinical characteristics of the patients including the laterality, serum lactate dehydrogenase (LDH), pathology classification, stage, International prognostic index (IPI) scores and more. RESULTS Complete remission (CR) was achieved in 34 patients and partial remission (PR) in 3 patients; Progressive disease (PD) was detected in 11 patients, and 10 patients died. The average progression-free survival (PFS) of all patients was 43.92 months, and the average overall survival (OS) was 47.55 months. The Ann Arbor stage, IPI score, and LDH were associated with OS, while Ann Arbor stage, IPI score, LDH, and histotype were significantly associated with PFS. Chemotherapy and radiotherapy following orchiectomy was associated with a significantly longer PFS. CONCLUSION Most patients can achieve CR after induced therapy or orchiectomy. However, there are many associated prognostic factors.
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Affiliation(s)
- Yujiao Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Xueshen Yan
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Hongguo Zhao
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Zhongguang Cui
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Yayun Wang
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Shuxiang Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Xiaohan Ning
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
| | - Hong Xu
- The Affiliated Hospital of Qingdao University, Qingdao, China, People's Republic of China
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Yan Z, Yao S, Wang Y, Liu Y, Yao Z. Primary Testicular Lymphoma with Central Nervous System Relapse Was Successfully Treated by a Chemo-Free Regimen: A Case Report and Literature Review. Cancer Manag Res 2022; 13:9489-9500. [PMID: 35002326 PMCID: PMC8725687 DOI: 10.2147/cmar.s341342] [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: 10/04/2021] [Accepted: 12/19/2021] [Indexed: 12/12/2022] Open
Abstract
Primary testicular lymphoma (PTL) is a rare malignancy of testis. Although the multimodality treatment (including orchiectomy, systemic chemotherapy, scrotal radiotherapy, and preventive central nervous system (CNS)-targeted treatment) is widely used to treat PTL, recurrence, especially CNS recurrence, occurred frequently. Patients with relapsed PTL have a dismal prognosis and limited treatment options. In this report, we described the case of a 63-year-old man with early-stage PTL. The patient received the multimodality treatment, but CNS relapse occurred 3 months following the front-line therapy. We gave him a combined chemo-free regimen treatment, including rituximab, ibrutinib, and lenalidomide (RIL), based on the tumor's gene mutation profile and the patient's preference. A complete response was achieved after the first cycle of treatment. Whole-brain radiotherapy was delivered as consolidative treatment following three more cycles of RIL. Thereafter, ibrutinib and lenalidomide continued as maintenance treatment. As of the submission of this manuscript, the response has lasted for more than 16 months. Based on the case, we believe chemo-free regimen RIL might be a favorable approach for PTL patients with CNS relapse, especially those frail elderly patients, when alternative treatments are not available.
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Affiliation(s)
- Zheng Yan
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Shuna Yao
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuanyuan Wang
- Department of Pathology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yanyan Liu
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Zhihua Yao
- Department of Internal Medicine, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan, People's Republic of China
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Fang Y, Su N, Ma S, Cai J, Zhong L, Li W, Huang H, Li Z, Huang H, Xia Y, Liu P, Guo L, Li Z, Wu Y, Tian X, Wang J, Zhang Y, Cai Q. Optimization of high-dose methotrexate prophylaxis for central nervous system relapse in diffuse large B-cell lymphoma: a multicenter analysis. Ann Hematol 2022; 101:595-605. [DOI: 10.1007/s00277-021-04739-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/02/2021] [Indexed: 11/01/2022]
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Ripalda Ferretti EA, Herranz Yagüe JA, Calderón Izquierdo JM, Páez Borda Á. Linfoma testicular primario. A propósito de 2 casos nuevos. Rev Int Androl 2022; 20:140-144. [DOI: 10.1016/j.androl.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/09/2020] [Accepted: 10/17/2020] [Indexed: 11/28/2022]
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Pollari M, Leivonen SK, Leppä S. Testicular Diffuse Large B-Cell Lymphoma-Clinical, Molecular, and Immunological Features. Cancers (Basel) 2021; 13:cancers13164049. [PMID: 34439203 PMCID: PMC8392512 DOI: 10.3390/cancers13164049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Simple Summary Testicular diffuse large B-cell lymphoma (T-DLBCL) is a rare and aggressive lymphoma entity that mainly affects elderly men. It has a high relapse rate with especially the relapses of the central nervous system associating with dismal outcome. T-DLBCL has a unique biology with distinct genetic characteristics and clinical presentation, and the increasing knowledge on the tumor microenvironment of T-DLBCL highlights the significance of the host immunity and immune escape in this rare lymphoma, presenting in an immune-privileged site of the testis. This review provides an update on the latest progress made in T-DLBCL research and summarizes the clinical perspectives in T-DLBCL. Abstract Primary testicular lymphoma is a rare lymphoma entity, yet it is the most common testicular malignancy among elderly men. The majority of the cases represent non-germinal center B-cell-like (non-GCB) diffuse large B-cell lymphoma (DLBCL) with aggressive clinical behavior and a relatively high relapse rate. Due to the rareness of the disease, no randomized clinical trials have been conducted and the currently recognized standard of care is based on retrospective analyses and few phase II trials. During recent years, the tumor microenvironment (TME) and tumor-related immunity have been the focus of many tumor biology studies, and the emergence of targeted therapies and checkpoint inhibitors has significantly modulated the field of cancer therapies. Testicular DLBCL (T-DLBCL) is presented in an immune-privileged site of the testis, and the roles of NF-κB pathway signaling, 9p24.1 aberrations, and tumor-infiltrating immune cells, especially immune checkpoint expressing lymphocytes and macrophages, seem to be unique compared to other lymphoma entities. Preliminary data on the use of immune checkpoint inhibitors in the treatment of T-DLBCL are promising and more studies are ongoing.
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Affiliation(s)
- Marjukka Pollari
- Research Program Unit, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-K.L.); (S.L.)
- Department of Oncology, Tays Cancer Center, Tampere University Hospital, 33521 Tampere, Finland
- Correspondence:
| | - Suvi-Katri Leivonen
- Research Program Unit, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-K.L.); (S.L.)
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Sirpa Leppä
- Research Program Unit, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland; (S.-K.L.); (S.L.)
- Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, 00029 Helsinki, Finland
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Combined chemotherapy and radiotherapy improves survival in 1897 testicular Lymphoma patients from a contemporary cohort. Urol Oncol 2020; 38:641.e1-641.e8. [PMID: 32307328 DOI: 10.1016/j.urolonc.2020.02.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/31/2020] [Accepted: 02/24/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The standard of care (SOC) for primary testicular lymphoma (PTL) is orchiectomy, chemotherapy (CHT), and radiotherapy (RT). We hypothesized that men may not receive SOC and may have worse outcomes. To assess this, we queried the National Cancer Database (NCDB) to analyze treatment patterns and survival in PTL patients. METHODS The NCDB was queried (2006-2016) for men diagnosed with extranodal lymphoma with primary site testis. Patients were placed in 2 treatment groups (1) orchiectomy with chemotherapy plus radiotherapy (CHT + RT), named the SOC group; and 2) CHT + orchiectomy, or RT + orchiectomy, or orchiectomy alone, grouped as non-SOC. Propensity score matching and Kaplan-Meier analysis were used to investigate 5-year overall survival (OS). RESULTS Two thousand two hundred thirty-two men with PTL underwent orchiectomy. After exclusions, 891 men were included in the SOC group and 1,006 men were included in the non-SOC group. KM analysis showed 5-year OS was significantly higher in the SOC group vs. non-SOC for all stages (hazard ratio = 0.54, with 95% confidence interval 0.45 to 0.65, P < 0.0001). CONCLUSIONS This study represents one of the largest PTL cohort reported to date reflecting current treatments and shows men receiving standard of care treatment have significantly improved survival. Additionally, analysis reveals that most men included in the NCDB do not receive the standard of care.
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Chen B, Cao DH, Lai L, Guo JB, Chen ZY, Huang Y, Qiu S, Lin TH, Gou Y, Ma N, Yang L, Liu LR, Wei Q. Adult primary testicular lymphoma: clinical features and survival in a series of patients treated at a high-volume institution in China. BMC Cancer 2020; 20:220. [PMID: 32171265 PMCID: PMC7071578 DOI: 10.1186/s12885-020-6711-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background To retrospectively investigate the clinical characteristics, initial treatment, relapse, therapy outcome, and prognosis of Chinese patients with primary testicular lymphoma (PTL) through analysis of the cases of our institute. Methods From December 2008 to July 2018, all patients with PTL were included in this study. Kaplan-Meier method was used to estimate PFS and OS. The Cox proportional hazards model was used to compare the survival times for groups of patients differing in terms of clinical and laboratory parameters. Results All 28 PTL patients (24 DLBCL, three NK/T lymphomas, and one Burkkit’s lymphoma) with a median age of 65.5 years were included in this study. Six patients were observed recurrence among all the 22 individuals evaluated. Following orchiectomy and systemic chemotherapy, with or without intrathecal prophylaxis, complete response was achieved in 15 (68%) patients. For DLBCL patients, the median progression-free survival (PFS) was 44.63 months (95% CI 17.71–71.56 months), and the median overall survival (OS) was 77.02 months (95% CI, 57.35–96.69 months). For all the DLBCL patients, the 5-year PFS and 5-year OS were 35.4% (95%CI, 14.8–56.0%) and 53.4% (95%CI, 30.1–76.7%). Without further chemotherapy following orchiectomy (HR = 3.4, P = 0.03) were associated with inferior PFS of DLBCL patients. Advanced Ann Arbor stage (HR =5.9, P = 0.009) and high (international prognostic index, IPI) score: 3–5 (HR =3.9, P = 0.04) were correlated with shorter OS of DLBCL patients. Conclusion This study confirms that PTL is an aggressive malignant with a poor prognosis. Limited Ann Arbor stage, further chemotherapy following orchiectomy, and low IPI score (less than 2) are correlated with superior survival for DLBCL patients.
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Affiliation(s)
- Bo Chen
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - De-Hong Cao
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Lai
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jian-Bing Guo
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ze-Yu Chen
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yin Huang
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Shi Qiu
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Tian-Hai Lin
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yue Gou
- Department of outpatient, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Na Ma
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Lu Yang
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China
| | - Liang-Ren Liu
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China. .,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China. .,Institution of Urology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, 610041, Sichuan, People's Republic of China.
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13
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Wang Q, Zheng D, Chai D, Wu S, Wang X, Chen S, Wu L, Cao R, Tao Y. Primary testicular diffuse large B-cell lymphoma: Case series. Medicine (Baltimore) 2020; 99:e19463. [PMID: 32195944 PMCID: PMC7220436 DOI: 10.1097/md.0000000000019463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Primary testicular lymphoma (PTL) is a rare type of extranodal non-Hodgkin's lymphoma (NHL). Although data of PTL in patients with diffuse large B-cell lymphoma (DLBCL) are accumulating, there are still patients respond poorly to prognosis. PATIENT CONCERNS All patients had disease of the DLBCL subtype and those patients had primary involvement of the testis. In our studies, eleven patients had stage I/II disease, and 3 patients had advanced disease with B symptoms. Four patients exhibited a MYC+, BCL2+, and BCL6- expression pattern, 4 patients had a MYC+, BCL6+, and BCL2- expression pattern, and 3 patients had a MYC+, BCL2+, and BCL6+ expression pattern. Additionally, 43% (7/16) of PT-DLBCL patients had a germinal center B-cell-like (GCB) phenotype, while the others had a non-GCB phonotype. DIAGNOSES In our case, most patients presented with unilateral painless scrotal swelling and the enlargement of the testicles in the first examination. After hospitalization, all patients underwent preoperative imageological examination of the testis and epididymis and postoperative revealed that all patients were the diffuse infiltration of a large number of anomalous lymphocytes. In addition, no invasion of other sites was observed within 3 months after diagnosis. INTERVENTIONS AND OUTCOMES Underwent orchiectomy on the affected side was performed by urologists after all patients were diagnosed with PTL. Meanwhile, some patients received at least one course of chemotherapy, or received postoperative combined RT and chemotherapy. Because of it particularity, nineteen instances of lymph node region involvement were discovered in 12 patients since the operation. LESSONS PT-DLBCL has unique biological characteristics, and its treatment modalities are becoming increasingly standardized. In the future, systematic interventions need to be actively considered in the early stages of PTL.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chemoradiotherapy/methods
- Germinal Center/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Neoplasm Staging
- Orchiectomy/methods
- Phenotype
- Prognosis
- Retrospective Studies
- Testicular Neoplasms/metabolism
- Testicular Neoplasms/pathology
- Testicular Neoplasms/therapy
- Testis/diagnostic imaging
- Testis/pathology
- Ultrasonography/methods
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Affiliation(s)
- Qi Wang
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Dafang Zheng
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Damin Chai
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Shiwu Wu
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Xiaolin Wang
- Department of Pathology
- Department of Pathology, Bengbu Medical College
| | - Shaonan Chen
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College
| | - Linhui Wu
- Research center of Clinical Laboratory Science, Bengbu Medical College, Bengbu, Anhui, China
| | - Ruoxue Cao
- Research center of Clinical Laboratory Science, Bengbu Medical College, Bengbu, Anhui, China
| | - Yisheng Tao
- Department of Pathology
- Department of Pathology, Bengbu Medical College
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14
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Yang J, Guo X, Hao J, Dong Y, Zhang T, Ma X. The Prognostic Value of Blood-Based Biomarkers in Patients With Testicular Diffuse Large B-Cell Lymphoma. Front Oncol 2019; 9:1392. [PMID: 31921649 PMCID: PMC6914857 DOI: 10.3389/fonc.2019.01392] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/25/2019] [Indexed: 02/05/2023] Open
Abstract
Objectives: Previous studies have reported the prognostic value of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and systemic immune-inflammation index (SII). However, the prognostic performance of these indices in patients with testicular lymphoma has not yet been studied. This study was to systematically evaluate the role of NLR, PLR, LMR, and SII in predicting survival for patients with testicular diffuse large B-cell lymphoma. Methods: In this study, 28 patients with testicular diffuse large B-cell lymphoma were enrolled. We performed univariate and multivariate analyses to assess associations of indices incorporating blood cell counts with progression-free survival (PFS) and overall survival (OS). Results: The results of univariate analysis revealed that International Prognostic Index (IPI) score (p = 0.010, p = 0.034, respectively), NLR (p = 0.003, p = 0.025, respectively), and LMR (p = 0.004, p = 0.010, respectively) were significantly associated with PFS and OS. Lactic dehydrogenase (LDH) (p = 0.017), absolute neutrophil counts (p = 0.018), absolute monocyte counts (p = 0.001), and SII (p = 0.005) were significantly associated with the risk of disease progression, while ECOG performance status (p = 0.016) was shown to be related to the risk of death. In the multivariate analysis, NLR (HR 9.069, p = 0.001) and absolute monocyte counts (HR 37.076, p = 0.001) were shown to be independently associated with risk for disease progression, while LMR (HR 0.077, p = 0.028), and ECOG performance status (HR 20.013, p = 0.026) were proved to be independent predictors of OS. Conclusions: In conclusion, high absolute monocyte counts, high NLR and low LMR may indicate unfavorable prognosis in testicular diffuse large B-cell lymphoma patients. Since indices incorporating blood cell counts are low cost parameters, they may provide additional prognostic value beyond standard clinicopathological parameters. However, further studies are needed to confirm our findings.
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Affiliation(s)
- Jing Yang
- State Key Laboratory of Biotherapy and Cancer Center, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xinli Guo
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqi Hao
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yiting Dong
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- State Key Laboratory of Biotherapy and Cancer Center, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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15
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Liu YZ, Luo P, Liu C, Xue K, Jin J, Xia ZG, Liu XJ, Zhang QL, Cao JN, Hong XN, Lv FF. Prognostic Significance of LDH Ratio in Serum/Cerebral Spinal Fluid of Patients with Primary Testicular Diffuse Large B-Cell Lymphoma. Onco Targets Ther 2019; 12:10469-10475. [PMID: 31819527 PMCID: PMC6897509 DOI: 10.2147/ott.s228746] [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] [Received: 08/26/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
Objective Primary testicular diffuse large B-cell lymphoma (PT-DLBCL) is relatively rare, and risk factors of this disease are still not well understood. This study aims to identify clinical features and prognostic factors of PT-DLBCL patients. Methods Thirty-two patients were included in this retrospective study who were diagnosed as PT-DLBCL and treated in Fudan University Shanghai Cancer Center between November 2010 and May 2018. The demographic details, clinico-pathological characteristics of the patients were summarized, and the impact on progression-free survival (PFS) and overall survival (OS) was analyzed. Results The median age of the patients was 57 (range 36-76) years old. All patients received rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for 4-6 cycles and central nervous system (CNS) prophylaxis, with a CR rate 87.5% and an ORR 96.9%. Nineteen patients continued prophylactic contralateral testis radiation therapy (PCTRT) in our hospital. The 3-year PFS and OS rates were 79% and 92%, respectively. None of the 19 patients who received PCTRT experienced local recurrence. All three patients who suffered from CNS relapse were germinal center B-cell subtype. Kaplan-Meier analyses showed that PT-DLBCL patients with late-stage (Stage IV) (P =0.022), higher IPI score (IPI≥ 2) (P =0.017), B symptoms (P =0.004), and elevated LDH level (P =0.03) had a shorter PFS. More importantly, we found that patients with the ratio of the LDH level in serum to that in CSF ≥ 6.5 suffered from a worse PFS (P =0.028). Conclusion Our work revealed that staging IV, IPI score ≥2, having B symptoms and elevated LDH level were risk factors for PT-DLBCL patients. Significantly, the PT-DLBCL patients with a high ratio of LDH level in serum to that in CSF were indicated to have a worse PFS.
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Affiliation(s)
- Yi-Zhen Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Pan Luo
- Department of Medical Oncology, First People's Hospital of Yueyang, Yueyang 414000, People's Republic of China
| | - Cheng Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai 200032, People's Republic of China
| | - Kai Xue
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Jia Jin
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Zu-Guang Xia
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Xiao-Jian Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Qun-Ling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Jun-Ning Cao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Xiao-Nan Hong
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
| | - Fang-Fang Lv
- Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People's Republic of China
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16
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Ma RZ, Tian L, Tao LY, He HY, Li M, Lu M, Ma LL, Jiang H, Lu J. The survival and prognostic factors of primary testicular lymphoma: two-decade single-center experience. Asian J Androl 2019; 20:615-620. [PMID: 30246707 PMCID: PMC6219299 DOI: 10.4103/aja.aja_73_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
This study aims to investigate the effect of different local testicular treatments and validate common prognostic factors on primary testicular lymphoma (PTL) patients. We retrospectively reviewed the clinical records of 32 patients from 1993 to 2017 diagnosed with PTL and included 22 patients for analysis. The Kaplan–Meier method, Log-rank test, and multivariate Cox proportional hazard regression analysis were applied to evaluate progression-free survival (PFS), overall survival (OS), and determine prognosis predictors. The median follow-up time was 30 months. Median OS and PFS were 96 months and 49 months, respectively. In univariate analysis, advanced Ann Arbor stage (III/IV) (P < 0.001), B symptoms (P < 0.001), and extranodal involvement other than testis (P = 0.001) were significantly associated with shorter OS and PFS. In multivariate analysis, Ann Arbor stage was significantly associated with OS (OR = 11.58, P = 0.049), whereas B symptom was significantly associated with PFS (OR = 11.79, P = 0.049). In the 10 patients with the systemic usage of rituximab, bilateral intervention could improve median OS from 16 to 96 months (P = 0.032). The study provides preliminary evidence on bilateral intervention in testes in the rituximab era and validates common prognostic factors for Chinese PTL patients.
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Affiliation(s)
- Run-Zhuo Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lei Tian
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
| | - Li-Yuan Tao
- Department of Biostatistics, Peking University Third Hospital, Beijing 100191, China
| | - Hui-Ying He
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Min Li
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, Beijing 100191, China
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Hui Jiang
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
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17
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Mannisto S, Vähämurto P, Pollari M, Clausen MR, Jyrkkiö S, Kellokumpu-Lehtinen PL, Kovanen P, Karjalainen-Lindsberg ML, d'Amore F, Leppä S. Intravenous but not intrathecal central nervous system-directed chemotherapy improves survival in patients with testicular diffuse large B-cell lymphoma. Eur J Cancer 2019; 115:27-36. [PMID: 31082690 DOI: 10.1016/j.ejca.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/23/2019] [Accepted: 04/02/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Testicular lymphoma is a rare malignancy affecting mainly elderly men, the majority representing diffuse large B-cell lymphoma (DLBCL). Its relapse rate is higher than that of nodal DLBCL, often affecting the central nervous system (CNS) with dismal prognosis. PATIENTS AND METHODS We searched for patients with testicular DLBCL (T-DLBCL) involvement from the pathology databases of Southern Finland University Hospitals and the Danish Lymphoma Registry. Clinical information was collected, and outcomes between treatment modalities were evaluated. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were assessed using Kaplan-Meier and Cox proportional hazards methods. RESULTS We identified 235 patients; of whom, 192 were treated with curative anthracycline-based chemotherapy. Full survival data were available for 189 patients. In univariate analysis, intravenous CNS-directed chemotherapy, and irradiation or orchiectomy of the contralateral testis translated into favourable PFS, DSS and OS, particularly among the elderly patients (each p ≤ 0.023). Intrathecal chemotherapy had no impact outcome. In multivariate analyses, the advantage of intravenous CNS-directed chemotherapy (hazard ration [HR] for OS, 0.419; 95% confidence interval [CI], 0.256-0.686; p = 0.001) and prophylactic treatment of contralateral testis (HR for OS, 0.514; 95% CI, 0.338-0.782; p = 0.002) was maintained. Rituximab improved survival only among high-risk patients (International Prognostic Index≥3, p = 0.019). The cumulative risk of CNS progression was 8.4% and did not differ between treatment modalities. CONCLUSION The results support the use of CNS-directed chemotherapy and prophylactic treatment of the contralateral testis in patients with T-DLBCL involvement. Survival benefit appears resulting from better control of systemic disease rather than prevention of CNS progression.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Central Nervous System Neoplasms/mortality
- Central Nervous System Neoplasms/prevention & control
- Central Nervous System Neoplasms/secondary
- Databases, Factual
- Denmark
- Disease Progression
- Finland
- Humans
- Infusions, Intravenous
- Infusions, Spinal
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Male
- Middle Aged
- Orchiectomy
- Progression-Free Survival
- Registries
- Risk Assessment
- Risk Factors
- Testicular Neoplasms/drug therapy
- Testicular Neoplasms/mortality
- Testicular Neoplasms/pathology
- Testicular Neoplasms/radiotherapy
- Time Factors
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Affiliation(s)
- S Mannisto
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
| | - P Vähämurto
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - M Pollari
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - M R Clausen
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - S Jyrkkiö
- Department of Oncology and Radiotherapy, Turku University Central Hospital, Turku, Finland
| | - P-L Kellokumpu-Lehtinen
- Department of Oncology, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - P Kovanen
- Department of Pathology, Helsinki University Hospital, Helsinki, Finland
| | | | - F d'Amore
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | - S Leppä
- Research Program Unit, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Department of Oncology, Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
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18
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Xu H, Yao F. Primary testicular lymphoma: A SEER analysis of 1,169 cases. Oncol Lett 2019; 17:3113-3124. [PMID: 30867741 PMCID: PMC6396186 DOI: 10.3892/ol.2019.9953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/07/2018] [Indexed: 01/22/2023] Open
Abstract
Primary testicular lymphoma (PTL) is a rare lymphoid malignancy. The present retrospective study aimed to investigate the demographic characteristics and survival of patients with PTL, as well as the associated prognostic factors, using a population-based database. All adults diagnosed with PTL in the Surveillance, Epidemiology, and End Results database were identified between 1973 and 2013. The Kaplan-Meier method was used to estimate cause-specific survival (CSS). Log-rank test or multivariate Cox regression model was used to assess the influence of demographic and clinical parameters on CSS. A total of 1,169 patients with PTL were identified from the database, and the median age was 70 years. The predominant histological subtype was diffuse large B-cell lymphoma, which affected 82.9% (970/1,169) of patients, and 68.6% (802/1,169) of patients had early stage disease (stages I–II). Patients >70 years, those diagnosed at the earlier time period, or those who had advanced-stage symptoms had the worst 5-year CSS rates; however, treatment with rituximab significantly improved the 5-year CSS. In conclusion, this retrospective study presented data from the largest cohort of patients with PTL and described the effects of rituximab on the CSS of patients with PTL.
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Affiliation(s)
- Haitao Xu
- Department of Hematology, Anqing Municipal Hospital, Anqing, Anhui 246003, P.R. China
| | - Fusheng Yao
- Department of Hematology, Anqing Municipal Hospital, Anqing, Anhui 246003, P.R. China
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19
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Primary extranodal lymphoma of the glands. Literature review and options for best practice in 2019. Crit Rev Oncol Hematol 2019; 135:8-19. [PMID: 30819450 DOI: 10.1016/j.critrevonc.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 12/04/2018] [Accepted: 01/15/2019] [Indexed: 01/01/2023] Open
Abstract
Primary extranodal non-Hodgkin's lymphomas (EN-NHL) are a heterogeneous group of malignancies that involve numerous entities with significant difference in terms of tumor site locations, prognostic factors, biology expression, and therapeutic options. In the literature, many EN-NHL types were reported from limited series which only allowed narrow views for elucidating prognostic factors and defining the role of loco-regional therapies in the era of new systemic and biologically targeted therapies. The Rare Cancer Network (RCN), an international multidisciplinary consortium, has published a number of reports on several EN-NHL sites which included many gland locations. In this review, we will focus on the recent literature for a selected number of EN-NHL types in both exocrine and endocrine gland locations. We aim to provide renewed and clear messages for the best practice in 2019 for diagnosis, histopathology, treatments, and also their prognostic implications. We believe that better understanding of molecular and genetic characteristics of these particular diseases is crucial for an appropriate management in the era of personalized treatment developments.
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20
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Qualls D, Abramson JS. Advances in risk assessment and prophylaxis for central nervous system relapse in diffuse large B-cell lymphoma. Haematologica 2018; 104:25-34. [PMID: 30573511 PMCID: PMC6312016 DOI: 10.3324/haematol.2018.195834] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/15/2018] [Indexed: 12/13/2022] Open
Abstract
Central nervous sytem recurrence of diffuse large B-cell lymphoma is an uncommon but devastating event, making identification of patients at high risk for relapse within the central nervous system essential for clinicians. Modern risk stratification includes both clinical and biological features. A validated clinical risk model employing the five traditional International Prognostic Index risk factors plus renal or adrenal involvement can identify a high-risk patient population with a central nervous system recurrence risk of greater than 10%. Lymphoma involvement of certain discrete extranodal sites such as the testis also confers increased risk, even in stage I disease. Adverse biological risk factors for central nervous system relapse include presence of translocations of MYC, BCL2 and/or BCL6, in so-called double- or triple-hit lymphoma. Immunohistochemically detectable co-expression of MYC and BCL2 in the absence of translocations also portends an increased risk of relapse within the central nervous system, particularly in the setting of the activated B-cell-like subtype of diffuse large B-cell lymphoma. The role, method, and timing of prophylactic therapy remain controversial based on the available data. We review both intrathecal and systemic strategies for prophylaxis in high-risk patients. Our preference is for systemic methotrexate in concert with standard chemoimmunotherapy in the majority of cases. Several novel agents have also demonstrated clinical activity in primary and secondary central nervous system lymphoma and warrant future investigation in the prophylactic setting.
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Affiliation(s)
- David Qualls
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Jeremy S Abramson
- Center for Lymphoma, Massachusetts General Hospital Cancer Center, Boston, MA, USA
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21
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Lee S, Yamauchi T, Kinoshita K, Imamura S, Kamiya K. High-dose chemotherapy with autologous stem cell transplantation following systemic chemotherapy, prophylactic intrathecal methotrexate, and radiotherapy prevents relapse and improves the outcome of advanced stage primary testicular lymphoma even with cardiac involvement. J Clin Exp Hematop 2017; 57:64-68. [PMID: 28883219 DOI: 10.3960/jslrt.17014] [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: 11/01/2022] Open
Abstract
Primary testicular lymphoma (PTL) is a rare but aggressive disease. Although most patients present in the early stage, their prognosis is poor. Similar with PTL, cardiac lymphoma is also an uncommon disease characterized by its aggressive clinical course and poor prognosis. We herein report an extremely rare case of advanced stage PTL with cardiac involvement, treated by high-dose chemotherapy with autologous stem cell transplantation (HDT-ASCT) followed by systemic chemotherapy, prophylactic intrathecal methotrexate (IT-MTX), and radiotherapy. A 48-year-old man presented with painless left scrotal swelling. He was diagnosed with PTL after orchiectomy, and the histological type was diffuse large B-cell lymphoma. For staging of lymphoma, positron emission tomography was performed, which revealed uptake in the right atrium and early cardiac metastasis within just 2 months after orchiectomy. He underwent 6 cycles of systemic chemotherapy that consisted of rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisolone (R-CHOP). He also received central nervous system prophylaxis 4 times with weekly IT-MTX during the first 2 cycles of R-CHOP. He achieved complete response after 6 cycles of R-CHOP, and underwent HDT-ASCT and radiotherapy as consolidation therapy without irreversible adverse effects. He is currently doing well, with a progression-free survival of 31 months. The above treatment strategy including HDT-ASCT may be one of the treatment options for advanced stage PTL with cardiac metastasis in patients younger than 65 years old.
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Affiliation(s)
- Shin Lee
- Department of Hematology, Fukui Red Cross Hospital
| | - Takahiro Yamauchi
- Department of Hematology and Oncology, Faculty of Medical Sciences, University of Fukui
| | | | - Shin Imamura
- Department of Hematology, Fukui Red Cross Hospital
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22
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Zhou D, Bao C, Ye X, Zhu L, Zhu J, Li L, Zhu M, Yang X, Zheng Y, Huang X, Xie M, Xie W. Clinical and histological features of primary testicular diffuse large B-cell lymphoma: a single center experience in China. Oncotarget 2017; 8:112384-112389. [PMID: 29348832 PMCID: PMC5762517 DOI: 10.18632/oncotarget.19736] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/23/2017] [Indexed: 01/22/2023] Open
Abstract
Primary testicular lymphoma (PTL) is a rare and aggressive form of extranodal lymphoma. Approximately 80–98% of PTLs are diffuse large B-cell lymphoma (PT-DLBCL). The prognosis of DLBCL patients has improved with the addition of rituximab to systemic chemotherapy, but outcomes of PT-DLBCL remain poor. This may be explained by the high rate of relapse in the central nervous system (CNS) and contralateral testis. We analyzed 1,132 newly diagnosed DLBCL patients (37 with PT-DLBCL) who were treated at our hospital between January 2009 and December 2014. Twenty-five patients finished follow-up. We analyzed clinical characteristics, response to chemotherapy, overall survival, and relapse in the CNS and contralateral testis. All patients underwent orchiectomy. The median age was 60 (range: 43–82) years. Eleven patients had stage III/IV disease. Five patients experienced CNS relapse, and three experienced relapse in the contralateral testis. Median overall survival (OS) was not reached at the time of reporting. The 3-year OS rate was 57%. None of the nine patients who received radiotherapy to the contralateral testis experienced relapse in that location. Intrathecal prophylaxis did not reduce the risk of CNS relapse. All five patients who experienced CNS relapse had the germinal center B-cell-like subtype of DLBCL.
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Affiliation(s)
- De Zhou
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Changqian Bao
- Program in Clinical Medicine, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiujin Ye
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Lixia Zhu
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Jingjing Zhu
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Li Li
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mingyu Zhu
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiudi Yang
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yanlong Zheng
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xianbo Huang
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Mixue Xie
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Wanzhuo Xie
- Department of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
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Tokiya R, Yoden E, Konishi K, Kamitani N, Hiratsuka J, Koresawa R, Hirose T, Sano F, Tokunaga H, Kondo T, Wada H, Sugihara T. Efficacy of prophylactic irradiation to the contralateral testis for patients with advanced-stage primary testicular lymphoma: an analysis of outcomes at a single institution. Int J Hematol 2017; 106:533-540. [DOI: 10.1007/s12185-017-2274-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/17/2022]
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Ho JC, Dabaja BS, Milgrom SA, Smith GL, Reddy JP, Mazloom A, Young KH, Deng L, Medeiros LJ, Dong W, Allen PK, Andraos TY, Fowler NH, Nastoupil LJ, Oki Y, Fayad LE, Turturro F, Neelapu SS, Westin J, Hagemeister FB, Rodriguez MA, Pinnix CC. Radiation therapy improves survival in patients with testicular diffuse large B-cell lymphoma<sup/>. Leuk Lymphoma 2017; 58:2833-2844. [PMID: 28482717 DOI: 10.1080/10428194.2017.1312381] [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: 10/19/2022]
Abstract
In 120 Stage I-IV testicular diffuse large B-cell lymphoma (DLBCL) patients treated from 1964 to 2015, we assessed the benefits of prophylactic contralateral testicular radiation (RT) and prophylactic central nervous system (CNS) therapy on overall, progression free, testicular relapse free, and CNS relapse free survival (OS, PFS, TRFS, and CRFS, respectively). Seventy percent of patients received RT, 53% received anthracyclines and rituximab (modern therapy), and 61% received CNS prophylaxis. On univariate analysis RT was associated with improved TRFS, PFS, and trended toward improved OS. On multivariate analysis (MVA), RT was significantly associated with improved OS and PFS; the PFS benefit persisted among patients receiving modern therapy. CNS prophylaxis was associated with improved OS, PFS, and TRFS, but not CRFS on univariate analysis, and was not significant on MVA. RT is associated with improved survival, and should be considered for all testicular DLBCL patients, but additional strategies are needed to prevent CNS relapse.
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Affiliation(s)
- Jennifer C Ho
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Bouthaina S Dabaja
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sarah A Milgrom
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Grace L Smith
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jay P Reddy
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ali Mazloom
- b Tacoma Valley Radiation Oncology , Tacoma , WA , USA
| | - Ken H Young
- c Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Lijuan Deng
- c Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - L Jeffrey Medeiros
- c Department of Hematopathology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Wenli Dong
- d Department of Biostatistics , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Pamela K Allen
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Therese Y Andraos
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Nathan H Fowler
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Loretta J Nastoupil
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Yasuhiro Oki
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Luis E Fayad
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Francesco Turturro
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Sattva S Neelapu
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jason Westin
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Fredrick B Hagemeister
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Maria Alma Rodriguez
- e Department of Lymphoma/Myeloma , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Chelsea C Pinnix
- a Department of Radiation Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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25
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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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26
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Kridel R, Telio D, Villa D, Sehn LH, Gerrie AS, Shenkier T, Klasa R, Slack GW, Tan K, Gascoyne RD, Connors JM, Savage KJ. Diffuse large B-cell lymphoma with testicular involvement: outcome and risk of CNS relapse in the rituximab era. Br J Haematol 2016; 176:210-221. [DOI: 10.1111/bjh.14392] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/31/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Robert Kridel
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - David Telio
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Diego Villa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Laurie H. Sehn
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Alina S. Gerrie
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Tamara Shenkier
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Richard Klasa
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Graham W. Slack
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - King Tan
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
| | - Randy D. Gascoyne
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Pathology; British Columbia Cancer Agency; Vancouver BC Canada
| | - Joseph M. Connors
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
| | - Kerry J. Savage
- Centre for Lymphoid Cancer; British Columbia Cancer Agency; Vancouver BC Canada
- Department of Medical Oncology; University of British Columbia; Vancouver BC Canada
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27
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Xu XQ, Yang P, Zhao W, Wan W, Hu K, Tian L, Ke XY. [Clinical analysis of 16 cases with primary testicular diffuse large B cell lymphoma]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:424-6. [PMID: 27210881 PMCID: PMC7348299 DOI: 10.3760/cma.j.issn.0253-2727.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Indexed: 11/12/2022]
Affiliation(s)
- X Q Xu
- Department of Hematology, Peking University Third Hospital, Beijing 100191, China
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28
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Deng L, Xu-Monette ZY, Loghavi S, Manyam GC, Xia Y, Visco C, Huh J, Zhang L, Zhai Q, Wang Y, Qiu L, Dybkær K, Chiu A, Perry AM, Zhang S, Tzankov A, Rao H, Abramson J, Sohani AR, Xu M, Hsi ED, Zhu J, Ponzoni M, Wang S, Li L, Zhang M, Ferreri AJM, Parsons BM, Li Y, Piris MA, Medeiros LJ, Young KH. Primary testicular diffuse large B-cell lymphoma displays distinct clinical and biological features for treatment failure in rituximab era: a report from the International PTL Consortium. Leukemia 2015; 30:361-72. [DOI: 10.1038/leu.2015.237] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 08/15/2015] [Accepted: 08/18/2015] [Indexed: 12/15/2022]
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29
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Ratkal V, Chawla A, Mishra DK, Monappa V. Testicular non-Hodgkin's lymphoma presenting in a young adult. BMJ Case Rep 2015; 2015:bcr-2014-208633. [PMID: 25795748 DOI: 10.1136/bcr-2014-208633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 27-year-old man who presented with a slowly growing left testicular swelling associated with mild pain over a period of 3 months. He was evaluated by his family physician with scrotal ultrasound and testicular tumour markers. He was diagnosed and treated as epididymo-orchitis and managed with antibiotics. When he later presented to us, he had an enlarged left testis with normal spermatic cord. Scrotal Doppler evaluation showed a globally enlarged left testis and epididymis with increased vascularity in the left testis, with the right testis being normal. Testicular tumour markers were normal. Fine-needle aspiration cytology of the left testis was suggestive of lymphoma. Exploration through an inguinal approach was carried out and a Chevassu manoeuvre with frozen section study was performed, which was reported as non-Hodgkin's lymphoma. Left radical orchidectomy was performed. Histopathology reported diffuse large B-cell lymphoma, of a germinal centre type. Contrast CT of the abdomen, chest and brain were normal. Sperm cryopreservation was carried out. The patient was started on chemotherapy with cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone (CHOP) regime.
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Affiliation(s)
- Vishal Ratkal
- Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Arun Chawla
- Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Dilip Kumar Mishra
- Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vidya Monappa
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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30
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Johnson S, Feldman M, Krishnamurthi V. Primary testicular lymphoma. J Urol 2014; 193:315-6. [PMID: 25444963 DOI: 10.1016/j.juro.2014.10.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Scott Johnson
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Myra Feldman
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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31
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Kim J, Yoon DH, Park I, Kim S, Park JS, Lee SW, Huh J, Park CS, Suh C. Treatment of primary testicular diffuse large B cell lymphoma without prophylactic intrathecal chemotherapy: a single center experience. Blood Res 2014; 49:170-6. [PMID: 25325036 PMCID: PMC4188782 DOI: 10.5045/br.2014.49.3.170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/14/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022] Open
Abstract
Background Primary testicular diffuse large B-cell lymphoma (DLBCL) is a rare but aggressive extranodal lymphoma, and its relapse in the central nervous system (CNS) is a major concern during treatment. Despite this, the role of intrathecal prophylaxis in primary testicular DLBCL remains controversial. Methods We retrospectively reviewed the medical records of 14 patients with primary testicular DLBCL diagnosed between November 2000 and June 2012, and analyzed the CNS relapse rate in patients treated without intrathecal prophylaxis. Survival curves were estimated using the Kaplan-Meier method. Results The median age at diagnosis was 57 years (range, 41-79 years). Unilateral testicular involvement was observed in 13 patients. Nine patients had stage I, 1 had stage II, and 4 had stage IV disease. The international prognostic index was low or low-intermediate risk in 12 patients and high-intermediate risk in 2 patients. Thirteen patients underwent orchiectomy. All the patients received systemic chemotherapy without intrathecal prophylaxis, and prophylactic radiotherapy was administered to the contralateral testis in 12 patients. The median follow-up period of surviving patients was 39 months (range, 10-139 months). Median overall survival was not reached and the median progression-free survival was 3.8 years. Four patients experienced relapse, but CNS relapse was observed in only one patient (7.1%) with stage IV disease, 27 months after a complete response. Conclusion Even without intrathecal prophylaxis, the rate of relapse in the CNS was lower in the Korean patients with primary testicular DLBCL compared to prior reports.
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Affiliation(s)
- Jeongseok Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Inkeun Park
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Shin Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Sun Park
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooryung Huh
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan-Sik Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheolwon Suh
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lokesh KN, Sathyanarayanan V, Kuntegowdanahalli CL, Suresh TM, Dasappa L, Kanakasetty GBK. Primary Diffuse large B-Cell lymphoma of testis: A single centre experience and review of literature. Urol Ann 2014; 6:231-4. [PMID: 25125896 PMCID: PMC4127860 DOI: 10.4103/0974-7796.134277] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/25/2013] [Indexed: 11/05/2022] Open
Abstract
Background: Primary testicular lymphoma constitutes 1-2% of Non-Hodgkin's lymphomas affecting elderly men >60 years of age. Most often it is a Diffuse large B cell lymphoma (DLBCL) and treatment involves multimodality approach involving surgery, chemotherapy and radiotherapy. Outcome remains poor in spite of aggressive therapy. Materials and Methods: We retrospectively reviewed 286 registered cases of DLBCL (aged >14 years) from 2007 to 2011 and found nine primary testicular involvement patients. These cases were analyzed for baseline clinical features, investigations, staging, treatment and outcome. Results: Median age was 58 (46-76) years. All patients presented with testicular swelling, two had the presence of B symptoms, and three with abdominal lymphadenopathy. Six had stage IE disease and three patients had stage IIE. All patients underwent orchiectomy. Eight patients received combination chemotherapy and six completed three or more cycles. Four achieved complete response, among these three relapsed after 32, 42, 70 months and one was lost to follow up. Two had a progressive disease, among these one died of disease and one alive with disease. Complete follow up was available from five patients and median survival was 36 months (11-78 months). Conclusion: Primary testicular DLBCL is uncommon, needs multimodality treatment and central nervous system prophylaxis to improve the survival. The outcome needs to be further investigated using biological approaches (Rituximab based) and/or more aggressive management.
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Affiliation(s)
| | | | | | - T M Suresh
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
| | - Lokanatha Dasappa
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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33
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Rituximab plus a CHOP-like regimen, central nervous system prophylaxis, and contralateral testicular irradiation for localized primary testicular diffuse large B-cell lymphoma lead to prolonged progression-free survival. Int J Hematol 2014; 100:370-8. [DOI: 10.1007/s12185-014-1646-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 12/01/2022]
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DU Z, Wang Y, Zhu P, Leng H, Tang F, Xu X, Chen Z. Primary testicular lymphoma with subcutaneous masses as the sole manifestation of the first relapse and central nervous system lymphoma as the second relapse: A case report and literature review. Oncol Lett 2014; 7:1881-1884. [PMID: 24932252 PMCID: PMC4049739 DOI: 10.3892/ol.2014.2052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 02/26/2014] [Indexed: 12/04/2022] Open
Abstract
Primary testicular lymphoma (PTL) accounts for ~1% of all non-Hodgkin’s lymphomas and has a marked tendency for systemic relapse. The current study presents a unique case of testicular diffuse large B-cell lymphoma of non-germinal center B-cell subtype, with subcutaneous masses as the sole manifestation of the first relapse and central nervous system lymphoma as the second relapse. Subcutaneous relapse and subsequent brain relapse are extremely rare signs of PTL dissemination. The patient received methotrexate-based combined chemotherapy and achieved a partial response. This case presents a rare pattern of treatment failure in this malignant clinical entity.
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Affiliation(s)
- Zunguo DU
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Yin Wang
- Department of Neuropathology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Ping Zhu
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Haiyan Leng
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Feng Tang
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Xiaoping Xu
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
| | - Zi Chen
- Department of Hematology, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China
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35
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Cheah CY, Seymour JF, Dickinson M. Ongoing challenge of optimal patient selection for CNS prophylaxis in patients with non-Hodgkin lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARY CNS relapse is a devastating and frequently lethal complication in patients with lymphoma, and selecting patients to receive CNS-directed prophylaxis is a common and frequently challenging decision for the clinician. Histologic subtype, anatomic location, molecular and clinical risk factors may all be used to stratify patients for CNS risk. In this paper we focus on these issues and attempt to provide practical guidance for the clinician in selecting which patients with lymphoma may benefit from CNS prophylaxis.
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Affiliation(s)
- Chan Yoon Cheah
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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36
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Mihaljevic B, Vukovic V, Smiljanic M, Milic N, Todorovic M, Bila J, Andjelic B, Djurasinovic V, Jelicic J, Antic D. Single-center experience in the treatment of primary testicular lymphoma. Oncol Res Treat 2014; 37:239-42. [PMID: 24853782 DOI: 10.1159/000362399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 03/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Primary testicular lymphoma (PTL) is a rare and highly aggressive extranodal non-Hodgkin's lymphoma. PATIENTS AND METHODS We evaluated the clinical and histopathological features and outcomes of 10 PTL patients treated in the period of 2003-2013 with multimodal therapy (rituximab, CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone), intrathecal prophylaxis, irradiation of the contralateral testis) following orchiectomy. RESULTS Complete remission was achieved in 8 patients after first-line therapy while 2 patients had disease progression. The median follow-up duration was 30 months (range 6-110 months). Relapse occurred in 3 patients. 1 patient relapsed in the contralateral testis, while the other 2 patients relapsed to the skin and the central nervous system (CNS), respectively. The time to relapse was 2, 8, and 9 months. Patients with disease progression and relapse received ESHAP (etoposide, methylprednisolone, cytarabine, and cisplatin) as salvage treatment, except for 1 patient who was treated with palliative radiotherapy. After second-line therapy, only 1 patient had a short partial remission of 2 months. The median overall survival was 48 months, and the mean progression-free survival was 36 months (the median was not reached). CONCLUSIONS We evaluated 10 patients with PTL treated with rituximab plus CHOP, prophylactic intrathecal chemotherapy, and prophylactic irradiation of the contralateral testis, resulting in good outcome and low incidence of relapse in the contralateral testis; however, the benefit of intrathecal chemotherapy is not yet confirmed.
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Abstract
Abstract
Primary testicular lymphoma (PTL) is a rare, clinically aggressive form of extranodal lymphoma. The vast majority of cases are histologically diffuse large B-cell lymphoma, but rarer subtypes are clinically important and must be recognized. In this review, we discuss the incidence, clinical presentation, and prognostic factors of PTL and present a summary of the recent advances in our understanding of its pathophysiology, which may account for the characteristic clinical features. Although outcomes for patients with PTL have historically been poor, significant gains have been made with the successive addition of radiotherapy (RT), full-course anthracycline-based chemotherapy, rituximab and central nervous system–directed prophylaxis. We describe the larger retrospective series and prospective clinical trials and critically examine the role of RT. Although rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone given every 21 days with intrathecal methotrexate and locoregional RT is the current international standard of care, a substantial minority of patients progress, representing an unmet medical need. Finally, we discuss new treatment approaches and recent discoveries that may translate into improved outcomes for patients with PTL.
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Cao B, Ji DM, Zhou XY, Zhao TP, Guo Y, Wang ZH, Cao JN, Hu XC, Hong XN. A clinical analysis of primary testicular diffuse large B-cell lymphoma in China. Hematology 2013; 16:291-7. [DOI: 10.1179/102453311x13085644680221] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Bing Cao
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Dong-Mei Ji
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Yan Zhou
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
- Department of PathologyFudan University Shanghai Cancer Center, Shanghai, China
| | - Ti-Ping Zhao
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Ye Guo
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Zhong-Hua Wang
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Jun-Ning Cao
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Xi-Chun Hu
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
| | - Xiao-Nan Hong
- Department of Medical OncologyFudan University Shanghai Cancer Center, Shanghai, China
- Department of OncologyShanghai Medical College, Fudan University, Shanghai, China
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Tsai YL, Hsieh PF, Lin WY, Su HH, Chuang CK, Chang YH, Chuang HC, Yu KJ, Shao IH, Chang CH, Wu HC, Chen KL, Huang CP, Wand SM, Chiang PH, Cheng YT, Lee WC, Pang ST. A retrospective study of clinical characteristics and prognostic factors of primary testicular lymphoma. UROLOGICAL SCIENCE 2013. [DOI: 10.1016/j.urols.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hatjiharissi E, Diamantidis MD, Papaioannou M, Dimou T, Chrisoulidou A, Patakiouta F, Constantinou N, Pazaitou-Panayiotou K. Long-term outcome of primary endocrine non-Hodgkin lymphomas: does the site make the difference? QJM 2013; 106:623-30. [PMID: 23426729 DOI: 10.1093/qjmed/hct048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AIM Primary lymphomas of endocrine glands are extremely rare. Our study adds more data to the few published series regarding the incidence, clinical characteristics, management and overall survival (OS) by comparing the various diffuse large B-cell endocrine lymphomas. Moreover, it contributes to a better understanding of these neoplasms and provides concepts for future research. METHODS We retrospectively evaluated the clinical profile and the patterns of outcome among patients who were treated in our center with the diagnosis of aggressive, B-cell, primary endocrine lymphoma. RESULTS Between May 1980 and December 2011, 450 patients were diagnosed as primary extranodal non-Hodgkin lymphomas. Among them, 18 cases (4%) were primary testicular lymphoma (PTL), 8 cases (2%) were primary thyroid lymphoma (PTHL) and 4 cases (1%) were primary adrenal lymphoma (PAL). The therapeutic approaches employed were variable, including mainly chemotherapy in combination with radiotherapy and surgery. The median OS for the patients with PTL and PAL was 27 and 6 months, respectively. Better outcome was observed in patients with PTHL for whom the median OS has not been reached yet, whereas the PAL group had the worst prognosis. CONCLUSIONS The discrepancies in the outcome among endocrine lymphomas could be partly attributed to their biologic variability, which might be determined by the initial site involved. We conclude that treatment decisions should be made according to a multi-disciplinary approach to avoid unnecessary surgery. Existing treatment strategies for PTL and PAL fail to provide long-term survival, rendering the application of novel therapeutic approaches essential.
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Affiliation(s)
- E Hatjiharissi
- Department of Hematology-Oncology, Theagenio Cancer Hospital, 2 Al. Simeonidis Street, Thessaloniki 54007, Greece.
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Wang Y, Li ZM, Huang JJ, Xia Y, Li H, Li YJ, Zhu YJ, Zhao W, Xia XY, Wei WX, Huang HQ, Lin TY, Jiang WQ. Three prognostic factors influence clinical outcomes of primary testicular lymphoma. Tumour Biol 2012; 34:55-63. [DOI: 10.1007/s13277-012-0510-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 08/30/2012] [Indexed: 11/24/2022] Open
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Guirguis HR, Cheung MC, Mahrous M, Piliotis E, Berinstein N, Imrie KR, Zhang L, Buckstein R. Impact of central nervous system (CNS) prophylaxis on the incidence and risk factors for CNS relapse in patients with diffuse large B-cell lymphoma treated in the rituximab era: a single centre experience and review of the literature. Br J Haematol 2012; 159:39-49. [DOI: 10.1111/j.1365-2141.2012.09247.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/15/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Hany R. Guirguis
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
| | - Matthew C. Cheung
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
| | - Mervat Mahrous
- Clinical Oncology; Minia University Hospital; El Minia; Egypt
| | - Eugenia Piliotis
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
| | - Neil Berinstein
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
| | - Kevin R. Imrie
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
| | - Liying Zhang
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
| | - Rena Buckstein
- Hematology/Oncology; Sunnybrook Odette Cancer Center; University of Toronto; Toronto; ON; Canada
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Brouwer CL, Wiesendanger EM, van der Hulst PC, van Imhoff GW, Langendijk JA, Beijert M. Scrotal irradiation in primary testicular lymphoma: review of the literature and in silico planning comparative study. Int J Radiat Oncol Biol Phys 2012; 85:298-308. [PMID: 22836054 DOI: 10.1016/j.ijrobp.2012.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 06/08/2012] [Accepted: 06/13/2012] [Indexed: 12/25/2022]
Abstract
We examined adjuvant irradiation of the scrotum in primary testicular lymphoma (PTL) by means of a literature review in MEDLINE, a telephone survey among Dutch institutes, and an in silico planning comparative study on scrotal irradiation in PTL. We did not find any uniform adjuvant irradiation technique assuring a safe planning target volume (PTV) coverage in published reports, and the definition of the clinical target volume is unclear. Histopathologic studies of PTL show a high invasion rate of the tunica albuginea, the epididymis, and the spermatic cord. In retrospective studies, a prescribed dose of at least 30 Gy involving the scrotum is associated with best survival. The majority of Dutch institutes irradiate the whole scrotum without using a planning computed tomography scan, with a single electron beam and a total dose of 30 Gy. The in silico planning comparative study showed that all evaluated approaches met a D(95%) scrotal dose of at least 85% of the prescription dose, without exceeding the dose limits of critical organs. Photon irradiation with 2 oblique beams using wedges resulted in the best PTV coverage, with a mean value of 95% of the prescribed dose, with lowest maximum dose. Adjuvant photon or electron irradiation of the whole scrotum including the contralateral testicle with a minimum dose of 30 Gy is recommended in PTL. Computed tomography-based radiation therapy treatment planning with proper patient positioning and position verification guarantees optimal dose coverage.
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Affiliation(s)
- Charlotte L Brouwer
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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Perry AM, Mitrovic Z, Chan WC. Biological Prognostic Markers in Diffuse Large B-Cell Lymphoma. Cancer Control 2012; 19:214-26. [DOI: 10.1177/107327481201900306] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Anamarija M. Perry
- Department of Pathology and Microbiology at the Nebraska Medical Center, Omaha, Nebraska
| | - Zdravko Mitrovic
- Department of Internal Medicine, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Wing C. Chan
- Department of Pathology and Microbiology at the Nebraska Medical Center, Omaha, Nebraska
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Dahiya S, Ooi WB, Mallidi J, Sivalingam S, Steingart R. Primary testicular lymphoma with cardiac involvement in an immunocompetent patient: case report and a concise review of literature. Rare Tumors 2012; 4:e43. [PMID: 23087799 PMCID: PMC3475950 DOI: 10.4081/rt.2012.e43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 06/20/2012] [Accepted: 06/25/2012] [Indexed: 11/23/2022] Open
Abstract
Primary testicular lymphoma (PTL) is a rare testicular tumor representing less than 9% of all testicular cancers. PTL usually tends to spread to or relapse at nodal structures or extra-nodal sites such as contralateral testes, central nervous system, skin, lung, pleura, waldeyer's ring and soft tissues. We present a case of PTL with huge left atrial mass, an extremely unusual site of involvement. Early disease usually carries a good prognosis, whereas advanced stage carries an extremely poor prognosis. Herein, we report the complete remission to date in a patient with advanced stage PTL with huge left atrial mass, treated with systemic rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone and intrathecal methotrexate. A brief review of literature focusing on various aspects of management of primary testicular lymphoma and lymphomatous involvement of heart is also discussed.
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Affiliation(s)
- Saurabh Dahiya
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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Ahmad SS, Idris SF, Follows GA, Williams MV. Primary testicular lymphoma. Clin Oncol (R Coll Radiol) 2012; 24:358-65. [PMID: 22424983 DOI: 10.1016/j.clon.2012.02.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 02/08/2012] [Indexed: 10/28/2022]
Abstract
Primary testicular non-Hodgkin lymphoma (PTL) comprises around 9% of testicular cancers and 1-2% of all non-Hodgkin lymphomas. Its incidence is increasing and it primarily affects older men, with a median age at presentation of around 67 years. By far the most common histological subtype is diffuse large B-cell lymphoma, accounting for 80-90% of PTLs. Most patients present with a unilateral testicular mass or swelling. Up to 90% of patients have stage I or II disease at diagnosis (60 and 30%, respectively) and bilateral testicular involvement is seen in around 35% of patients. PTL demonstrates a continuous pattern of relapse and propensity for extra-nodal sites such as the central nervous system and contralateral testis. Retrospective data have emphasised the importance of prophylactic radiotherapy in reducing recurrence rates within the contralateral testis. Recent outcome data from the prospective IELSG-10 trial have shown far better progression-free and overall survival than historical outcomes. This supports the use of orchidectomy followed by Rituximab- cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP), central nervous system prophylaxis and prophylactic radiotherapy to the contralateral testis with or without nodal radiotherapy in patients with limited disease. Central nervous system relapse remains a significant issue and future research should focus on identifying the best strategy to reduce its occurrence. Here we discuss the evidence supporting combination chemotherapy and radiotherapy in PTL.
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Affiliation(s)
- S S Ahmad
- The Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
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Takahashi H, Tomita N, Yokoyama M, Tsunoda S, Yano T, Murayama K, Hashimoto C, Tamura K, Sato K, Ishigatsubo Y. Prognostic impact of extranodal involvement in diffuse large B-cell lymphoma in the rituximab era. Cancer 2011; 118:4166-72. [PMID: 22213346 DOI: 10.1002/cncr.27381] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 10/25/2011] [Accepted: 11/29/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extranodal involvement is considered a poor prognostic factor for patients with diffuse large B-cell lymphoma (DLBCL); however, the prognostic impact of specific sites of involvement has not been fully elucidated. METHODS The authors retrospectively analyzed 1221 patients treated uniformly with standard R-CHOP therapy between 2003 and 2006. Patients with distinct forms of DLBCL such as intravascular lymphoma, primary effusion lymphoma, pyothorax-associated lymphoma, primary central nervous system lymphoma, and intraocular lymphoma were also excluded. The authors evaluated 26 extranodal sites of involvement with respect to prognostic impact. The median age was 64 years (range, 15-91 years). RESULTS Univariate analysis revealed that patients with involvement of specific extranodal sites had significantly worse overall survival (OS) than did patients without such involvement; these sites included nasal cavity, paranasal sinus, lung, pleura, small intestine, peritoneum, liver, pancreas, stomach, spleen, adrenal gland, testis, bone, bone marrow, peripheral blood, skin, and subcutaneous tissue. Patients with Waldeyer ring involvement had significantly better OS. Multivariate analysis revealed that patients with the involvement of the pleura (P < .001), small intestine (P = .015), peritoneum (P = .002), adrenal gland (P < .001), testis (P = .005), bone marrow (P < .001), and peripheral blood (P = .002) had significantly worse OS, whereas those with Waldeyer ring involvement had significantly better OS (P = .038). Subgroup analysis with the nodal and/or Waldeyer patient group also showed prognostic impact of Waldeyer ring by multivariate analysis (relative risk, 0.3; P = .04). CONCLUSIONS Extranodal involvement affects the prognosis of patients undergoing R-CHOP therapy for DLBCL.
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Affiliation(s)
- Hiroyuki Takahashi
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Mise au point sur le lymphome testiculaire primaire. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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