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Din F, Mellor F, Millard T, Pace E, Khan N, Attygalle AD, Cunningham D, Zafar S, Sharma B. Radiology of Castleman disease: the pivotal role of imaging in diagnosis, staging, and response assessment of this rare entity. Clin Radiol 2022; 77:399-408. [PMID: 35177229 DOI: 10.1016/j.crad.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Castleman Disease (CD) is a rare entity that typically presents as an enhancing nodal mass in the mediastinum or head and neck region on computed tomography (CT). It may manifest as unicentric or multicentric regions of lymph node enlargement. A key clinical issue in the context of CD is delayed diagnosis, which contributes adversely to patient outcome, given that accurate diagnosis facilitates earlier treatment of this curable disease. This article will address relevant imaging aspects, with reference to typical and atypical imaging features of CD, illustrated using examples from our specialist centre; the imaging journey for patients with CD; and will provide practical pointers to radiologists in differentiating CD from other benign and malignant causes of enhancing lymphadenopathy, including lymphoma and neoplastic adenopathy. We will also review current classification tools and staging challenges with reference to World Health Organization guidelines, International Working Group guidelines as well as the Lugano classification. Finally, we will discuss the potential role of additional imaging techniques in CD, highlighting novel imaging methods and expanded utilities from our specialist centre.
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Affiliation(s)
- F Din
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - F Mellor
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - T Millard
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - E Pace
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
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Mehdi AS, Bitar G, Sharma RK, Iyengar S, El-Sharkawi D, Tasoulis MK, Attygalle AD, Cunningham D, Sharma B. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL): a good practice guide, pictorial review, and new perspectives. Clin Radiol 2021; 77:79-87. [PMID: 34579859 DOI: 10.1016/j.crad.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/02/2021] [Indexed: 11/03/2022]
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare but emerging T-cell non-Hodgkin lymphoma. It has two distinct subtypes, "effusion-only" or "mass-forming" disease, arising around implants in patients with in situ or previous history of textured-surface breast implants. The clinical, histopathological and imaging features are unique and nuanced as compared to primary breast malignancy and other lymphoma categories. Prompt recognition and diagnosis triggers referral to appropriate BIA-ALCL centres and initiation of treatment, with potential for excellent prognosis. Definitive management of both subtypes involves implant and capsule removal; systemic therapy is reserved for mass-forming disease and advanced-stage disease. There have been recent crucial advances in the diagnostic pathway, with publication of national and international guidelines: from the UK Medicines Healthcare products Regulatory Agency (MHRA) Plastic, Reconstructive and Aesthetic Surgery Expert Advisory Group (PRASEAG), and the United States National Comprehensive Cancer Network (NCCN). This review provides a practical guide to the clinical work-up of BIA-ALCL, enabling optimisation of the diagnostic imaging pathway, with representative cases.
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Affiliation(s)
- A S Mehdi
- Radiology Department, Imperial College Healthcare NHS Trust, London, UK
| | - G Bitar
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - R K Sharma
- Medical School, College of Medicine and Health, University of Exeter, UK
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- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - S Iyengar
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - D El-Sharkawi
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - M K Tasoulis
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - A D Attygalle
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - D Cunningham
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK
| | - B Sharma
- Lymphoma Unit, Royal Marsden NHS Foundation Trust, London, UK; Lymphoma Unit, The Institute of Cancer Research, ICR, London, UK.
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Zafar S, Sharma RK, Cunningham J, Mahalingam P, Attygalle AD, Khan N, Cunningham D, El-Sharkawi D, Iyengar S, Sharma B. Current and future best practice in imaging, staging, and response assessment for Non-Hodgkin's lymphomas: the Specialist Integrated Haematological Malignancy Imaging Reporting (SIHMIR) paradigm shift. Clin Radiol 2021; 76:391.e1-391.e18. [PMID: 33579517 DOI: 10.1016/j.crad.2020.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/24/2020] [Indexed: 12/12/2022]
Abstract
Non-Hodgkin's lymphoma (NHL) encompasses over 40 different haematological malignancies, including low and high-grade neoplasms, such as follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) respectively. A key clinical issue in the context of NHL is delayed and inaccurate diagnosis, which contributes adversely to patient morbidity and mortality. This article will address relevant imaging aspects, with particular reference to advancements in NHL imaging, including computed tomography (CT), integrated positron-emission tomography (PET)-CT, and magnetic resonance imaging (MRI). We provide multiparametric (anato-functional) imaging display items, including histological correlation. We will also introduce our original concept of "Specialist Integrated Haematological Malignancy Imaging Reporting" (SIHMIR), a paradigm shift in lymphoma radiology.
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Affiliation(s)
- S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
| | - R K Sharma
- College of Medicine and Health, University of Exeter, UK
| | - J Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - P Mahalingam
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D El-Sharkawi
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Iyengar
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK; The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
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Stanciu PI, Ind TEJ, Barton DPJ, Butler JB, Vroobel KM, Attygalle AD, Nobbenhuis MAE. Development of Peritoneal Carcinoma in women diagnosed with Serous Tubal Intraepithelial Carcinoma (STIC) following Risk-Reducing Salpingo-Oophorectomy (RRSO). J Ovarian Res 2019; 12:50. [PMID: 31128592 PMCID: PMC6535186 DOI: 10.1186/s13048-019-0525-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/17/2019] [Indexed: 01/29/2023] Open
Abstract
Introduction The management of Serous Tubal Intraepithelial Carcinoma (STIC) found at the time of Risk-Reducing Salpingo-Oophorectomy (RRSO) remains unclear. We set out to analyse the incidence of peritoneal carcinomas developed after prophylactic surgery and to formulate further guidance for these patients. Methods This is a retrospective study of 300 consecutive RRSO performed at the Royal Marsden Hospital between January 2008 and January 2017. Results The median age at RRSO was 47.8 years (range 34 to 60 years) and median BMI was 26.2 kg/m2 (range 16 to 51 kg/m2). A total of 273 patients (91%) were tested for BRCA mutations. Of these, 124 (45.4%) had a BRCA 1 mutation, 118 (43.2%) had a BRCA 2 mutation, 2 (0.7%) had both a BRCA 1 and a BRCA 2 mutation and 29 (10.6%) had no BRCA mutation detected. Isolated STIC lesions were identified in 7 cases (2.3%) and p53 signatures in 75 cases (25%). There were five (1.6%) incidental tubal carcinomas and one (0.3%) ovarian carcinoma at the time of surgery. Two (28.6%) of the 7 patients with STIC identified following RRSO had high grade serous peritoneal carcinoma diagnosed at 53 and 75 months. One (0.3%) patient from the other 287 patients from our series with no STIC diagnosis or incidental carcinomas at RRSO developed high grade serous carcinoma of peritoneal origin after 92 months. Conclusion This study demonstrates that when a STIC lesion is identified following RRSO there is a significantly higher risk of a subsequent peritoneal cancer. Although there is no published consensus in literature, we recommend that consideration should be given for long term follow-up if a STIC lesion is identified at RRSO.
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Affiliation(s)
- P I Stanciu
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK.
| | - T E J Ind
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - D P J Barton
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - J B Butler
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
| | - K M Vroobel
- Pathology Department, The Royal Marsden Hospital, London, UK
| | - A D Attygalle
- Pathology Department, The Royal Marsden Hospital, London, UK
| | - M A E Nobbenhuis
- Gynaecological Oncology Department, The Royal Marsden Hospital, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
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Downey K, Jafar M, Attygalle AD, Hazell S, Morgan VA, Giles SL, Schmidt MA, Ind TEJ, Shepherd JH, deSouza NM. Influencing surgical management in patients with carcinoma of the cervix using a T2- and ZOOM-diffusion-weighted endovaginal MRI technique. Br J Cancer 2013; 109:615-22. [PMID: 23868012 PMCID: PMC3738120 DOI: 10.1038/bjc.2013.375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/11/2013] [Accepted: 06/22/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Endovaginal MRI (evMRI) at 3.0-T with T2-weighted (T2-W) and ZOnal Oblique Multislice (ZOOM)-diffusion-weighted imaging (DWI) potentially improves the detection of stage Ia/Ib1 cervical cancer. We aimed to determine its sensitivity/specificity, document tumour-to-stromal contrast and establish the effect of imaging on surgical management. METHODS Following ethical approval and written informed consent, 57 consecutive patients with suspected stage Ia/Ib1 cervical cancer underwent evMRI at 3.0-T using T2-W and ZOOM-DWI. Sensitivity/specificity were calculated against histopathology for two independent observers. Tumour-to-stromal contrast was determined on T2-W, and diffusion-weighted (b=800 s mm(-2)) images and apparent diffusion coefficients (ADCs) were recorded. In patients due for radical vaginal trachelectomy (RVT), change of surgical management based on imaging findings was documented. RESULTS Sensitivity/specificity for detecting tumour was the following: reporting read 88.0/81.8%, anonymised read 92.0/81.8% (observer 1); 84.0/72.7% (observer2; median tumour volume=1.7 cm(3)). Intraobserver agreement was excellent (kappa=0.89) and the interobserver agreement was good (kappa=0.65). Tumour-to-stromal contrast was greater on ZOOM-DWI compared with T2-W images (3.35±2.36 vs 1.39±0.95; P<0.0004). Tumour and stromal ADCs were significantly different (P<0.00001). In 31 patients due for RVT, evMRI altered surgical management in 12 (38.7%) cases (10 cone-biopsy, 2 chemoradiotherapy). CONCLUSION T2-W+ZOOM-DWI evMRI has high sensitivity/specificity for detecting stage Ia/Ib1 cervical tumours; in patients due for RVT, the surgical management was altered in ∼39%.
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Affiliation(s)
- K Downey
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
| | - M Jafar
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
| | - A D Attygalle
- Department of Histopathology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - S Hazell
- Department of Histopathology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - V A Morgan
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
| | - S L Giles
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
| | - M A Schmidt
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
| | - T E J Ind
- Department of Gynecology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - J H Shepherd
- Department of Gynecology, Royal Marsden NHS Foundation Trust, Downs Road, Surrey SM2 5PT, UK
| | - N M deSouza
- CRUK and EPSRC Cancer Imaging Centre, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Surrey SM2 5PT, UK
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Attygalle AD, Chuang SS, Diss TC, Du MQ, Isaacson PG, Dogan A. Distinguishing angioimmunoblastic T-cell lymphoma from peripheral T-cell lymphoma, unspecified, using morphology, immunophenotype and molecular genetics. Histopathology 2007; 50:498-508. [PMID: 17448026 DOI: 10.1111/j.1365-2559.2007.02632.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To identify distinguishing histological, immunophenotypic and molecular genetic features between angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma (PTL). METHODS Nodal T-cell lymphomas examined (n =137), included AITL (n = 89), PTL (n = 22), anaplastic large cell lymphoma (n = 16) and 'AITL/PTL indeterminate' (n = 10) with overlapping features between AITL and PTL, showing morphology typical of AITL but lacking follicular dendritic cell expansion. Immunohistochemistry for CD3, CD20, CD21 and CD10, in situ hybridization for Epstein-Barr virus encoded RNA (EBER) and polymerase chain reaction for T-cell and B-cell clonality analysis were performed. RESULTS Of the AITLs, 74/89 showed typical morphology, whereas 15/89 showed hyperplastic follicles. AITL and 'AITL/PTL indeterminate' showed a polymorphous infiltrate and prominent vascularity in all cases. In both groups, CD10 was present in the majority and clear cells and EBER positivity were specific (but not universal) features lacking in PTL. Detection of T-cell clonality was significantly higher in AITL (90%) compared with PTLu (59%). CONCLUSION Clear cells and EBV infection (when present) are useful distinguishing features and CD10 a sensitive and specific marker of AITL. Hyperplastic follicles are present in a significant minority of AITL. AITL/PTL indeterminate probably falls within the spectrum of AITL rather than PTL.
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MESH Headings
- Antigens, CD20/metabolism
- B-Lymphocytes/pathology
- CD3 Complex/metabolism
- Clone Cells
- Diagnosis, Differential
- Gene Rearrangement
- Herpesvirus 4, Human/genetics
- Humans
- Immunoblastic Lymphadenopathy/diagnosis
- Immunoblastic Lymphadenopathy/genetics
- Immunoblastic Lymphadenopathy/pathology
- Immunoglobulin Heavy Chains/genetics
- Immunohistochemistry
- Immunophenotyping
- Lymphoma, T-Cell, Peripheral/diagnosis
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/pathology
- Neprilysin/metabolism
- Polymerase Chain Reaction
- RNA, Viral/analysis
- Receptors, Antigen, T-Cell, gamma-delta/genetics
- Receptors, Complement 3d/metabolism
- Sensitivity and Specificity
- T-Lymphocytes/pathology
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Affiliation(s)
- A D Attygalle
- Department of Histopathology, The Royal Marsden NHS Foundation Trust, London, UK.
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