1
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Yan X, Chen B, Jing H, Yang Z, Zhang T, Lin Y, Shi J. A rare case of fluid overload-associated large B-cell lymphoma and antigen loss at relapse. J Hematop 2023; 16:235-240. [PMID: 38175437 DOI: 10.1007/s12308-023-00566-3] [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: 06/20/2023] [Accepted: 11/07/2023] [Indexed: 01/05/2024] Open
Abstract
Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a new addition to the list of large B-cell lymphomas in the 5th edition of the World Health Organization Classification of Haematolymphoid Tumours (WHO-HAEM5). This report presents an unusual case of FO-LBCL with partial B cell antigen loss at relapse and reviews the characteristics, treatment, and prognosis of these patients to enhance our understanding of this disease. Immunophenotyping was performed through immunohistochemistry and flow cytometry. Immunoglobulin gene rearrangements were analyzed using BIOMED-2 multiplex primers. MYC, BCL2, and BCL6 gene rearrangements were detected by fluorescent in situ hybridization (FISH). Cell-free DNA (cfDNA) from pleural effusion and peripheral blood was subjected to somatic mutation evaluation using next-generation sequencing (NGS). In 2020, the patient was initially diagnosed with tuberculous pleurisy and received anti-tuberculous drugs. Subsequent testing of the pleural effusion cell block revealed that the large cells to be positive for CD10, CD20, CD79a, PAX5, MUM1, Bcl-2, Bcl-6, and c-myc and negative for CD3, CD30, Cyclin D1, and HHV8. In situ hybridization for Epstein-Barr virus (EBV)-associated mRNA (EBER-ISH) was negative. Additionally, a clonal rearrangement of immunoglobulin heavy locus (IGH) FR2-JH was detected; the results of MYC, BCL2, and BCL6 gene rearrangements were all negative. Following pleural drainage treatment, the patient achieved symptom remission and was diagnosed with large B-cell lymphoma (HHV8-unrelated PEL-like lymphoma). In 2022, the patient was readmitted due to the recurrence of pleural effusion. The pleural effusion cell block revealed a distinct immunophenotype compared to previous findings, positivity for PAX5 and negativity for CD20, CD10, CD3, CD5, CD30, CD38, CD138, CD79a, MUM1, Bcl-2, Bcl-6, Cyclin D1, c-myc, ALK, and HHV8. Identical IGH FR2-JH clonal rearrangement suggested the recurrence of the original clone. CfDNA analysis showed mutations in CD79B, MYD88, CCND3, and DTX1. The patient was ultimately diagnosed with FO-LBCL based on the WHO-HAEM5 classification. Diagnosis of FO-LBCL should be differentiated from primary effusion lymphoma (PEL). The features of this case align with the description of "FO-LBCL" in WHO-HAEM5 and "HHV8 and EBV-negative primary effusion-based lymphoma" in International Consensus Classification (ICC). FO-LBCL patients generally have a more favorable prognosis compared to PEL. In this case, the patient exhibited a favorable prognosis for over 22 months without additional treatment apart from pleural drainage.
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Affiliation(s)
- Xue Yan
- Department of Hematology, The Affiliated Jiangning Hospital With Nanjing Medical University, Hushan Road, Jiangning District, Nanjing, 211100, Jiangsu, China
| | - Bin Chen
- Sino-US Diagnostics Lab, Tianjin Enterprise Key Laboratory of AI-Aided Hematopathology Diagnosis, Tianjin, 300385, China
| | - Hongxia Jing
- Department of Hematology, The Affiliated Jiangning Hospital With Nanjing Medical University, Hushan Road, Jiangning District, Nanjing, 211100, Jiangsu, China
| | - Zhinan Yang
- Department of Hematology, The Affiliated Jiangning Hospital With Nanjing Medical University, Hushan Road, Jiangning District, Nanjing, 211100, Jiangsu, China
| | - Ting Zhang
- Department of Hematology, The Affiliated Jiangning Hospital With Nanjing Medical University, Hushan Road, Jiangning District, Nanjing, 211100, Jiangsu, China
| | - Yani Lin
- Sino-US Diagnostics Lab, Tianjin Enterprise Key Laboratory of AI-Aided Hematopathology Diagnosis, Tianjin, 300385, China.
| | - Jinning Shi
- Department of Hematology, The Affiliated Jiangning Hospital With Nanjing Medical University, Hushan Road, Jiangning District, Nanjing, 211100, Jiangsu, China.
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Hayashino K, Meguri Y, Yukawa R, Komura A, Nakamura M, Yoshida C, Yamamoto K, Oda W, Imajo K. Primary Effusion Lymphoma-like Lymphoma Mimicking Tuberculous Pleural Effusion: Three Case Reports and a Literature Review. Intern Med 2023; 62:2531-2537. [PMID: 36575018 PMCID: PMC10518533 DOI: 10.2169/internalmedicine.1143-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/16/2022] [Indexed: 12/28/2022] Open
Abstract
Primary effusion lymphoma-like lymphoma (PEL-LL) is a rare lymphoma, localized in the body cavity without detectable tumor masses. Tuberculous pleural effusion is a form of extra pulmonary tuberculous. We herein report three cases of PEL-LL in patients with a history of pulmonary tuberculosis. Despite the presentation with lymphocyte predominance and high levels of adenosine deaminase, a notable characteristic of tuberculous pleural effusion, the patients were ultimately diagnosed with PEL-LL. Pleural fluid laboratory tests yield similar results for PEL-LL and tuberculous pleural effusion; therefore, cytological and immunophenotyping examinations are useful for their differential diagnosis and the determination of treatment.
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Affiliation(s)
| | - Yusuke Meguri
- Department of Hematology, Okayama City Hospital, Japan
| | - Ryouya Yukawa
- Department of Hematology, Okayama City Hospital, Japan
| | - Aya Komura
- Department of Hematology, Okayama City Hospital, Japan
| | | | | | | | - Wakako Oda
- Department of Pathology, Okayama City Hospital, Japan
| | - Kenji Imajo
- Department of Hematology, Okayama City Hospital, Japan
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Ogasawara F, Higuchi T, Nishimori T, Hashida Y, Kojima K, Daibata M. Targeting
VEGF
with bevacizumab inhibits malignant effusion formation of primary human herpesvirus 8‐unrelated effusion large B‐cell lymphoma in vivo. J Cell Mol Med 2022; 26:5580-5589. [PMID: 36209502 PMCID: PMC9667516 DOI: 10.1111/jcmm.17570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 11/26/2022] Open
Abstract
Primary human herpesvirus 8 (HHV8)‐unrelated effusion large B‐cell lymphoma (ELBCL) is recognized as a new clinical entity, but its pathogenesis and therapeutic strategies remain largely unknown. We have generated two mouse models with profuse lymphomatous effusions that resemble HHV8‐unrelated ELBCL occurring in humans, by grafting the cell lines designated as Pell‐1 and Pell‐2. Using these in vivo models, we evaluated the potential role of vascular endothelial growth factor (VEGF) in the pathogenesis of HHV8‐unrelated ELBCL. Both Pell‐1 and Pell‐2 cells consistently produced very high levels of VEGF in mice, in contrast to in vitro findings of relatively low VEGF production in culture medium by HHV8‐unrelated ELBCL cells, especially Pell‐1 cells. Conversely, returning Pell‐1 cells grown in mice to culture medium markedly suppressed VEGF production to the original in vitro level. These findings suggest that the tumour microenvironment plays a role in the steady production of VEGF. We also found that the interaction between HHV8‐unrelated ELBCL cells and peritoneal mesothelial cells increased the production of VEGF in vitro. Finally, we found that bevacizumab significantly suppressed effusion formation and lymphoma cell growth in both mouse models. These results suggest that bevacizumab is a rational approach to the treatment of HHV8‐unrelated ELBCL.
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Affiliation(s)
- Fumiya Ogasawara
- Department of Microbiology and Infection Kochi Medical School, Kochi University Nankoku Japan
- Department of Hematology Kochi Medical School, Kochi University Nankoku Japan
| | - Tomonori Higuchi
- Department of Microbiology and Infection Kochi Medical School, Kochi University Nankoku Japan
| | - Tomohiro Nishimori
- Department of Microbiology and Infection Kochi Medical School, Kochi University Nankoku Japan
| | - Yumiko Hashida
- Department of Microbiology and Infection Kochi Medical School, Kochi University Nankoku Japan
| | - Kensuke Kojima
- Department of Hematology Kochi Medical School, Kochi University Nankoku Japan
| | - Masanori Daibata
- Department of Microbiology and Infection Kochi Medical School, Kochi University Nankoku Japan
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4
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Liu CY, Chen BJ, Chuang SS. Primary Effusion Lymphoma: A Timely Review on the Association with HIV, HHV8, and EBV. Diagnostics (Basel) 2022; 12:diagnostics12030713. [PMID: 35328266 PMCID: PMC8947353 DOI: 10.3390/diagnostics12030713] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Primary effusion lymphoma (PEL) is defined by the WHO classification as a large B-cell neoplasm without detectable tumor masses. It is universally associated with HHV8, with most cases occurring in the setting of immunodeficiency such as HIV infection, and a poor prognosis. Morphologically, the neoplastic cells range from immunoblastic, plasmablastic, to anaplastic; and phenotypically, most cases express plasma cell but not B-cell markers, i.e., plasmablastic. During the past decade, primary HHV8-negative effusion lymphoma has been reported. Such cases were considered in the WHO classification scheme as effusion-based lymphoma. We performed a systemic review of 167 HHV8-negative effusion lymphomas from the literature and found that only 42% were associated with a fluid overload state, and with low rates of HIV (6%) or EBV (21%) infection. Furthermore, most patients are old (or immunosenescent) with underlying medical conditions/comorbidities, most neoplasms are of B-cell phenotype, and the outcome is more favorable than that of HHV8-positive PEL. These distinctive findings supported our prior proposal of designating these HHV8-negative cases as type II PEL, in contrast to the classic or type I PEL as defined by the WHO. Furthermore, we propose an algorithmic approach for the diagnosis of PEL and its mimickers.
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Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City 221, Taiwan;
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 221, Taiwan
| | - Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 221, Taiwan;
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan 710, Taiwan
- Correspondence: ; Tel.: +886-6-2812811 (ext. 53686)
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Nakako S, Nishimura M, Murakami Y, Mugitani A. Diagnostic significance of adenosine deaminase in pleural effusate for primary effusion lymphoma-like lymphoma. Clin Case Rep 2020; 8:3216-3219. [PMID: 33363910 PMCID: PMC7752432 DOI: 10.1002/ccr3.3296] [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: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
Our case and review of the literature suggests the possibility that pleural effusate adenosine deaminase levels in patients with primary effusion lymphoma-like lymphoma (PEL-LL) might be much higher than those in patients with other types of lymphomas and those with tuberculous pleural effusion.
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Affiliation(s)
- Soichiro Nakako
- Department of Hematological MedicineOsaka City University HospitalOsakaJapan
| | | | | | - Atsuko Mugitani
- Department of Hematological MedicineFuchu HospitalIzumiJapan
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Age and CD20 Expression Are Significant Prognostic Factors in Human Herpes Virus-8-negative Effusion-based Lymphoma. Am J Surg Pathol 2019; 42:1607-1616. [PMID: 30273194 DOI: 10.1097/pas.0000000000001168] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Human herpes virus-8 (HHV-8)-negative effusion-based lymphoma (HHV-8-negative EBL) can be distinguished from primary effusion lymphoma based on clinical and pathologic findings. Although the morphology between the 2 is similar and they both originate from body cavities with serous effusions and are characterized by lack of tumor masses, HHV-8-negative EBL generally occurs in older patients, and has favorable response to therapy and better prognosis than primary effusion lymphoma. However, no systematic studies have investigated prognostic factors in patients with HHV-8-negative EBL. In this report, clinical and pathologic characteristics of 67 cases of HHV-8-negative EBL, including 2 of our own cases, were analyzed. Univariate analyses revealed older age (70 y and above), Japanese ethnicity, pericardial effusion, CD20 expression, and chemotherapy with rituximab were significantly favorable prognostic factors. Peritoneal effusion was identified as an unfavorable prognostic factor. In the multivariate analysis, age and CD20 expression were independent prognostic factors (P=0.013 and 0.003, respectively). A past history of induced fluid overload, hepatitis C viral infection, and peritoneal effusion were significantly correlated with patients aged below 70 years, while pericardial and pleural effusions were significantly correlated with patients aged 70 years and above. A comparison of cases with and without CD20 expression revealed that Japanese ethnicity and pericardial effusion were significantly correlated with CD20 expression, whereas a past history of induced fluid overload and peritoneal effusion were significantly correlated with the absence of CD20. We concluded that older age and CD20 expression are significant and favorable independent prognostic factors of HHV-8-negative EBL.
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Shin J, Ko YH, Oh SY, Yoon DH, Lee JO, Kim JS, Park Y, Shin HJ, Kim SJ, Won JH, Yoon SS, Kim WS, Koh Y. Body Cavity-Based Lymphoma in a Country with Low Human Immunodeficiency Virus Prevalence: A Series of 17 Cases from the Consortium for Improving Survival of Lymphoma. Cancer Res Treat 2019; 51:1302-1312. [PMID: 30764603 PMCID: PMC6790843 DOI: 10.4143/crt.2018.555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/28/2019] [Indexed: 12/14/2022] Open
Abstract
Purpose Primary effusion lymphoma (PEL) is a type of body cavity–based lymphoma (BCBL). Most patients with PEL are severely immunocompromised and seropositive for human immunodeficiency virus (HIV). We investigated the distinctive clinicopathologic characteristics of BCBL in a country with low HIV burden. Materials and Methods We retrospectively collected data on the clinicopathologic characteristics, treatments, and outcomes of 17 consecutive patients with BCBL at nine institutions in Korea. Results Latency-associated nuclear antigen 1 (LANA1) immunostaining indicated that six patients had PEL, six patients had human herpesvirus 8 (HHV8)-unrelated BCBL, and five patients had HHV8-unknown BCBL. The patients with PEL exhibited no evidence of immunodeficiency except for one who was HIV positive. One (20%) and four (80%) patients with PEL and six (100%) and zero (0%) patients with HHV8-unrelated BCBL were positive for CD20 and CD30 expression, respectively. The two patients with PEL (one HIV-positive and one HIV-negative patient) with the lowest proliferation activity as assessed by the Ki-67 labeling index survived for > 1 and > 4 years without chemotherapy, respectively, in contrast to the PEL cases in the literature, which mostly showed a high proliferation index and poor survival. Conclusion PEL mostly occurred in ostensibly immunocompetent individuals and had a favorable outcome in Korea. A watchful waiting approach may be applicable for managing HIV-seronegative patients with PEL with a low Ki-67 labeling index. A possible trend was detected among LANA1, CD20, and CD30 expression in BCBL.
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Affiliation(s)
- Junghoon Shin
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Hyeh Ko
- Department of Pathology, Samsung Medical Center, Seoul, Korea
| | - Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, Seoul, Korea
| | - Jeong-Ok Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Seok Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Park
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Ho Jin Shin
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Seok Jin Kim
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Jong Ho Won
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Won Seog Kim
- Department of Medicine, Samsung Medical Center, Seoul, Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | -
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Usuda D, Arahata M, Takeshima K, Sangen R, Takamura A, Kawai Y, Kasamaki Y, Iinuma Y, Kanda T. A Case of Diffuse Large B-Cell Lymphoma Mimicking Primary Effusion Lymphoma-Like Lymphoma. Case Rep Oncol 2017; 10:1013-1022. [PMID: 29279707 PMCID: PMC5731153 DOI: 10.1159/000484042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 02/05/2023] Open
Abstract
A 93-year-old female was transferred to the emergency ward of our hospital due to disturbance of consciousness and hypotension. Computed tomography showed bilateral pleural and pericardial effusion without evidence of tumor masses or lymphadenopathy. Cytodiagnosis of pleural effusion revealed proliferation of atypical lymphoid-like cells with pan-B surface markers. We suspected primary effusion lymphoma-like lymphoma; however, the monoclonality of these cells was not confirmed. Cytodiagnosis of bone marrow revealed lymphoma cells with monoclonal B-cell markers. These findings prompted a diagnosis of diffuse large B-cell lymphoma with bone marrow invasion. In the case of pericardial or pleural effusion, clinicians should consider carefully both hematological malignancy and its classification.
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Affiliation(s)
- Daisuke Usuda
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
- *Daisuke Usuda, Department of Infectious Diseases, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa-ken 920-0293 (Japan), E-Mail
| | - Masahisa Arahata
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Japan
| | - Kento Takeshima
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Ryusho Sangen
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Akiteru Takamura
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Yasuhiro Kawai
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
| | - Yuji Kasamaki
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Yoshitsugu Iinuma
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
| | - Tsugiyasu Kanda
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
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