Primary Malignant Lymphoma of the Breast: Clinicopathological study of 9 cases / 대한혈액학회지

BACKGROUND: Primary lymphoma of the breast is rare disease, accounting for 1.7% to 2.2% of extranodal lymphoma and 0.38% to 0.7% of non-Hodgkin's lymphoma. The aim of this study was to evaluate the clinicopathological features and treatment outcome of patients with primary breast lymphoma (PBL). METHODS: We conducted retrospective review of cases of non-Hodgkin's lymphoma diagnosed at Korea Cancer Center Hospital between 1989 and 2002. Nine of the 1050 cases fulfilled the criteria for PBL. RESULTS: All patients were women (median age, 45 years) and they usually had breast masses that had recently become enlarged. Six cases involved the breast alone (stage IE), whereas three cases also involved the ipsilateral lymph nodes (stage IIE). Histopathologic studies revealed diffuse large B cell in 7 cases, marginal zone B cell lymphoma in 1 case, small lymphocytic lymphoma in 1 case. Immunohistochemical analysis revealed B-cell phenotype in all cases. Modified radical mastectomy and chemotherapy was done in 4 cases, modified radical mastectomy and chemoradiotherapy was done in 1 case, chemoradiotherapy was done in 1 case, modified radical mastectomy alone was done in 1 case, chemotherapy alone was done in 1 case, and radiotherapy alone was done in 1 case. All cases achieved a complete remission, but median overall survival was 12 months. CONCLUSION: PBL represented 0.9% of all non-Hodgkin's lymphomas in our institute. The most frequent pathologic type was diffuse large B-cell lymphoma. There was no uniform approach to the treatment of PBL. The patients showed very poor prognosis irrespective of the type of treatment modality.

Primary Non-Hodgkin's Lymphoma of Bone: A Single Institution Experience / 대한혈액학회지

BACKGROUND: The purpose of this study was to evaluate the clinical features and treatment outcome of patients with primary non- Hodgkin's lymphoma (NHL) of bone. METHODS: A survey of 1,050 NHL patients who had been diagnosed at Korea Cancer Center Hospital between 1989 and 2001 identified 32 patients with NHL involving bone. Of these 32 patients, 22 patients were diagnosed as primary NHL of bone. The clinical data were available in 17 of the patients, and analyzed retrospectively. RESULTS: The male to female ratio was 3.3:1 and the median age was 31 years (range, 16- 52 years). The most common presenting symptom was bone pain of involved site (76.5%) and the most commonly involved site was tibia. Stages at diagnosis were as follows: stage I in 6 patients; stage II in 2 patients; stage III in 2 patients; stage IV in 7 patients. According to the REAL classification, the most common histologic subtype was diffuse large B cell lymphoma. Of evaluable 16 patients, 5 patients had B symptoms. The risk groups accord-ing to International Prognostic Index (IPI) were as follows: low risk in 9 patients, low-intermediate risk in 4 patients, high-intermediate risk in 1 patient, high risk in 2 patients, not evaluable in 1 patient. The first-line treatment modalities were as follows: combined radiation and chemotherapy in 8 patients (1 for palliative aim, 7 for curative aim); chemotherapy only in 4 patients; radiation only in 2 patients; surgery and chemotherapy in 1 patient. Objective response rate to treatment was 93.3% (95% confidence interval; 80.9~100%) and five-year survival rate was 57% (95% confidence interval; 30.5~83.4%). CONCLUSION: Most patients complained bone pain at involved site. The histologic subtype was diverse, but the most common subtype was diffuse large B cell lymphoma. The prognosis is similar to other non- Hodgkin's lymphomas.

A Case of Catamenial Hemoptysis Treated successfully with Gonadotropin-releasing Hormone (GnRH) Analogue / 결핵

Catamenial hemoptysis is syndrome characterized by bleeding from the bronchial trees and lungs that occurs synchronously with the female menstrual cycle. Etiologic mechanism of pulmonary endometriosis is still controversial, and the diagnosis is usually made on the basis of the clinical history and exclusion of other causes of recurrent hemoptysis. Serial computed tomograms of the chest during and in the interval between menstruations have been proved to be a useful confirmatory test. We experienced a 33-year-old female patient who had been previously diagnosed as pelvic endometriosis pathologically, experienced cyclic hemoptysis during menstruations. The diagnosis of pulmonary endometriosis was made based on her history and changes in the character of the lesions as documented on radiologic studies of the chest. She was treated successfully with GnRH analogue and there is no evidence of recurrence.

The Effect of Intensified Induction Using Vanderbilt Regimen in Patients with an Intermediate Grade Non-Hodgkin's Lymphoma Having 2 or 3 Adverse Factors on the Age-adjusted International Prognostic Index / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of our study was to evaluate the outcome of intensified induction therapy using the Vanderbilt regimen in patients with a poor prognosis non-Hodgkin's lymphoma (NHL). MATERIALS AND METHODS: We retrospectively analyzed the results of two pilot studies, which enrolled the patients aged 60 years or less, with a previously untreated NHL of intermediate grade on the Working formulation, having 2 or 3 adverse prognostic factors on the age- adjusted International Prognostic Index. Patients received an intensified induction, with the regimen described by the Vanderbilt group. RESULTS: Thirty-five patients were analyzed. After induction, 29 patients (83%) achieved more than partial response (PR): 22 (63%) complete response (CR) and 7 (20%) PR. Three of the PRs were subsequently converted to CR following consolidation therapy. The overall CR rate, following the completion of treatment, was 71%. The 3-year overall survival (OS) rate of all patients was 53%. In the univariate analysis, age (50 years) was the only factor affecting the OS. The 3-year disease-free survival (DFS) rate of patients with CR was 68%. In the univariate analysis, age and bone marrow involvement were the factors affecting the DFS. Two patients died from the treatment-related toxicity of the induction therapy: one due to sepsis and the other due to congestive heart failure. CONCLUSION: Although the CR rate was relatively high, the OS or DFS of patients with a poor prognosis NHL, who had received the intensified induction using the Vanderbilt regimen, were no different from those that had received the conventional chemotherapy, as reported by the International Prognostic Index Project. However, the OS or DFS in the young patient groups were encouraging. To test the hypothesized benefits of our approach in the young patient groups, a larger cohort of patients aged 50 years or less should be studied.

A Case of Extraskeletal Ewing's Sarcoma Arising from Duodenum / Journal of the Korean Cancer Association, 대한암학회지

Extraskeletal Ewing's sarcomas (EES) are rare. Recently, Ewing's sarcoma of the bone, primitive neuroectodermal tumor (PNET), Askin tumor and EES have been included into the family of Ewing's tumors, due to the overlapping features relating to their clinico-pathological and cytogenetic appearance. We experienced a case of an EES arising from the duodenum in a 14-year-old girl who presented with hematemesis and epigastric discomfort. A duodenal biopsy specimen revealed the infiltration of small round cells and rich vasculatures, with immunohistochemical finding of MIC-2 (CD99) (+), vimentin (+), CD56 (NCAM) (+), LCA (-), T-cell (-), B-cell (-), CD43 (-) and CD68 (-). She was treated with several cycles of multiagent chemotherapy, and achieved an initial partial response, but rapid progression of tumor followed, so she was treated with surgical excision. This is the first case report of an EES arising from the duodenum in the literature.