Primary colonic MALT lymphoma associated with Crohn's disease: Case report and review of the literature

Key Clinical Message

To date, the pathogenic mechanisms of the association between Crohn's disease and MALT lymphoma are ambiguous and yet remain to be elucidated. The publication of other cases illustrating this rare association would be interesting to properly plan therapeutic strategies and to better understand the pathogenesis and the prognosis of this association.

Abstract

Crohn's disease is a progressive disease, with increasing incidence, that leads to bowel damage and disability. Primary colonic MALT lymphoma is a low-grade B lymphoma, representing only 2.5% of all MALT lymphomas. The pathogenesis of these two cancers is still not clearly elucidated and their association is rare. To our knowledge, only two cases have illustrated synchronous Crohn's disease and MALT lymphoma. The possible role of Crohn's disease as a precursor of MALT lymphoma is still debated; some studies proposed that immunosuppressive drugs used in Crohn's disease are involved in the lymphomagenesis of MALT lymphoma. Other studies supposed no relation between these two neoplasms.We present a rare case of association between Crohn's disease and primary colonic MALT lymphoma in an elderly female patient who had not received any immunosuppressive therapy. The patient presented with chronic diarrhea, epigastric pain, and weight loss. A colonoscopy with biopsies was performed. The histopathologic examination concluded with the diagnosis of not only Crohn's disease but also MALT lymphoma. This discovery of MALT lymphoma was incidental. We highlight the clinical and histopathological features, and we discuss the association between Crohn's disease and MALT lymphoma, which may provide additional information about pathogenic mechanisms.

Hyperthyroidism secondary to a primary mediastinal goiter with normal functional cervical thyroid gland

Primary mediastinal goiter is extremely uncommon. The majority of primary mediastinal goiters were reported as incidental findings on chest imaging of asymptomatic patients. Symptoms related to compression of adjacent structures or hyperthyroidism were rarely described. Herein we report a case of hyperthyroidism secondary to a primary mediastinal goiter.

Isolated bladder metastasis from lung adenocarcinoma: a case report

Cancers of extra bladder origin represent between 2 and 12% of bladder neoplasms and are most often secondary to contiguous bladder invasion. Metastasis from distant organs is exceptional, especially from pulmonary adenocarcinoma with <10 cases identified over the last 20 years. We report here a new case of a 55-year-old patient with a recently diagnosed pulmonary adenocarcinoma referred to the urology department for macroscopic hematuria. Computed tomography scan showed, in addition to the lung mass of the right lower lobe with a right mediastinal adenopathy, a thickening of the right lateral bladder wall. Cystoscopy showed inflammatory lesions on the bladder mucosa, which biopsy with immunohistochemical examination revealed to be tumoral proliferation in the lamina propria realizing the same immunohistochemical profile of the primary lung tumor (CK7+/TTF1+/CK20-/PSA-). The patient was treated with palliative platinum-based chemotherapy and unfortunately died 5 months after diagnosis.

Accuracy of fine-needle aspiration cytology in the diagnosis of salivary gland masses according to the Milan reporting system and to an in-house system

BACKGROUND

This study aims to assess in our institutional experience the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of salivary gland masses (SGM) according to the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) and to an in-house system.

METHODS

The study included 189 FNACs conducted between January 2011 and December 2019. The FNACs, classified according to the in-house system, were reclassified according the MSRSGC. Taking histopathology as gold standard, the measures of diagnostic accuracy of FNAC were determined for suspicion for malignancy (SFM) and malignant categories.

RESULTS

According to the in house system, FNAC diagnoses were classified as: 23 (12.2%) non-diagnostic (ND), 23 (12.2%) non-neoplastic (NN), 119 (62.9%) benign neoplasm (BN), 10 (5.2%) indefinite neoplasm (IN), 2 (1.1%) SFM, and 12 (6.4%) malignant (M). Based on the MSRSGC, there were 3 (1.5%) cases of atypia of undetermined significance (AUS) and 7 (3.7%) neoplasms of uncertain malignant potential (SUMP). The number of ND, NN, BN, SFM, and M cases were identical in the two systems. For both systems, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy for malignancy diagnosis were 77.8%, 100%, 100%, 97.6%, and 97.8%, respectively.

CONCLUSION

According to the MSRGC and to our in-house reporting system, FNAC is an accurate technique for the diagnosis of malignant salivary tumors with excellent specificity and good sensitivity. However, MSRGC has the advantage of standardization of salivary gland cytology reporting.

Evaluation of fine needle aspiration cytology in the diagnosis of cervical lymph node lymphomas

PURPOSE

Surgical biopsy examination is the gold standard for the diagnosis of lymph node lymphomas. Fine-needle aspiration cytology (FNAC) is a quick and safe method in the management of cervical lymph nodes. Its value in confirming recurrent or residual lymphoma is well established. However, its role in the primary diagnosis of lymph node lymphoma remains controversial. The aim of this study was to assess, in our experience, the reliability of FNAC in the diagnosis of cervical lymph node lymphomas.

MATERIALS AND METHODS

This was a retrospective study carried out over a 6-year period (January 2011 to December 2016) and conducted at the Cytology Unit in our Pathology Department (Charles Nicolle Hospital, Tunisia). The measures of diagnostic accuracy of FNAC in the diagnosis of cervical lymph node lymphomas were calculated taking histopathology as the gold standard.

RESULTS

A total of 937 FNA samples were obtained from 851 patients. The diagnosis of lymphoma was obtained in 65 cases (6.9%). Cytological diagnoses of lymphoma were as follows: 28 (44%) Hodgkin lymphoma, 17 (25%) high-grade lymphoma, 15 (23%) low-grade lymphoma, and 5 (8%) "suggestive of lymphoma." FNAC of cervical lymph nodes had a sensitivity of 95.5%, specificity of 98.7%, positive predictive value (PPV) of 97.7%, and negative predictive value (NPP) of 97.5%.

CONCLUSION

The present study demonstrated that cytology is capable to detect nodes suspicious for the presence of lymphoma precisely, in terms of low- or high-grade lymphoma, which is a relevant and very achievable first step in the management of patients with cervical lymph node lymphoma.

Assessment of EGFR mutation status in Tunisian patients with pulmonary adenocarcinoma

BACKGROUND

Despite recent advances, non-small cell lung cancer carries a grim prognosis. For appropriate treatment selection, the updated guidelines recommend broad molecular profiling for all patients with pulmonary adenocarcinoma. Precise histological subtyping and targeted epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) testing are mandatory.

METHODS

Herein, we assessed the EGFR mutation status of 26 formalin fixed-paraffin embedded (FFPE) samples of lung adenocarcinoma. Mutational analysis concerned exons 18-21 of EGFR by real-time polymerase chain reaction (Real time-PCR) using the Therascreen EGFR RGQ PCR mutation kit. ALK status was established on 22 among 26 patients using D5F3 antibody with a fully automated Ventana CDx technique.

RESULTS

Activating EGFR mutations were found in 3 men among 26 patients (11.5%). Positive ALK expression was found in 2 cases among 22 patients (9.09%).

CONCLUSION

Frequency of EGFR mutations in pulmonary adenocarcinomas of our series is similar to that found in the European ones with some particularities. The mutations detected are uncommon. Whereas, we found a high frequency of positive ALK expression in our series compared to frequency reported in literature. Further studies with larger Tunisian series are required to obtain more conclusive results.

Thyroid oncocytic neoplasms

BACKGROUND

Oncocytic tumors (OT) are rare, representing 3 to 10% of epithelial tumors of the thyroid. It is important to individualize these TO given the relatively high frequency of carcinomas in this group: 30% against 15% for micro-vesicular lesions of classical cytology and the aggressiveness of malignant OT due to their low iodine uptake.

AIM

The aim of our study was to describe the anatomo-clinical aspects of oncocytic tumors of the thyroid.

METHODS

Our study was retrospective, realized on 99 cases of oncocyte thyroid tumors collected at the Anatomy and Pathology Cytology laboratory of Tunis Charles Nicolle Hospital during a 10-year period (2004-2014).

RESULTS

Our series included: 76 oncocyte adenomas, 13 oncocytic papillary carcinomas, 7 oncocytic carcinomas and 3 tumors of uncertain malignant potential (3%). The correlation of the anatomo-clinical data with the diagnostic categories showed a statistically significant difference concerning the macrovesicular architecture. We found no difference between benign and malignant TO, in relation to age, echogenicity, tumor size, macroscopic appearance, capsule thickness, percentage of oncocyte cells, and the presence of associated lymphocyte thyroiditis.

CONCLUSIONS

In view of the literature data and the findings of our study, it seems that there are no predictive factors for the malignancy of oncocytic tumors at the pre- and peroperative stage, with the exception of papillary-type nuclear atypia for Oncocytic papillary carcinoma.

ALK protein expression in pulmonary adenocarcinoma of Tunisian patients

BACKGROUND

It is now necessary to determine ALK status in order to use targeted therapy.

AIM

herein, we assess immunohistochemical profile of ALK protein in a series of Tunisian patients with pulmonary adenocarcinoma.

MATERIALS AND METHODS

ALK protein expression was studied applying the D5F3 antibody with a fully automated Ventana CDx technique on a series of 19 patients.

RESULTS

Positive ALK expression was found in one case (5.2%) corresponding to a papillary adenocarcinoma which showed a strong granular and homogenous cytoplasmic staining. The patient was a 30-years-old woman.

CONCLUSION

The frequency of positive ALK expression based on immunohistochemistry in our series was similar to that reported in the world literature.

Clear Cell Adenocarcinoma of the Female Urethra, Mimicking Cystocele

Clear cell adenocarcinoma of the urethra is an extremely rare neoplasm mainly described in women. Anterior pelvic exenteration was the treatment performed in most reported cases. It seems to have poorer prognosis than urothelial carcinomas.

[Osteoclast-type giant cell tumor of the parotid gland]

INTRODUCTION

Osteoclast-type giant cell tumors of the salivary gland are extremely rare; only 23 cases have been reported. Two presentations were observed: isolated tumor or tumor associated with a carcinomatous contingent.

CASE REPORT

A 51-year-old female patient consulted for a painless left retro-angulo-mandibular swelling having appeared 2 years before. This was a 2 cm parotid mass without facial nerve palsy or cervical lymphadenopathy. The patient underwent a superficial parotidectomy to remove the nodule. The direct microscopic examination revealed an osteoclastic giant cell tumor without any carcinomatous contingent. At immunohistochemistry, mononuclear cells were diffusely and intensely stained by anti-pancytokeratin, while multinucleated cells were totally negative and CD68 positive. The patient was not given any complementary treatment. She was followed-up 23 months later and did not present any signs of recurrence or metastasis.

DISCUSSION

The histogenesis and nosology of osteoclastic giant cell are currently unknown. Although this entity was not integrated into the latest WHO classification, most authors consider it as a variant of carcinoma. Published data on the epithelial or histiocytic nature of multinucleated cells is not consensual. Our case presentation supports the hypothesis of a histiocytic differentiation of giant cells and epithelial mononuclear cells.

Primary testicular non-Hodgkin lymphoma. a 10-year Tunisian single-institute experience

BACKGROUND

Primary testicular non-Hodgkin lymphoma (NHL) is an uncommon extra nodal presentation, accounting for 1% of all NHL and 1 to 9% of testicular neoplasms. Median age at time of presentation is 60 years old. Anthracycline based chemotherapies are most frequently used.

AIM

To analyze baseline characteristics, treatment modalities and survival of six cases of primary testicular non-Hodgkin lymphoma.

METHODS

We screened 46 testicular neoplasm cases registered from January 1999 to January 2009 and found six primary testicular lymphoma patients. These six cases were analyzed for baseline clinical features, investigations, treatment and outcome variables.

RESULTS

Median age was 50 years old and median duration of symptoms was 4 months. All patients had testicular swelling. Four patients had abdominal lymphadenopathy. Most patients had diffuse large B-cell histology. All patients underwent high inguinal orchidectomy and five were treated with anthracycline based chemotherapy. Four patients completed therapy and one of them relapsed two years later.

CONCLUSION

Primary testicular NHL is an uncommon entity and with current combined modality treatment, the outcome may be as good as nodal NHL.

A case of multiple epithelioid angiomatous nodules

Cutaneous epithelioid angiomatous nodule (CEAN) is a distinct type of epithelioid vascular tumor that is usually solitary. Herein we present a 31-year-old man with multiple, rapidly growing nodules on the scalp.

[Sclerosing hemangioma of the lung: a rare lesion with a difficult diagnosis]

Sclerosing hemangioma of the lung is a rare lesion described for the first time in 1956 by Liebow. We report a case in a 45 year-old woman who was admitted for exploration of chronic cough. The chest x-ray revealed a round opacity, well delimited in the left pulmonary parenchyma. Surgical resection enabled the histopathological diagnosis of sclerosing hemangioma. We review progress in our knowledge of the histogenesis and diagnosis of this tumor. Immunohistochemistry has been highly contributory although numerous points remain controversial.