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El Fakih R, Bajuaifer YS, Shah AY, Sulaiman R, Almohamady R, ELGohary G, Alothaimeen HS, Aljurf M. Paraneoplastic syndromes associated with classic Hodgkin lymphoma, a systematic literature review. Ann Hematol 2024; 103:1131-1137. [PMID: 37428199 DOI: 10.1007/s00277-023-05357-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
PNS are uncommon manifestations of cancer. The current literature about these syndromes in the setting of cHL is disintegrated. A systematic literature review of all published literature was conducted. One hundred twenty-eight patients from 115 publications met the inclusion/exclusion criteria. Eight-five patients were of the NS subtype (66.4%). The most frequent clinical presentation of the PNS was CNS manifestation (25.8%). The majority of patients were diagnosed with the cHL and PNS simultaneously (42.2%). In 33.6% of patients, the lymphoma diagnosis preceded the PNS diagnosis. In 16.4% of patients, the PNS diagnosis preceded the lymphoma diagnosis. The presence of PNS antibodies was reported in 35 patients (27.3%). Age older than 18 was associated with higher prevalence of PNS. The CR rate of the lymphoma was 77.3%. The complete resolution rate of the PNS was 54.7%. Relapse of lymphoma was reported in 13 patients, and recurrence of the PNS upon relapse was reported in 10/13 patients.
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Affiliation(s)
- Riad El Fakih
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia.
| | - Yazeed S Bajuaifer
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Amna Yousaf Shah
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Reem Sulaiman
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Rawan Almohamady
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Ghada ELGohary
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
- Oncology Center, University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Haya S Alothaimeen
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Centre, PO Box 3354, Riyadh, 11471, Saudi Arabia
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2
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Xu J, Liu Y, Yang F, Cao Y, Chen W, Li JSS, Zhang S, Comjean A, Hu Y, Perrimon N. Mechanistic characterization of a Drosophila model of paraneoplastic nephrotic syndrome. Nat Commun 2024; 15:1241. [PMID: 38336808 PMCID: PMC10858251 DOI: 10.1038/s41467-024-45493-8] [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: 04/11/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
Paraneoplastic syndromes occur in cancer patients and originate from dysfunction of organs at a distance from the tumor or its metastasis. A wide range of organs can be affected in paraneoplastic syndromes; however, the pathological mechanisms by which tumors influence host organs are poorly understood. Recent studies in the fly uncovered that tumor secreted factors target host organs, leading to pathological effects. In this study, using a Drosophila gut tumor model, we characterize a mechanism of tumor-induced kidney dysfunction. Specifically, we find that Pvf1, a PDGF/VEGF signaling ligand, secreted by gut tumors activates the PvR/JNK/Jra signaling pathway in the principal cells of the kidney, leading to mis-expression of renal genes and paraneoplastic renal syndrome-like phenotypes. Our study describes an important mechanism by which gut tumors perturb the function of the kidney, which might be of clinical relevance for the treatment of paraneoplastic syndromes.
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Affiliation(s)
- Jun Xu
- CAS Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Plant Sciences, Shanghai Institute of Plant Physiology and Ecology, Chinese Academy of Sciences, Shanghai, China.
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
| | - Ying Liu
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
| | - Fangying Yang
- CAS Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Plant Sciences, Shanghai Institute of Plant Physiology and Ecology, Chinese Academy of Sciences, Shanghai, China
| | - Yurou Cao
- CAS Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Plant Sciences, Shanghai Institute of Plant Physiology and Ecology, Chinese Academy of Sciences, Shanghai, China
| | - Weihang Chen
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Joshua Shing Shun Li
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Shuai Zhang
- CAS Key Laboratory of Insect Developmental and Evolutionary Biology, CAS Center for Excellence in Molecular Plant Sciences, Shanghai Institute of Plant Physiology and Ecology, Chinese Academy of Sciences, Shanghai, China
| | - Aram Comjean
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Yanhui Hu
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA
| | - Norbert Perrimon
- Department of Genetics, Blavatnik Institute, Harvard Medical School, Boston, MA, USA.
- Howard Hughes Medical Institute, Boston, MA, USA.
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3
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Shervedani AK, Tabibian F, Khotbesara MG, Adibi I. Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids triggered by Hodgkin's lymphoma: A case report and brief literature review. Clin Case Rep 2024; 12:e8377. [PMID: 38161651 PMCID: PMC10753635 DOI: 10.1002/ccr3.8377] [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: 09/05/2023] [Revised: 11/27/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Key Clinical Message We presented a patient, diagnosed with lymphoma-associated CLIPPERS, 11 years after lymphoma treatment. Therefore, CLIPPERS may be paraneoplastic neurological syndrome of lymphoma, which needs to be considered in the follow-up of lymphoma cases. Abstract Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare central nervous system disorder with a recent increase in incidence. There are few reports of lymphoma-associated CLIPPERS, although the relationship between these two diseases and the pathophysiology of CLIPPERS in general need further investigation. Here, we present a patient with a history of Hodgkin's lymphoma (HL) more than 10 years before the onset of CLIPPERS, in contrast to the majority of previously reported lymphoma-associated cases, and discuss the possibility that CLIPPERS is the paraneoplastic neurological syndrome of HL. This highlights the need to consider CLIPPERS as a differential diagnosis during follow-up of patients with a history of lymphoma.
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Affiliation(s)
| | - Farinaz Tabibian
- Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
| | | | - Iman Adibi
- Neurosciences Research CenterIsfahan University of Medical SciencesIsfahanIran
- Department of NeurologyIsfahan University of Medical SciencesIsfahanIran
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Masel R, Roche ME, Martinez-Outschoorn U. Hodgkin Lymphoma: A disease shaped by the tumor micro- and macroenvironment. Best Pract Res Clin Haematol 2023; 36:101514. [PMID: 38092473 DOI: 10.1016/j.beha.2023.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 12/18/2023]
Abstract
The tumor microenvironment (TMicroE) and tumor macroenvironment (TMacroE) are defining features of classical Hodgkin lymphoma (cHL). They are of critical importance to clinicians since they explain the common signs and symptoms, allow us to classify these neoplasms, develop prognostic and predictive biomarkers, bioimaging and novel treatments. The TMicroE is defined by effects of cancer cells to their immediate surrounding and within the tumor. Effects of cancer cells at a distance or outside of the tumor define the TMacroE. Paraneoplastic syndromes are signs and symptoms due to effects of cancer at a distance or the TMacroE, which are not due to direct cancer cell infiltration. The most common paraneoplastic symptoms are B-symptoms, which manifest as fevers, chills, drenching night sweats, and/or weight loss. Less common paraneoplastic syndromes include those that affect the central nervous system, skin, kidney, and hematological autoimmune phenomena including hemophagocytic lymphohistiocytosis (HLH). Paraneoplastic signs such as leukocytosis, lymphopenia, anemia, and hypoalbuminemia are prognostic biomarkers. The neoplastic cells in cHL are the Hodgkin and Reed Sternberg (HRS) cells, which are preapoptotic germinal center B cells with a high mutational burden and almost universal genetic alterations at the 9p24.1 locus primarily through copy gain and amplification with strong activation of signaling via PD-L1, JAK-STAT, NFkB, and c-MYC. In the majority of cases of cHL over 95% of the tumor cells are non-neoplastic. In the TMicroE, HRS cells recruit and mold non-neoplastic cells vigorously via extracellular vesicles, chemokines, cytokines and growth factors such as CCL5, CCL17, IL6, and TGF-β to promote a feed-forward inflammatory loop, which drives cancer aggressiveness and anti-cancer immune evasion. Novel single cell profiling techniques provide critical information on the role in cHL of monocytes-macrophages, neutrophils, T helper, Tregs, cytotoxic CD8+ T cells, eosinophils, mast cells and fibroblasts. Here, we summarize the effects of EBV on the TMicroE and TMacroE. In addition, how the metabolism of the TMicroE of cHL affects bioimaging and contributes to cancer aggressiveness is reviewed. Finally, we discuss how the TMicroE is being leveraged for risk adapted treatment strategies based on bioimaging results and novel immune therapies. In sum, it is clear that we cannot effectively manage patients with cHL without understanding the TMicroE and TMacroE and its clinical importance is expected to continue to grow rapidly.
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Affiliation(s)
- Rebecca Masel
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University-Philadelphia, USA; Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA
| | - Megan E Roche
- Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA
| | - Ubaldo Martinez-Outschoorn
- Department of Medicine, Cardeza Foundation for Hematological Research, Thomas Jefferson University-Philadelphia, USA.
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Altaf F, Qureshi ZA, Moore S, Golek TM, Chawala A. A Textbook Case of Human T-lymphotropic Virus-1 (HTLV-1)-Induced Adult T-cell Leukemia Treated With Cyclophosphamide, Hydroxydaunorubicin, Oncovin, and Prednisone/Prednisolone (CHOP). Cureus 2023; 15:e49169. [PMID: 38024023 PMCID: PMC10660912 DOI: 10.7759/cureus.49169] [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: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
Human T-lymphotropic virus-1 (HTLV-I) is an enveloped, single-stranded RNA virus of the Retroviridae family. The virus causes two well-recognized disease associations: adult T-cell leukemia/lymphoma (ATL) and HTLV-I-associated myelopathy (HAM), also known as tropical spastic paraparesis (TSP). We report a case of HTLV-1-induced adult T-cell lymphoma/leukemia in a 45-year-old female who presented with complaints of swelling on the right side of her neck and rash on her upper and lower extremities and abdomen. The patient also had a history of strongyloidiasis infection and Crohn's disease. She was found to have hypercalcemia and multiple lytic lesions of the bone found on the imaging. She also tested positive for HTLV-1 and T cell-positive for cluster of differentiation (CD) 2, CD3, partial CD5, and minimal CD56, later confirmed by the bone marrow (BM) and skin punch biopsies. ATL is characterized by the clonal proliferation of CD4+ T cells containing randomly integrated HTLV-I provirus, often associated with T-cell receptor gene rearrangements. ATL, in its aggressive forms, has one of the poorest prognoses of non-Hodgkin lymphoma. It is essential to raise awareness of ATL, although further research and trials are needed to solidify the treatment options to prevent mortality.
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Affiliation(s)
- Faryal Altaf
- Department of Internal Medicine, BronxCare Health System, Bronx, USA
| | - Zaheer A Qureshi
- Department of Internal Medicine, The Frank H. Netter M.D. School of Medicine at Quinnipiac University, Bridgeport, USA
- Department of Internal Medicine, BronxCare Health System, Bronx, USA
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, USA
| | - Sarah Moore
- Department of Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Tiffany-Marie Golek
- Department of Medicine, American University of the Caribbean School of Medicine, Cupecoy, SXM
| | - Arpan Chawala
- Department of Internal Medicine, BronxCare Health System, Bronx, USA
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Paquin AR, Oyogoa E, McMurry HS, Kartika T, West M, Shatzel JJ. The diagnosis and management of suspected lymphoma in general practice. Eur J Haematol 2023; 110:3-13. [PMID: 36093749 PMCID: PMC10042228 DOI: 10.1111/ejh.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
With rapid advancements in diagnosis and treatment of malignancies, the gap between generalists and subspecialists continues to widen, particularly in cancers like lymphoma where the spectrum of disease varies from indolent to rapidly progressive. Prior to establishing with a hematologist/oncologist, patients must be accurately and comprehensively diagnosed and managed for lymphoma in the generalist setting. In the following manuscript, we review the common clinical presentations in which should raise concern for lymphoma. We summarize the literature regarding the role of laboratory studies including complete blood count and peripheral blood flow cytometry, the recommendations for lymph node sampling, the role and selection of imaging modalities, and ideal patient monitoring for high-risk clinical syndromes that may be encountered in lymphoma.
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Affiliation(s)
- Ashley R. Paquin
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Emmanuella Oyogoa
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Hannah Stowe McMurry
- Division of Internal Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Thomas Kartika
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Malinda West
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Joseph J. Shatzel
- Division of Hematology and Medical Oncology, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA
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7
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Goyal V, Salmasi G, Leavitt AD, Rubenstein JL, Banerjee R. Acquired factor VII inhibitor associated with primary central nervous system Lymphoma: A case report. EJHAEM 2022; 3:1000-1002. [PMID: 36051043 PMCID: PMC9421997 DOI: 10.1002/jha2.482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022]
Abstract
Paraneoplastic coagulopathies are uncommon in patients with lymphoma. We report the first case of an acquired coagulopathy in a patient with isolated primary central nervous system lymphoma (PCNSL) demonstrating large‐cell histology. In our patient, a paraneoplastic factor VII inhibitor significantly delayed a diagnostic lumbar puncture despite fresh frozen plasma and inactivated prothrombin complex concentrate. While her coagulopathy was effectively overcome with recombinant activated factor VIIa and subsequently with lymphoma‐directed therapy, her delayed diagnosis likely contributed to a poor outcome. Our case highlights the importance of rapidly identifying and correcting paraneoplastic coagulopathies when PCNSL is suspected.
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Affiliation(s)
- Vanshika Goyal
- Department of Neurobiology Physiology, and Behavior, University of California Davis California USA
| | - Giselle Salmasi
- Division of Hematology/Oncology Department of Medicine University of California San Francisco California USA
| | - Andrew D. Leavitt
- Division of Hematology/Oncology Department of Medicine University of California San Francisco California USA
- Department of Laboratory Medicine University of California San Francisco San Francisco California USA
| | - James L. Rubenstein
- Division of Hematology/Oncology Department of Medicine University of California San Francisco California USA
| | - Rahul Banerjee
- Division of Hematology/Oncology Department of Medicine University of California San Francisco California USA
- Division of Medical Oncology Department of Medicine University of Washington Seattle Washington USA
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8
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[Clinical analysis of 11 cases of lymphoma complicated with paraneoplastic neurological syndrome]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2022; 43:311-315. [PMID: 35680630 PMCID: PMC9189489 DOI: 10.3760/cma.j.issn.0253-2727.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective: To evaluate the clinical characteristics, treatment, and prognosis of patients with paraneoplastic neurological syndrome (PNS) associated with lymphoma. Methods: Between January 2012 and May 2021, the clinical data of 11 patients with lymphoma complicated with PNS treated at Peking Union Medical College Hospital were retrospectively reviewed. Results: Among the 11 patients (8 male and 3 female) , the median onset age was 61 (range, 33-78) years. The symptoms of PNS preceded lymphoma in 10 patients. The median time from the onset of PNS to the diagnosis of lymphoma was 4 months. Of the 11 patients, one had Hodgkin's lymphoma, 8 had B-cell non-Hodgkin's lymphoma, and 2 had peripheral T-cell lymphoma. Seven patients were evaluated for onconeural antibody, of whom 2 were positive (1 for anti-Ma2 antibody and 1 for anti-Yo antibody) . Of the 11 patients, the PNS symptoms of 3 patients were located in the central nervous system, 4 were located in the peripheral nervous system, and 3 were located in the muscle. Eight of the 11 patients were treated with glucocorticoid-based immunosuppressive therapy before the diagnosis of lymphoma. Patients with central nervous system involvement and dermatomyositis responded well to glucocorticoid, whereas patients with peripheral neuropathy did not significantly benefit. All 11 patients were treated with chemotherapy after the diagnosis of lymphoma. The efficacy of chemotherapy was assessed in 9 patients, 7 cases achieved complete remission, 1 case was evaluated as stable disease, and 1 case was evaluated as disease progression. The PNS symptoms of the patients who achieved complete response were almost completely recovered. The median follow-up time was 42 (range, 4-95) months. At the end of the follow-up period, 6 of the 11 patients survived, 3 were lost to follow-up, and 2 died. The median overall survival of the whole group was not reached. Conclusions: PNS can involve various parts of the nervous system and can be associated with different types of lymphoma. Through early diagnosis and treatment, the PNS symptoms could improve in most patients who achieve complete remission of lymphoma.
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Elkoshi Z. Cancer and Autoimmune Diseases: A Tale of Two Immunological Opposites? Front Immunol 2022; 13:821598. [PMID: 35145524 PMCID: PMC8822211 DOI: 10.3389/fimmu.2022.821598] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 01/21/2023] Open
Abstract
The present article compares, side-by-side, cancer and autoimmune diseases in terms of innate and adaptive immune cells involvement, MHC Class I and Class II expression, TGFβ effect, immune modulating drugs effect and the effect of reactive oxygen species. The change in the inflammatory immune reaction during the progress of cancer and the effect of this change on the comorbidity of autoimmune diseases and cancer are discussed. The similar inflammatory properties of autoimmune diseases and early cancer, and the contrasting inflammatory properties of autoimmune diseases and advanced cancer elucidate the increased incidence of many types of cancer in patients with pre-existing autoimmune diseases and the decreased cancer-specific mortality of these patients. Stage-dependent effects of reactive oxygen-species on tumor proliferation are an additional probable cause for these epidemiological observations. The relationship: {standardized incidence ratio (SIR)} > {cancer-specific hazard ratio (HR)} for cancer patients with a history of autoimmune diseases is substantiated and rationalized.
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A Diverse Spectrum of Immune Complex- and Complement-Mediated Kidney Diseases Is Associated With Mantle Cell Lymphoma. Kidney Int Rep 2021; 7:568-579. [PMID: 35257069 PMCID: PMC8897291 DOI: 10.1016/j.ekir.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/20/2022] Open
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Kume A, Kashiwakuma D, Kubodera A, Hayashi K, Shimizu R, Suzuki Y, Tanaka H. Monoclonal B-cell Lymphocytosis Exacerbated by Prednisolone Therapy for Dermatomyositis. Intern Med 2021; 60:2853-2858. [PMID: 33746170 PMCID: PMC8479216 DOI: 10.2169/internalmedicine.6956-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lymphoproliferative diseases have been associated with various autoimmune diseases. We experienced a case of non-chronic lymphocytic leukemia type monoclonal B-cell lymphocytosis (MBL) that was exacerbated by increasing prednisolone for dermatomyositis and then improved by decreasing the dosage. Because MBL is difficult to diagnose, cases like ours may not be rare. These findings will facilitate our understanding of the mechanism underlying lymphoproliferative diseases and autoimmune diseases.
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Affiliation(s)
- Ayaka Kume
- Department of Hematology, Asahi General Hospital, Japan
| | - Daisuke Kashiwakuma
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Japan
| | - Ai Kubodera
- Department of Hematology, Asahi General Hospital, Japan
| | | | - Ryo Shimizu
- Department of Hematology, Asahi General Hospital, Japan
| | - Yoshio Suzuki
- Department of Clinical Pathology, Asahi General Hospital, Japan
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12
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Banerjee A, Bhuller K, Sudhir R, Bajaj A. Diagnostic dilemma of Hodgkin's lymphoma versus tuberculosis: a case report and review of the literature. J Med Case Rep 2021; 15:351. [PMID: 34275479 PMCID: PMC8287740 DOI: 10.1186/s13256-021-02927-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hodgkin's Lymphoma (HL) is a rare malignancy characterised histologically by the presence of Reed-Sternberg cells. Diagnosis of lymphomas can be difficult due to broad, non-specific presentations of disease, which can be similar to several other conditions ranging from infective, inflammatory or malignant causes, with one of the most common differentials being tuberculosis (TB). We aim to highlight the diagnostic dilemma of TB versus lymphoma with an atypical presentation of HL and explored areas for further research and improvement with a non-systematic literature review using MEDLINE database and Google Scholar. Written consent was obtained from the patient in compliance with ethical guidelines. CASE PRESENTATION A 23-year-old Asian female initially presented to rheumatology with over a one-year history of neuropathic pain, alongside abnormal white cell count and inflammatory markers. This was investigated with magnetic resonance imaging resulting in an incidental finding of mediastinal mass and pulmonary infiltrates. An initial diagnosis of TB was made despite testing negative for acid-fast bacilli and anti-tubercular treatment was commenced. Four months later, following clinical deterioration and further investigations, a mediastinal biopsy assisted in diagnosing Stage IV HL. CONCLUSIONS Lymphoma is often misdiagnosed as TB, prolonging time to treatment and may adversely impact patient prognosis due to disease progression. Existing TB guidelines for smear-negative cases are not clear when to consider alternative diagnoses. In smear-negative TB, lymphoma should be considered as a differential and definitive diagnostic tests such as molecular testing and histological examination of biopsies should be considered earlier in the diagnostic work-up to prevent diagnostic delay.
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Affiliation(s)
| | - Kaljit Bhuller
- Haematology, Children's and Adolescent Services, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rajini Sudhir
- Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Amrita Bajaj
- Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK
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13
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Prasad R, Yen TJ, Bellacosa A. Active DNA demethylation-The epigenetic gatekeeper of development, immunity, and cancer. ADVANCED GENETICS (HOBOKEN, N.J.) 2020; 2:e10033. [PMID: 36618446 PMCID: PMC9744510 DOI: 10.1002/ggn2.10033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 01/11/2023]
Abstract
DNA methylation is a critical process in the regulation of gene expression with dramatic effects in development and continually expanding roles in oncogenesis. 5-Methylcytosine was once considered to be an inherited and stably repressive epigenetic mark, which can be only removed by passive dilution during multiple rounds of DNA replication. However, in the past two decades, physiologically controlled DNA demethylation and deamination processes have been identified, thereby revealing the function of cytosine methylation as a highly regulated and complex state-not simply a static, inherited signature or binary on-off switch. Alongside these fundamental discoveries, clinical studies over the past decade have revealed the dramatic consequences of aberrant DNA demethylation. In this review we discuss DNA demethylation and deamination in the context of 5-methylcytosine as critical processes for physiological and physiopathological transitions within three states-development, immune maturation, and oncogenic transformation; and we describe the expanding role of DNA demethylating drugs as therapeutic agents in cancer.
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Affiliation(s)
- Rahul Prasad
- Cancer Epigenetics and Cancer Biology Programs, Fox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | - Timothy J. Yen
- Cancer Epigenetics and Cancer Biology Programs, Fox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | - Alfonso Bellacosa
- Cancer Epigenetics and Cancer Biology Programs, Fox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
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14
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Villano F, Peixoto A, Riva E, Di Matteo C, Díaz L. Digital Ischemia as an Unusual Manifestation of Hodgkin's Lymphoma. Case Rep Hematol 2018; 2018:1980749. [PMID: 30210881 PMCID: PMC6120276 DOI: 10.1155/2018/1980749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/04/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022] Open
Abstract
Digital ischemia is associated with atherosclerotic, thromboembolic, or connective tissue diseases. Less often, it can be related to malignancy. Paraneoplastic vascular acrosyndromes (Raynaud's syndrome, acrocianosis, and acronecrosis) are associated with adenocarcinoma and less frequently with hematological malignancies. We report the case of a 45-year-old male, smoker, with a 10-day history of pain, cyanosis, and progressive digital necrosis in both hands. In the previous four months, he noticed painless mass in the right axillary gap, drenching night sweats, and weight loss. Physical examination at admission highlighted necrotic lesions on the distal phalanges of both hands (except the thumbs), enlarged lymph nodes in right axillary, and right supraclavicular gaps. Arteriography of upper limbs demonstrated a distal stop in all bilateral digital arteries. Digital ischemia was interpreted as a paraneoplastic phenomenon after other common etiologies were ruled out. Amputation of three phalanges was required due to necrosis. Biopsy of axillary nodes demonstrated nodular sclerosis classical Hodgkin's lymphoma (HL). The patient started conventional ABVD protocol (doxorubicin, bleomycin, vinblastine, and dacarbazine). After 6 cycles, he remained asymptomatic and symptoms of digital ischemia were completely resolved. It was concluded that the presence of acral vascular syndromes should alert the physician about the possibility of underlying malignant disease. Prompt investigation and treatment should be rapidly performed to avoid digital sequelae.
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Affiliation(s)
- Fiorella Villano
- Department of Hematology, Médica Uruguaya (MUCAM), Montevideo, Uruguay
| | - Adriana Peixoto
- Department of Hematology, Médica Uruguaya (MUCAM), Montevideo, Uruguay
| | - Eloísa Riva
- Department of Hematology, Médica Uruguaya (MUCAM), Montevideo, Uruguay
| | | | - Lilián Díaz
- Department of Hematology, Médica Uruguaya (MUCAM), Montevideo, Uruguay
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15
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Laher AE, Ebrahim O. HTLV-1, ATLL, severe hypercalcaemia and HIV-1 co-infection: an overview. Pan Afr Med J 2018; 30:61. [PMID: 30344845 PMCID: PMC6191272 DOI: 10.11604/pamj.2018.30.61.13238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 04/30/2018] [Indexed: 11/11/2022] Open
Abstract
HIV and HTLV (Human T-ymphotropic Virus) are the only known retroviruses responsible for causing infection in humans. HTLV-1 and HIV-1 are frequent co-pathogens, however, despite its potential for accelerated progression of HIV disease and the risk of developing adult T-cell lymphoma/leukemia (ATLL), HTLV-1 is seldom considered for investigation in the HIV-1 positive individual. Severe/refractory hypercalcaemia, unresponsive to conventional calcium lowering therapy may complicate up to 70% of cases of ATLL. In addition, HTLV-1 and ATLL have both been associated with a rise in dysfunctional CD4 lymphocytes, thereby conveying a false sense of immune competence in the HIV-1 infected individual.
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Affiliation(s)
- Abdullah Ebrahim Laher
- Department of Emergency Medicine and Department of Critical Care, Faculty of Health Sciences, University of the Witwatersrand, 5 Jubilee Road, Parktown, Johannesburg, 2193, South Africa
| | - Osman Ebrahim
- Department of Internal Medicine and HIV clinic, Life Brenthurst Hospital, Johannesburg, South Africa
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16
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Laher AE, Motara F, Moolla M, Ebrahim O. HTLV-1, ATLL, refractory hypercalcaemia and HIV-1 co-infection. Oxf Med Case Reports 2018; 2018:omx081. [PMID: 29744126 PMCID: PMC5934651 DOI: 10.1093/omcr/omx081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/10/2017] [Accepted: 10/25/2017] [Indexed: 11/18/2022] Open
Abstract
Adult T-cell lymphoma/leukemia (ATLL) is a rare tumour of T-lymphocytes that is associated with human T-lymphotrophic virus type 1 (HTLV-1) infection as well as severe/refractory hypercalcaemia. Human immunodefficiency virus type 1 (HIV-1) infected individuals are at increased risk of acquiring co-infection with HTLV-1. We present the case of a 37 -year -old HIV-1 positive and antiretroviral therapy naive woman who was admitted to the ICU with delirium, a generalised maculopapular rash, severe hypercalcaemia of 4.48 mmol/L (normal < 2.7 mmol/L) and a positive HTLV-1 serology. The diagnosis of ATLL was confirmed on biopsy. Her hypercalcaemic state proved refractory to conventional therapy, but was rapidly corrected with a modified haemodialysis technique using a dialysate with a low low-calcium concentration.
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Affiliation(s)
- Abdullah E Laher
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Feroza Motara
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Muhammed Moolla
- Department of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Osman Ebrahim
- Department of Internal Medicine and HIV Clinic, Life Brenthurst Hospital, Johannesburg, South Africa
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17
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Abstract
Paraneoplastic neurological syndromes (PNS) are rare, remote effects of cancer that are usually caused by an altered immune response to the tumor and not due to the tumor mass, metastasis, infection, ischemia, or metabolic derangements. PNSs can affect any area of the central, the peripheral, and the autonomic nervous systems. These are rare in lymphomas compared with solid tumors attributed to their presentation even in late stages and the absence of onconeural antibodies. We present a child with stage IIB Hodgkin lymphoma who presented with dual PNS, achalasia cardia, and Holmes Adie pupil occurring synchronously with the cancer.
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18
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Monge E, Coolen-Allou N, Mascarel P, Gazaille V. [Pulmonary MALT lymphoma and paraneoplastic syndromes]. Rev Mal Respir 2016; 33:799-803. [PMID: 27155897 DOI: 10.1016/j.rmr.2016.02.008] [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: 10/05/2015] [Accepted: 02/22/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Primary pulmonary lymphoma is a rare disease; diagnosis is often delayed because of atypical clinical presentation and slow progression. OBSERVATION A 42-year-old woman consulted because of haemoptysis. Chest CT-scan showed multiple nodular calcified masses. A lung biopsy led to the diagnosis of pulmonary amyloidosis with pulmonary MALT lymphoma (mucosa-associated lymphoid tissue). The patient developed two paraneoplastic syndromes: a hypertrophic osteoarthropathy and mucinosis. CONCLUSION Multiple nodular amyloidosis can be a mode of presentation for pulmonary lymphoma. Paraneoplastic syndromes must be systematically considered and can help in early diagnosis of the disease and its relapse.
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Affiliation(s)
- E Monge
- Service de pneumologie, CHU Félix-Guyon, allée des Topazes, 97400 Saint-Denis, Réunion.
| | - N Coolen-Allou
- Service de pneumologie, CHU Félix-Guyon, allée des Topazes, 97400 Saint-Denis, Réunion
| | - P Mascarel
- Service de radiologie, clinique Sainte-Clotilde, 127, route de Bois-de-Nèfles, 97492 Sainte-Clotilde, Réunion
| | - V Gazaille
- Service de pneumologie, CHU Félix-Guyon, allée des Topazes, 97400 Saint-Denis, Réunion
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19
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Abstract
Adult-onset opsoclonus-myoclonus syndrome (OMS) has been associated with multiple cancers, most commonly small-cell lung carcinoma and breast adenocarcinoma. A 53-year-old woman who presented with OMS was found to have primary central nervous system (CNS) diffuse large B-cell lymphoma. OMS has been described in only 5 cases with non-Hodgkin lymphoma (NHL), and this is only the third reported case of OMS in NHL limited to the CNS. Although the paraneoplastic antibody panel was negative, we presume that the OMS was a paraneoplastic manifestation. Antineoplastic and anti-immune therapy had no effect on the neurologic manifestations.
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20
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Cheptou M, Pichault V, Campagni R, Vodoff MV, Fischbach M, Paillard C. [Hodgkin disease revealed by a nephrotic syndrome: A case report]. Arch Pediatr 2015; 22:1268-71. [PMID: 26598043 DOI: 10.1016/j.arcped.2015.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/04/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
Pediatric nephrotic syndrome (NS) is most often idiopathic or primary but in rare cases, it can be secondary to neoplasia. We report on a case of steroid-resistant NS revealing as a paraneoplastic syndrome of Hodgkin disease (HD) in a 12-year-old boy. The onset of the NS can be earlier, later, or simultaneous to the HD. Treatment of the lymphoma allows the disappearance of the NS. In the case we observed, the diagnosis of HD was delayed because HD presented with an isolated, hilar adenopathy in the absence of retroperitoneal or peripheral locations. In children aged 10 years or more presenting with NS, steroid-resistant or otherwise, a possible paraneoplastic origin such as Hodgkin lymphoma should always be taken into consideration and eventually eliminated.
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Affiliation(s)
- M Cheptou
- Pôle médicochirurgical pédiatrique, service de pédiatrie III, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - V Pichault
- Service de pédiatrie, hôpital du Hasenrain, 87, avenue d'Altkirch, BP 1070, 68051 Mulhouse cedex, France.
| | - R Campagni
- Service de pédiatrie, hôpital du Hasenrain, 87, avenue d'Altkirch, BP 1070, 68051 Mulhouse cedex, France
| | - M-V Vodoff
- Service de pédiatrie, hôpital du Hasenrain, 87, avenue d'Altkirch, BP 1070, 68051 Mulhouse cedex, France
| | - M Fischbach
- Pôle médicochirurgical pédiatrique, service de pédiatrie I, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - C Paillard
- Pôle médicochirurgical pédiatrique, service de pédiatrie III, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
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21
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Zakharova EV. Renal Consequences of Lymphoproliferative Disorders and Monoclonal Gammopathy. ACTA ACUST UNITED AC 2015. [DOI: 10.15406/unoaj.2015.02.00047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Hughes CL, Yorio JT, Kovitz C, Oki Y. Treatment decisions in a man with Hodgkin lymphoma and Guillian-Barré syndrome: a case report. J Med Case Rep 2014; 8:455. [PMID: 25528252 PMCID: PMC4307131 DOI: 10.1186/1752-1947-8-455] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/18/2014] [Indexed: 12/02/2022] Open
Abstract
Introduction Guillain-Barre syndrome, or acute inflammatory demyelinating polyneuropathy, has been described in the presence of malignancies such as lymphoma. Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy causes paresthesias and weakness, which can make the treatment of lymphoma with chemotherapy challenging. Given the rarity of this co-presentation it is not known if the effects of Guillain-Barre syndrome should be considered when selecting a treatment regimen for Hodgkin lymphoma. To the best of our knowledge, the impact of these treatment modifications has not been previously reported. Case presentation We report the case of a 37-year-old Caucasian man with a diagnosis of stage IIB classical Hodgkin lymphoma with concomitant Guillain-Barre syndrome. Our patient originally presented with an enlarged cervical lymph node and quickly developed distal paresthesia and progressive weakness of all four extremities. He was diagnosed with Hodgkin’s lymphoma and initiated on treatment with doxorubicin, bleomycin, vinblastine, and dacarbazine. Doses of bleomycin and vinblastine were held or dose-reduced throughout his initial treatment course due to underlying neuropathy and dyspnea. He continued to have persistent disease after five cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine and went on to receive salvage treatments including more chemotherapy, radiation, autologous stem cell transplant and is currently preparing for an allogeneic stem cell transplant. Conclusions Paraneoplastic syndromes such as Guillain-Barre syndrome/acute inflammatory demyelinating polyneuropathy can make the treatment of patients with Hodgkin lymphoma more challenging and can interfere with delivering full-dose chemotherapy. Further case series are needed to evaluate the effect that paraneoplastic syndromes, or adjustments made in therapy due to these syndromes, negatively affect the prognosis of patients with Hodgkin lymphoma.
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Affiliation(s)
- Caren L Hughes
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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23
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Gastric diffuse large B cell lymphoma presenting as paraneoplastic cerebellar degeneration: case report and review of literature. J Egypt Natl Canc Inst 2013; 25:231-5. [PMID: 24207096 DOI: 10.1016/j.jnci.2013.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/20/2013] [Accepted: 07/01/2013] [Indexed: 02/04/2023] Open
Abstract
Paraneoplastic cerebellar degeneration (PCD) is a type of paraneoplastic neurological disorder (PND) that is associated with many solid tumors, Hodgkin's lymphoma (HL) and very rarely with non-Hodgkin's lymphoma (NHL). We report a case of PCD associated with gastric diffuse large B-cell lymphoma (DLBCL) in a patient who presented with acute onset of giddiness and double vision and had complete remission of the gastric lesion and marked improvement of cerebellar syndrome with rituximab-based combination chemotherapy. A brief review of the literature is also presented.
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24
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Carlesimo M, Narcisi A, Rossi A, Saredi I, Orsini D, Pelliccia S, Aloe Spiriti M, Mari E, Cox M. Cutaneous manifestations of systemic non-Hodgkin lymphomas (NHL): study and review of literature. J Eur Acad Dermatol Venereol 2013; 28:133-41. [DOI: 10.1111/jdv.12201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 05/17/2013] [Indexed: 01/01/2023]
Affiliation(s)
| | - A. Narcisi
- Department of Dermatology; NESMOS Department
| | - A. Rossi
- Department of Dermatology; University of Rome “Sapienza”; Rome Italy
| | - I. Saredi
- Department of Dermatology; NESMOS Department
| | - D. Orsini
- Department of Dermatology; NESMOS Department
| | - S. Pelliccia
- Department of Haematology; Sant'Andrea Hospital; University of Rome “Sapienza”
| | - M.A. Aloe Spiriti
- Department of Haematology; Sant'Andrea Hospital; University of Rome “Sapienza”
| | - E. Mari
- Department of Dermatology; NESMOS Department
| | - M.C. Cox
- Department of Haematology; Sant'Andrea Hospital; University of Rome “Sapienza”
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25
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Alirhayim Z, Dyal H, Alarhayem A, Donthireddy V. Non-Hodgkin's lymphoma: a cause of paraneoplastic cholestasis. BMJ Case Rep 2013; 2013:bcr-2013-009714. [PMID: 23704453 DOI: 10.1136/bcr-2013-009714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a 79-year-old gentleman with a longstanding history of chronic lymphocytic leukaemia who presented with subacute onset of cholestatic jaundice. Comprehensive review of the patient's data and medications failed to reveal any obvious causes. Exhaustive testing including abdominal CT and magnetic resonance cholangiopancreatography failed to reveal any obstruction. A liver biopsy demonstrated scattered non-caseating granulomas. The patient was diagnosed with granulomatous hepatitis and treated with oral steroids and eventually improved. It was thought to be due to paraneoplastic cholestasis as an extrahepatic manifestation of non-Hodgkin's lymphoma.
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26
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Yang X, Miyawaki T, Kanegane H. Lymphoproliferative disorders in immunocompromised individuals and therapeutic antibodies for treatment. Immunotherapy 2013; 5:415-25. [DOI: 10.2217/imt.13.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The incidence of lymphoproliferative disease (LPD) is significantly higher in individuals who have congenital, acquired or iatrogenically induced immunodeficiency. Although there are a wide range of LPDs including lymphoma and leukemia, this article only covers LPDs in patients with impaired immune function, which are called immunodeficiency-associated LPDs (ID-LPDs). Three of the four ID-LPD categories recognized by WHO have been selected for discussion: LPD in primary immune disorders, post-transplant LPD and LPD in HIV infection. Because of the high incidence and mortality of ID-LPDs, careful evaluation of the morphology, immunophenotype, genotype, viral status and clinical history is required for accurate diagnosis and treatment. Recently, treatment with monoclonal antibodies (mAbs) has been widely used and developed because of its potential benefits. The aim of this review is to describe new information concerning mAb treatment in LPDs and to draw physicians’ attention to mAb therapy, which should be effective for some types of LPD.
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Affiliation(s)
- Xi Yang
- Department of Pediatrics, Graduate School of Medicine & Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Toshio Miyawaki
- Department of Pediatrics, Graduate School of Medicine & Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan
| | - Hirokazu Kanegane
- Department of Pediatrics, Graduate School of Medicine & Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama 930-0194, Japan.
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27
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28
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Sands J, Tuscano JM. Geoepidemiology and autoimmune manifestations of lymphoproliferative disorders. Autoimmun Rev 2009; 9:A335-41. [PMID: 19914405 DOI: 10.1016/j.autrev.2009.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The pathogenesis of lymphoproliferative disorders represents an underlying dysfunction in lymphocyte development and homeostasis. This typically manifests with the accumulation of lymphocytes in the bone marrow, peripheral blood or lymph nodes and spleen. It has been hypothesized that the mechanism for elimination of dysfunctional and autoreactive lymphocytes is defective and contributes to the pathogenesis of these disorders. Based on this hypothesis, it would not be surprising to find an increased incidence of autoimmune manifestations that are associated with these disorders. Autoimmune paraneoplastic syndromes (PNS) are often the result of a dysfunctional immune response, which is related to an underlying malignant process. While all the PNS that are associated with lymphoproliferative disorders do not have an autoimmune basis, many do. Here we review the literature of PNS associated with lymphoproliferative disorders. A concise overview of each syndrome is provided with a focus on clinical manifestations, diagnostics, pathophysiology, and treatment. While the treatment is typically directed at managing the underlying lymphoproliferative process, and can be assumed to be case throughout this review, there are exceptions that are described within the context of each disorder.
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Affiliation(s)
- Jacob Sands
- Department of Internal Medicine, University of California, Davis, Sacramento, CA 95817, USA
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29
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Smedby KE, Askling J, Mariette X, Baecklund E. Autoimmune and inflammatory disorders and risk of malignant lymphomas--an update. J Intern Med 2008; 264:514-27. [PMID: 19017176 DOI: 10.1111/j.1365-2796.2008.02029.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
As specific autoimmune disorders now constitute established risk factors for malignant lymphomas, we describe this association. We review reported risk levels, risk determinants, lymphoma subtypes and biological mechanisms in autoimmunity/inflammation, emphasizing on recent findings. Whilst numerous reports describe average lymphoma risks in large patient groups, there's a recent shift of focus to risk determinants and the role of inflammatory activity. Studies highlight associations with diffuse large B-cell lymphoma, apart from lymphoma development in target organs of inflammation. Future studies of high-risk patient subsets using detailed assessments of autoimmunity/inflammation and lymphoma may give important clues to lymphomagenesis.
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Affiliation(s)
- K E Smedby
- Department of Medicine, Clinical Epidemiology Unit, Karolinska University Hospital, Stockholm, Sweden.
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30
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Leonard JP, Link BK, Emmanouilides C, Gregory SA, Weisdorf D, Andrey J, Hainsworth J, Sparano JA, Tsai DE, Horning S, Krieg AM, Weiner GJ. Phase I trial of toll-like receptor 9 agonist PF-3512676 with and following rituximab in patients with recurrent indolent and aggressive non Hodgkin's lymphoma. Clin Cancer Res 2007; 13:6168-74. [PMID: 17947483 DOI: 10.1158/1078-0432.ccr-07-0815] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE PF-3512676 (formerly CpG 7909) is a novel Toll-like receptor 9-activating oligonucleotide with single-agent antitumor activity that augments preclinical rituximab efficacy. This Phase I trial was designed to investigate the safety, tolerability, and preliminary antitumor activity of PF-3512676 in combination with rituximab. EXPERIMENTAL DESIGN Patients with relapsed/refractory CD20+ B cell non-Hodgkin's lymphoma received i.v. rituximab (375 mg/m2/week for 4 weeks) and PF-3512676 weekly for 4 weeks either i.v. (0.04, 0.16, 0.32, or 0.48 mg/kg) or s.c. (0.01, 0.04, 0.08, or 0.16 mg/kg). An additional extended-treatment cohort received 4 weeks of 0.24 mg/kg s.c. PF-3512676 in combination with rituximab followed by s.c. PF-3512676 alone weekly for 20 weeks. RESULTS Patients (N = 50) had received a median of three prior therapies (range, 1-11) including rituximab in 80% of patients. Treatment-related adverse events occurred in 11 of 19 (58%) i.v. patients, 15 of 19 (79%) s.c. patients, and all 12 patients in the extended-treatment cohort. Most common adverse events were mild to moderate systemic flu-like symptoms and injection-site reactions (s.c. cohorts only). Grade 3/4 neutropenia occurred in four patients. Objective responses occurred in 12 of 50 (24%) patients overall and in 6 of 12 (50%) patients in the extended-treatment cohort, including 2 patients with rituximab-refractory disease. CONCLUSION Brief or extended-duration PF-3512676 can be safely administered in combination with rituximab in patients with relapsed/refractory non-Hodgkin's lymphoma.
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Affiliation(s)
- John P Leonard
- Weill Medical College of Cornell University, New York, New York, USA
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31
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Unusual presentation of non-Hodgkin lymphoma: polyarthritis and uveitis mimicking a rheumatologic disease. Rheumatol Int 2007; 28:613-4. [PMID: 18058104 DOI: 10.1007/s00296-007-0500-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2007] [Accepted: 11/21/2007] [Indexed: 10/22/2022]
Abstract
We report a case of 45-year-old male who presented with polyarthritis and posterior uveitis. He was given azathioprine (AZA) 150 mg day(-1) and methyl-prednisolone 48 mg day(-1) for his uveitis and polyarthritis. Eye and joint complaints improved with these medications within 1 month. Three months later, while he was on AZA, the patient presented with pain on his anterior chest wall associated with diffuse hyperemic and warm mass lesion. A wedge biopsy of the lesion was reported as diffuse large B-cell NHL. Here, we briefly discuss the relationship between arthritis, uveitis and lymphoproliferative disease.
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32
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Lyell V, Khatamzas E, Allain T. Severe hypercalcaemia and lymphoma in an HTLV-1 positive Jamaican woman: a case report. J Med Case Rep 2007; 1:56. [PMID: 17651486 PMCID: PMC1950877 DOI: 10.1186/1752-1947-1-56] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 07/25/2007] [Indexed: 11/16/2022] Open
Abstract
Human T cell lymphotrophic virus type-1 infection is endemic in the Afro-Caribbean community in Britain, with carriage rates of about 3%. Although there is a long latency, carriers have a 1–5% chance of developing adult T cell leukaemia/lymphoma, a condition frequently complicated by marked and refractory hypercalcaemia, and with a poor prognosis. We present the case of an elderly Jamaican woman with severe hypercalcaemia and a raised PTHrP who was found to have lymphoma and was positive for HTLV-1.
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Affiliation(s)
- Veronica Lyell
- Department of Care of the Elderly, Southmead Hospital, Bristol, UK
| | - Elham Khatamzas
- Department of Care of the Elderly, Southmead Hospital, Bristol, UK
| | - Theresa Allain
- Department of Care of the Elderly, Southmead Hospital, Bristol, UK
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33
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Solak Y, Aksoy S, Kilickap S, Celik I. Acrocyanosis as a presenting symptom of Hodgkin lymphoma. Am J Hematol 2006; 81:151-2. [PMID: 16432859 DOI: 10.1002/ajh.20479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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34
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András C, Csiki Z, Ponyi A, Illés A, Dankó K. Paraneoplastic rheumatic syndromes. Rheumatol Int 2005; 26:376-82. [PMID: 16091919 DOI: 10.1007/s00296-005-0005-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 04/20/2005] [Indexed: 10/25/2022]
Abstract
Paraneoplastic symptoms caused by a malignancy but not directly related to tumour invasion are the result of a wide variety of tumour-derived biologic mediators, such as hormones, peptides, antibodies, cytotoxic lymphocytes, autocrine and paracrine mediators. Recognition of paraneoplastic syndromes is important, as it may lead to an early diagnosis of cancer. On the other hand, the clinical severity of the symptoms can be used as a guide to the extent of response to underlying tumour therapy. The quality of life of the patient is affected, therefore the palliative treatment of paraneoplasia is very important.
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Affiliation(s)
- Csilla András
- Department of Oncology, University of Debrecen, Medical and Health Science Center, 4012, Debrecen, Nagyerdei krt. 98, Hungary
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