T-cell-rich B-cell lymphoma. Analysis of clinical features, response to treatment, survival and comparison with diffuse large B-cell lymphoma

OBJECTIVES

Clinical features, response to treatment and survival of T-cell-rich B-cell lymphoma (TCRBCL) patients were compared to those of a similar group of patients with diffuse large B-cell lymphoma (DLBCL).

METHODS

Between 1992 and 1999, 10 patients with a diagnosis of TCRBCL were treated in our department. Over the same 7-year period, a group of 65 patients with DLBCL were diagnosed in the same department. Both groups of patients were treated with the same anthracycline-based chemotherapy.

RESULTS

A significantly higher percentage of patients with TCRBCL presented with B-symptoms, elevated LDH, bone marrow infiltration and disseminated extranodal involvement compared to patients with DLBCL. TCRBCL patients responded poorly to combination chemotherapy, since only 3 of them achieved complete remission (33%) compared to 48 (75%) patients with DLBCL. All patients with TCRBCL who achieved complete response relapsed within the first 2 years while 65% of patients with DLBCL survive disease free for a median follow-up period of 4 years. The median overall survival for DLBCL patients has not been reached yet, while it was 18 months for TCRBCL patients.

CONCLUSIONS

Although the number of patients in our study is small, it seems that patients with TCRBCL present with advanced disease, respond poorly to chemotherapy and display a short disease-free and overall survival compared to patients with DLBCL.

Efficacy of intravenous immunoglobulin in the treatment of thrombotic thrombocytopaenic purpura. A study of 44 cases

Thrombotic thrombocytopaenic purpura (TTP) is characterised by platelet aggregation in the capillaries, thrombocytopaenia and microangiopathic haemolytic anaemia that result in organ ischaemia, mainly of the CNS and kidneys. Since the institution of plasma exchange therapy no further treatments have been proved to improve the survival and the relapse rate of TTP patients. In this retrospective study, we evaluated the efficacy of normal human immunoglobulin treatment in 44 patients suffering from TTP. Patients were divided into two groups that either did not receive (group A: 15 patients) or received (group B: 29 patients) 400 mg/kg of human normal immunoglobulin intravenously (ivIgG) for 5 days. All patients received treatment with corticosteroids, anti-platelet agents and plasma exchange. The results clearly showed that there was no statistically significant difference between the two groups in either remission rate or time to relapse following remission. In conclusion, this study did not prove any beneficial effect of ivIgG in the treatment of TTP patients.

Gallbladder adenomyomatosis presenting as fever of unknown origin: a case report

Gallbladder adenomyomatosis is a rare disorder, characterized by benign hyperplasia of the gallbladder mucosa creating invaginations through the muscular layer, known as Rokitansky-Aschoff sinuses. It is considered an acquired disease, with pathophysiology similar to that of the diverticular disease of the colon. Diagnosis is often achieved by ultrasound, but a significant percentage is misdiagnosed as chronic cholecystitis, whereas the diagnosis is finally achieved histologically. We describe a case of gallbladder adenomyomatosis presenting as fever of unknown origin. The patient was a 17-year-old girl with a history of sustained fever of 38.5 degrees C of two months' duration. There were no accompanying symptoms and the whole diagnostic workup, including abdominal ultrasound, was negative. Gallbladder inflammation was evident during an eventual investigatory laparoscopy, and cholecystectomy was performed. The histologic results were consistent with diffuse adenomyomatosis. The patient became afebrile immediately after cholecystectomy. To our knowledge, fever has never been associated with gallbladder adenomyomatosis before in bibliography, nor has adenomyomatosis been mentioned as a cause of fever of unknown origin. We therefore believe that gallbladder adenomyomatosis should be considered in the differential diagnosis of sustained fever with negative workup.

Massive hemothorax due to intrathoracic extramedullary hematopoiesis in a patient with hereditary spherocytosis

Extramedullary hematopoiesis (EMH) is a rare disorder, characterized by the appearance of hematopoietic elements outside of the bone marrow, which occurs in patients with chronic myeloproliferative disorders or congenital hemolytic anemias. We report on a 64-year-old man with hereditary spherocytosis, who presented with anemia, jaundice, intrathoracic EMH, and massive hemothorax. The diagnosis of EMH was established after computer tomography (CT)-guided punctuation of the paravertebral mass. The patient underwent splenectomy and thoracic drainage. After 1 year, the patient is in good health, with normal hemoglobin values, and hemothorax has not recurred.

Outbreak of measles in adults in the north west of Greece

The overall incidence of measles fell markedly in Greece after measles vaccination was introduced (although precise data are not available), but sporadic outbreaks continue to occur. A live monovalent measles vaccine was introduced in Greece in 1965 and r