1
|
Huang HH, Qing X. When Lymphoma Strikes the Pancreas: A Rare Presentation of Systemic Anaplastic Lymphoma Kinase-Negative Anaplastic Large Cell Lymphoma in a Human Immunodeficiency Virus-Positive Patient. J Hematol 2023; 12:236-242. [PMID: 37936974 PMCID: PMC10627364 DOI: 10.14740/jh1138] [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: 05/31/2023] [Accepted: 09/04/2023] [Indexed: 11/09/2023] Open
Abstract
Anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL) is an uncommon subtype of non-Hodgkin lymphoma, with pancreatic involvement being exceedingly rare and documented in only a handful of case reports. We present a unique case of a 31-year-old human immunodeficiency virus (HIV)-positive male with multisite ALK-negative ALCL, who initially presented with a buttock ulcer, leading to a suspicion of primary cutaneous ALCL or lymphomatoid papulosis. However, the discovery of multiple extracutaneous sites, including an atypical pancreatic head involvement, confirmed the diagnosis of systemic ALK-negative ALCL with cutaneous manifestation. The patient received six cycles of brentuximab vedotin + cyclophosphamide-doxorubicin-prednisone (BV + CHP) treatment, achieving a substantial reduction in the size of the pancreatic head mass and no detectable fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan. This case underscores the diagnostic challenges of ALK-negative ALCL in HIV-positive patients with extranodal presentations and demonstrates the potential effectiveness of targeted therapeutic strategies for such cases.
Collapse
Affiliation(s)
- Hehua Hannah Huang
- Department of Pathology and Laboratory Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Xin Qing
- Department of Pathology and Laboratory Medicine, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| |
Collapse
|
2
|
Chen L, Krause JR, Zhang H. Primary anaplastic large cell lymphomas of the pancreas. Proc AMIA Symp 2022; 35:675-677. [DOI: 10.1080/08998280.2022.2082228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Ling Chen
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - John R. Krause
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| | - Haiying Zhang
- Department of Pathology, Baylor University Medical Center, Dallas, Texas
| |
Collapse
|
3
|
Facchinelli D, Boninsegna E, Visco C, Tecchio C. Primary Pancreatic Lymphoma: Recommendations for Diagnosis and Management. J Blood Med 2021; 12:257-267. [PMID: 33981170 PMCID: PMC8107008 DOI: 10.2147/jbm.s273095] [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: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary pancreatic lymphoma (PPL) is a rare disease representing 0.1% of all malignant lymphomas, which lacks well-defined diagnostic and therapeutic protocols. We conducted a systematic review to analyze demographic, diagnostic and therapeutic features of PPL. METHODS This review identified small series and single case reports. Sources were MEDLINE, PubMed, and the Cochrane library from January 2001 to December 2020. Data were screened, extracted and the risk of bias analyzed by three independent reviewers. RESULTS A total of 107 eligible papers (17 small series, 90 single case reports) describing 266 patients were identified. Patients had a median age of 53.1 (range 3-86) years and were males in 64.6% of cases. Abdominal pain and jaundice were the most common presenting symptoms, affecting 75.3% and 41.8% of patients, respectively. PPL had a median size of 60.6 mm (range 16-200) and it was localized in the pancreatic head in 63.7% of cases. At diagnosis most patients underwent ultrasonography followed by computed tomography. PPL typically showed low echogenicity, and lower contrast enhancement than solid tumors. Histopathological specimens were obtained by percutaneous or endoscopic biopsies in 47.7% of patients; abdominal surgery was performed in 33.5% of cases. Overall, diffuse large B-cell lymphoma was the most frequent histological diagnosis (53.6%). However, patients aged <18 years were affected by Burkitt lymphoma in 52.4% of cases. Most patients (53.6%) received immunochemotherapy (IC) or IC plus radiotherapy (14%). Demolitive surgery appeared to be associated with impaired survival. Central nervous system (CNS) relapse or progression was observed in 20% of patients. CONCLUSION PPL is a rare entity, with some peculiar features at modern imaging. For diagnostic purposes percutaneous or endoscopic biopsies might be preferable, as opposed to surgery. No definite data is available about the optimal treatment, which should be tailored on the histological type and associated with CNS prophylaxis.
Collapse
Affiliation(s)
| | - Enrico Boninsegna
- Department of Radiology, Azienda Socio Sanitaria Territoriale, Mantova, Italy
| | - Carlo Visco
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Cristina Tecchio
- Hematology and Bone Marrow Transplant Unit, Department of Medicine, University of Verona, Verona, Italy
| |
Collapse
|
4
|
Mohapatra S, Mishra P, Patra S, Srinivasan A, Padhi S, Sable M, Samal S. Primary gastrointestinal anaplastic large cell lymphoma: A critical reappraisal with a systematic review of the world literature. J Cancer Res Ther 2021; 17:1307-1313. [DOI: 10.4103/jcrt.jcrt_955_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
5
|
Abstract
Anaplastic large cell lymphoma is an exceedingly rare subtype of non-Hodgkin lymphoma with fewer than 10 cases reported in the literature. We present a 64-year-old woman who presented with a pancreatic head mass, causing acute pancreatitis, which was eventually diagnosed as an anaplastic large cell lymphoma. The disease is very responsive to chemotherapy, further highlighting the importance of early recognition and treatment.
Collapse
|
6
|
Abstract
Aims and backgrounds Primary pancreatic lymphoma is non-Hodgkin lymphoma primarily involving the pancreas, which is rare in pancreatic diseases. The aim of this work is to summarize the diagnostic and therapeutic experience of primary pancreatic lymphoma. Methods We retrospectively reviewed the clinical data of 7 cases of primary pancreatic lymphoma admitted to Huashan Hospital in the past 3 years. Available English literature was also reviewed using the following terms: primary pancreatic lymphoma and pancreatic lymphoma. Results The literature review identified 157 additional cases, and a total of 164 cases had been analyzed. In this series, only 30% had a successful non-operative diagnosis. The curative rate of the surgery-adjuvant chemotherapy group was higher than that of the chemotherapy alone group. Conclusions Obtaining specimens through surgery is an effective diagnostic tool. Surgical resection in combination with postoperative chemotherapy plays a therapeutic role.
Collapse
Affiliation(s)
- Guopei Luo
- Pancreatic Disease Institute, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Chen Jin
- Pancreatic Disease Institute, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Deliang Fu
- Pancreatic Disease Institute, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiang Long
- Pancreatic Disease Institute, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Feng Yang
- Pancreatic Disease Institute, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Quanxing Ni
- Pancreatic Disease Institute, Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Philips CA, Augustine P, Joseph G, Kumar L, Mahadevan P. A Rare Surprising Cause of Acute Severe Pancreatitis. J Clin Diagn Res 2017; 11:OD03-OD04. [PMID: 28969182 DOI: 10.7860/jcdr/2017/27421.10386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/08/2017] [Indexed: 11/24/2022]
Abstract
A 39-year-old woman is admitted with clinical, biochemical and imaging features suggestive of acute pancreatitis. Conservative and guideline based management failed to improve her condition. Repeate the imaging utilizing contrast revealed the progression of extra-pancreatic signs in the absence of pancreatic necrosis, the absence of intra-abdominal fluid collections, but enhancing omental and peritoneal deposits and obstructive pancreatitis. A biopsy and histopathological evaluation of the omentum revealed rare anaplastic large cell lymphoma causing obstructive pancreatitis. In patients who present with pancreatitis not responding to conventional treatment and with an atypical disease course, the diagnostic possibility of rare causes of pancreatitis such as obstructive/infiltrative pathology must be thought of.
Collapse
Affiliation(s)
- Cyriac Abby Philips
- Associate Director, Department of Hepatology and Liver Transplant Medicine, PVS Institute of Digestive Diseases, Kochi, Kerala, India
| | - Philip Augustine
- Chairman, Department of Gastroenterology, PVS Institute of Digestive Diseases, Kochi, Kerala, India
| | - George Joseph
- Senior Consultant, Department of Radiology, PVS Institute of Digestive Diseases, Kochi, Kerala, India
| | - Lijesh Kumar
- Consultant, Department of Radiology, PVS Institute of Digestive Diseases, Kochi, Kerala, India
| | - Pushpa Mahadevan
- Head, Department of Pathology, Lakeshore Hospital, Kochi, Kerala, India
| |
Collapse
|
8
|
Anaplastic Lymphoma Kinase-Negative Anaplastic Large Cell Lymphoma Manifesting as a Scalp Hematoma After an Acute Head Injury-a Case Report and Literature Review. World Neurosurg 2015; 88:688.e13-688.e16. [PMID: 26615790 DOI: 10.1016/j.wneu.2015.11.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Anaplastic large cell lymphoma (ALCL) is a malignant non-Hodgkin lymphoma, typically associated with anaplastic lymphoma kinase (ALK) expression. In some cases, lack of ALK translocation correlated with a more unfavorable prognosis. CASE DESCRIPTION We describe a case of ALK(-) ALCL that manifested as a progressive, enlarged, swollen mass on the scalp after an acute head injury in an 84-year-old man. Neither palpable lymph nodes nor any B symptoms were noted on admission. Brain computed tomography showed a hematoma in the right posterior occipital region of the scalp as the only remarkable finding. Débridement and biopsy were performed. Histologic and immunohistochemical analysis of the specimen revealed an ALK(-) ALCL of the scalp. The lymphoma was resistant to bendamustine-containing chemotherapies, ultimately leading to the patient's death within 2 months. CONCLUSIONS This case report highlights the importance of recognizing the possibility of an ALCL manifesting as a focal inflammatory swelling mass on the scalp.
Collapse
|
9
|
|
10
|
Anaplastic large cell lymphoma, ALK-negative. Crit Rev Oncol Hematol 2012; 85:206-15. [PMID: 22789917 DOI: 10.1016/j.critrevonc.2012.06.004] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/11/2012] [Accepted: 06/15/2012] [Indexed: 12/20/2022] Open
Abstract
Anaplastic large cell lymphoma (ALCL), anaplastic lymphoma kinase (ALK)-negative (ALCL-ALK-) is a provisional entity in the WHO 2008 Classification that represents 2-3% of NHL and 12% of T-cell NHL. No particular risk factor has been clearly identified for ALCL, but a recent study showed an odds ratio of 18 for ALCL associated with breast implants. Usually, the architecture of involved organs is eroded by solid, cohesive sheets of neoplastic cells, with peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) and classical Hodgkin lymphoma being the main differential diagnoses. In this regard, staining for PAX5 and CD30 is useful. Translocations involving ALK are absent, TCR genes are clonally rearranged. CGH and GEP studies suggest a tendency of ALCL-ALK- to differ both from PTCL-NOS and from ALCL-ALK+. Patients with ALCL-ALK- are usually adults with a median age of 54-61 years, and a male-to-female ratio of 0.9. At presentation, ALCL-ALK- is often in III-IV stage, with B symptoms, high International Prognostic Index score, high lactate dehydrogenase serum levels, and an aggressive course. ALCL-ALK- presents with lymph node involvement in ∼50% of cases; extranodal spread (20%) is less common. Staging work-up for ALCL-ALK- is similar to that routinely used for nodal NHL. Overall prognosis is poor, with a 5-year OS of 30-49%, which is significantly worse when compared to OS reported in patients with ALCL-ALK+ (5-year: 70-86%). Patients with systemic ALCL exhibit a significantly better survival compared with patients with PTCL-NOS, with a 5-year OS of 51% and 32%, respectively. Age, PIT scoring system, β2-microglobulin, and bone marrow infiltration are the main prognostic factors. The expression of proteins involved in the regulation of apoptosis (caspase 3, Bcl-2, PI9) and of CD56 is related to clinical outcome. ALCL-ALK- is generally responsive to doxorubicin-containing chemotherapy, but relapses are frequent. CHOP is the most commonly used regimen to treat systemic ALCL with complete remission rates of 56%, and a 10-year DFS of 28%. Encouraging results have been reported with more intensive chemotherapy regimens. The addition of etoposide improved outcome. Alemtuxumab-CHOP regimen was associated with excellent remission rate but increased toxicity. The role of high-dose chemotherapy supported by ASCT has not been investigated in a trial of exclusively ALCL patients. When used in first remission, it was associated with a 5-year PFS of 64%. High-dose chemotherapy with ASCT is the standard therapeutic option for patients with relapsed or refractory disease. The role of allogeneic transplantation in patients with relapsed/refractory ALCL remains to be defined but there are data to support the contention that a graft-versus-lymphoma effect does exist. Myeloablative conditioning has been associated with 5-year PFS and OS of 40% and 41%, respectively, but a 5-year TRM of 33% was reported. Allo-SCT can be an option for relapsed/refractory ALCL in younger patients, preferably in the setting of a clinical trial. Pralatrexate, anti-CD30 monoclonal antibodies, brentuximab vedotin (SGN-35) in particular, (131)I-anti-CD45 radioantibody, yttrium-anti-CD25 radioimmunoconjugates, histone deacetylase inhibitors, bortezomib, gemcitabine, vorinostat, lenalidomide, and their combinations represent the most appealing chemotherapy and/or targeted agents to be investigated in future trials.
Collapse
|
11
|
Ghobakhlou M, Alizadeh AHM, Naderi N, Haghighi S, Molaei M, Rafiezadeh M, Zali MR. A patient with chronic hepatitis C and a pancreatic mass in endoscopic ultrasound. Case Rep Gastroenterol 2012; 6:387-93. [PMID: 22855657 PMCID: PMC3398077 DOI: 10.1159/000339693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
We report a rare case of pancreas tumor (lymphoma) in a patient with a history of chronic hepatitis C virus (HCV) infection without treatment, with a high viral load (20,199,805 IU/ml). He presented with abdominal pain, jaundice, weight loss and sweating. Computed tomography showed a hypodense mass located in the head of the pancreas, and immunohistochemistry of a specimen obtained by endoscopic ultrasound-guided fine needle aspiration revealed non-Hodgkin's lymphoma of the pancreas, B cell type. An association of HCV infection with pancreatic lymphoma has only been reported rarely in the literature and its clinical significance is uncertain.
Collapse
Affiliation(s)
| | - Amir Houshang Mohammad Alizadeh
- Research Center for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Taleghani Hospital, Tehran, Iran
| | | | | | | | | | | |
Collapse
|
12
|
Rock J, Bloomston M, Lozanski G, Frankel WL. The spectrum of hematologic malignancies involving the pancreas: potential clinical mimics of pancreatic adenocarcinoma. Am J Clin Pathol 2012; 137:414-22. [PMID: 22338053 DOI: 10.1309/ajcpcxw7qug9efto] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Hematologic malignancies often involve the pancreas, causing potential diagnostic pitfalls and, rarely, potentially avoidable surgical resection. We review the spectrum of hematologic malignancies involving the pancreas and describe features useful in preoperative distinction from adenocarcinoma. Archived clinical, pathologic, and radiologic data (1965 to present) for hematologic malignancies involving the pancreas were reviewed and compared with the data for 157 surgically resected pancreatic adenocarcinomas. Of 42 cases, 27 (64%) were clinically "suspicious" for hematologic malignancies. Of the remaining 15 cases, 4 patients underwent resection for presumed pancreatic adenocarcinoma. Isolated pancreatic masses proved most difficult to identify clinically. Significant factors in distinguishing hematologic malignancies from adenocarcinoma included history of hematologic malignancy, young age, large tumor size, low CA19-9 level, B symptoms, and lack of jaundice or diabetes mellitus. Various hematologic malignancies involve the pancreas, most commonly diffuse large B-cell lymphoma. Pancreatic masses are usually correctly identified clinically. Preoperative and operative sampling is strongly recommended when hematologic malignancies cannot be excluded.
Collapse
|
13
|
Mosunjac MB, Sundstrom JB, Mosunjac MI. Unusual presentation of anaplastic large cell lymphoma with clinical course mimicking fever of unknown origin and sepsis: autopsy study of five cases. Croat Med J 2009; 49:660-8. [PMID: 18925700 DOI: 10.3325/cmj.2008.5.660] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM To describe a subset of cases with the unusual clinical and histomorphological presentation of anaplastic large cell lymphoma (ALCL) mimicking fever of unknown origin (FUO) and sepsis. METHODS A pathology database was searched using full term Systematized Nomenclature of Medicine codes for ALCL to identify 23ALCL cases from the period 1999-2006. Of those, five cases that did not have a correct premortem diagnosis were further analyzed to elucidate the reasons for delayed and incorrect pre-mortem diagnosis. The analyzed data included clinical presentation, duration of symptoms, duration of hospital stay, premortem presumed cause of death, white blood cell count, platelet count, anion gap and blood pH, liver enzymes (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, alkaline phosphatase), lactate, coagulation tests (prothrombin time, partial thromboplastin time, fibrinogen, D-dimers), microbiology cultures, and radiology and surgical pathology reports. Autopsy reports were reviewed for description of major gross findings, initial clinical diagnosis, and cause of death. RESULTS Five fatal and pre-mortem unrecognized ALCL cases were characterized by rapid decline, with histologic findings showing predominantly extranodal involvement, intravascular lymphomatosis, and hemophagocytosis. The cases were also characterized by unusual clinical manifestations including a FUO, sepsis, and disseminated intravascular coagulation-like picture, lactic acidosis, hepatosplenomegaly, and absence of significant peripheral adenopathy. CONCLUSIONS There is a distinct group of ALCLs with unique and specific clinical, gross autopsy, and histopathologic findings. Recognition of this clinical variant may facilitate early detection and potentially timely diagnosis and therapy.
Collapse
Affiliation(s)
- Marina B Mosunjac
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Room CG 42, Atlanta, GA 30303, USA.
| | | | | |
Collapse
|
14
|
Liakakos T, Misiakos EP, Tsapralis D, Nikolaou I, Karatzas G, Macheras A. A role for surgery in primary pancreatic B-cell lymphoma: a case report. J Med Case Rep 2008; 2:167. [PMID: 18489739 PMCID: PMC2396657 DOI: 10.1186/1752-1947-2-167] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 05/19/2008] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Primary pancreatic lymphoma is a very rare but manageable malignant tumour which may be clinically confused as a pancreatic carcinoma. This case report demonstrates the value of surgical resection in the management of pancreatic lymphoma. CASE PRESENTATION We report a case of a 65-year-old man who was admitted with obstructive jaundice, vague upper abdominal pain and weight loss. Ultrasonography and computed tomography showed a mass at the head of the pancreas which was compressing the bile duct. The patient underwent pancreaticoduodenectomy. Histopathologic and immunohistochemical assessment of the pancreatic lesion established the diagnosis of a diffuse, extranodal, high-grade B-cell non-Hodgkin's lymphoma. Several doses of chemotherapy were administered postoperatively and at present the disease remains in remission. CONCLUSION The favourable outcome for this patient and a thorough review of the literature underline the important role that operative resection may have in the management of at least the early stage of primary pancreatic lymphoma.
Collapse
Affiliation(s)
- Theodore Liakakos
- Third Department of Surgery, University of Athens School of Medicine, Attikon University Hospital, Rimini 1 Street, Chaidari, Athens, Greece.
| | | | | | | | | | | |
Collapse
|