ABSTRACT
Polyarthritis is a common manifestation of rheumatologic disorders; however, paraneoplastic arthropathies also arise as polyarthritis or polymyalgia, particularly in patients with myelomas, lymphomas, acute leukemia, and solid tumors. Because paraneoplastic syndromes, in some instances, might be manifested before a cancer diagnosis, they are difficult to diagnose and are often misdiagnosed. We experienced a 63-year-old female patient who had nonspecific arthritis on both hands and feet accompanied by fever. She had been diagnosed as rheumatoid arthritis and treated with prednisolone and disease modifying anti-rheumatic drugs (DMARDs) including methotrexate and anti-tumor necrosis factor agents. Her arthritis did not respond with anti-rheumatic treatment and diffuse large B-cell lymphoma was diagnosed by bone marrow biopsy. After 6 cycles of chemotherapy, her arthritis was improved as well as underlying lymphoma.
Subject(s)
Female , Humans , Middle Aged , Antirheumatic Agents , Arthritis , Arthritis, Rheumatoid , B-Lymphocytes , Biopsy , Bone Marrow , Diagnosis , Drug Therapy , Fever , Foot , Hand , Leukemia , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Methotrexate , Necrosis , Paraneoplastic Syndromes , PrednisoloneABSTRACT
A central nervous system (CNS) relapse is a rare but mostly fatal complication in patients with diffuse large B cell lymphoma (DLBCL). CNS involvement can occur as an isolated event or can be combined with progression of systemic disease. There are limited data on treatment outcomes of patients with DLBCL and secondary CNS involvement. We report the clinical data, treatments, and outcomes of two DLBCL patients with isolated CNS relapses involving the brain parenchyma. Isolated CNS disease involving the brain parenchyma may be potentially treatable as the initial relapse site after complete remission from systemic treatment.
Subject(s)
Humans , Brain , Central Nervous System , Central Nervous System Diseases , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , RecurrenceABSTRACT
Primary esophageal lymphoma is very rare, and most reported cases are histologically mucosa-associated lymphoid tissue lymphoma. Therefore, the principle treatment strategy for primary esophageal lymphoma focuses on local treatments, such as endoscopic mucosal resection or radiation therapy, but systemic chemotherapy plays the central role in the treatment of diffuse large B cell lymphoma (DLBCL). Generally, standard treatment for DLBCL is six or three cycles of R-CHOP chemotherapy followed by involved field radiation therapy according to stage. However, the optimal treatment strategy for primary esophageal DLBCL, and the role of additional radiation is not settled, due to a paucity of cases. Moreover, the clinical characteristics related to the etiology and natural course are also unknown. Here, we present two cases of primary esophageal DLBCL with a literature review.
Subject(s)
Drug Therapy , Esophagus , Lymphoma , Lymphoma, B-Cell , Lymphoma, B-Cell, Marginal Zone , Lymphoma, Large B-Cell, DiffuseABSTRACT
Primary testicular lymphomas (PTL) are rare entities representing 1-2% of Non-Hodgkin's Lymphoma (NHL) and 1-7% of malignant testicular tumours. They are most commonly seen in men older than 60 years. The most common type of primary testicular lymphoma (PTL) is diffuse large B-cell type which has the potential for aggressive clinical behaviour. We report the case of a 45 years old male with primary testicular lymphoma which was first diagnosed on Fine Needle Aspiration Cytology (FNAC) and subsequently confirmed histopathologically and immunophenotypically as Diffuse Large B-Cell Lymphoma (DLBCL) showing CD20 positivity. This case report confirms the literature data concerning the rarity of testicular Non Hodgkin's Lymphoma (TNHL) with DLBCL being the most common phenotype and the poor prognosis of the disease despite aggressive management.
ABSTRACT
A 3-year-old girl presented with a history of intermittent fever of six months duration associated with respiratory symptoms consisting of recurrent cough, fever, wheeze and a suspected history of contact with tuberculosis (TB). Chest radiograph revealed pulmonary infiltrates mimicking miliary TB. She was started on anti-tuberculous treatment, but in view of clinical deterioration, a further work-up including a lung biopsy revealed non-Hodgkin’s lymphoma (NHL). This case documents the extremely rare occurrence of pulmonary involvement and miliary infiltrates on the chest radiograph in NHL.
Subject(s)
Antineoplastic Agents/administration & dosage , Antitubercular Agents/administration & dosage , Antitubercular Agents/adverse effects , Biopsy , Child, Preschool , Cyclophosphamide/administration & dosage , Diagnosis, Differential , Female , Humans , Lung/pathology , Lung Neoplasms/drug therapy , Lung Neoplasms/pathology , Lung Neoplasms/physiopathology , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Lymphoma, Large B-Cell, Diffuse/physiopathology , Prednisolone/administration & dosage , Symptom Assessment/methods , Treatment Outcome , Tuberculosis, Miliary/diagnosis , Tuberculosis, Miliary/drug therapy , Vincristine/administration & dosageABSTRACT
A 76-year-old woman, suffering from rapidly worsening dyspnea, and general fatigue was referred for evaluation and treatment of cardiac tumor. Echocardiography and computed tomography revealed a large tumor occupying the right atrium and inferior vena cava. We performed partial resection with cardiopulmonary bypass, in order to improve hemodynamics. The pathological examination suggested malignant lymphoma, diffuse large B-cell type. The patient was treated with cyclophosphamide, cyosine, arabinoside, etoposide, dexamethasone and rituximab (CHASER) postoperatively and gained complete response.
ABSTRACT
PURPOSE: To determine the optimal radiation dose in a localized non-Hodgkin's lymphoma of the head and neck in the treatment setting for combined chemoradiotherapy. MATERIALS AND METHODS: Fifty-three patients with stage I and II diffuse large cell non-Hodgkin's lymphoma of the head and neck, who were treated with combined chemoradiotherapy between 1985 and 1998 were retrospectively reviewed. The median age was 49 years, and the male-to-female ratio was approximately 1.6. Twenty-seven patients had stage I disease and 26 had stage II. Twenty-three patients had bulky tumors (> or =5 cm) and 30 had non-bulky tumors ( or =5 cm. CONCLUSION: A dose of 30 Gy is sufficient for local control in patients with a non-bulky ( or =5 cm).
Subject(s)
Humans , Chemoradiotherapy , Disease-Free Survival , Drug Therapy , Head , Lymphoma , Lymphoma, Large B-Cell, Diffuse , Lymphoma, Non-Hodgkin , Neck , Radiotherapy , Recurrence , Retrospective StudiesABSTRACT
The diffuse large B-cell lymphoma category of the Revised European American Classification of Lymphoid Neoplasms (REAL) encompasses different morphologic lymphoma subtypes in a single entity, especially the diffuse large cell (DLC) and the immunoblastic (IBL) subtypes by Working Formulation (WF). The aim of this study is to determine the influence of the morphologic subdivision within this category with respect to clinical outcome and proliferative index using Ki-67 immunostainig combined with image analysis. We retrospectively reviewed 74 patients from 1990 to 1996, who were diagnosed with diffuse large B-cell lymphoma. All cases were reclassified according to REAL and Working Formulation (WF), and Ki-67 immunostaining was performed in all the cases. Fifty-eight cases (78.4%) were classified as DLC and 16 cases (21.6%) as IBL, according to WF. Twenty one cases (28.4%) showed nodal involvement and 53 cases (71.6%), extranodal involvement. All cases were found to display a variable degree of nuclear Ki-67 staining. A proliferative index of 50% or higher identified a group of patients (77%) who had poor clinical results. Overall survival was significantly reduced in these patients displaying high Ki-67 associated proliferative index compared to those with a low proliferative index (p=0.007). 5-year survival estimates were 93% in the low proliferative index group and 55% in the high proliferative index group. A multivariate regression analysis incorporating commonly used clinical prognostic factors confirmed the independent effect of proliferation index on survival. Moreover, all of the 16 IBL cases showed Ki-67 positivity of 50% or higher, which correlates with the poor clinical outcome compared to 70.7% of DLC (p=0.014). We conclude that subdivision of the diffuse large B-cell lymphoma category of the REAL classification is necessary in terms of prognostic significance in correlation with Ki-67 proliferative index.
Subject(s)
Humans , B-Lymphocytes , Classification , Lymphoma , Lymphoma, B-Cell , Lymphoma, Large B-Cell, Diffuse , Retrospective StudiesABSTRACT
The t(8;14)(q24;q32) translocation or its variants, t(2;8)(p12;q24) and t(8;22)(q24;q32) are classically seen in Burkitt's lymphoma, but are also found in diffuse large cell lymphoma (DLCL). Burkitt's lymphoma is very rare in Korea and t(8;14) or its variants have not been reported. We report a case of DLCL (B-cell type) with t(8;22) and additional chromosomal abnormalities. The patient, 45-year-old male, complained intermittent abdominal pain. The histologic examination of sigmoid colon revealed DLCL. Lymphoma cells were counted about 58.8% of all nucleated cells in bone marrow aspiration and showed surface membrane immunoglobulin positivity. Chromosome study of bone marrow aspiration was done using high resolution banding technique. The karyotype was 47,XY,+1,del(6)(q21),t(8;22)(q24;q11),del(13)(q31),der(14)t(1;14)(q23;q32)?, del(17)(p11) in all of the nineteen metaphases which were analyzed. Although he was treated by chemotherapy and radiotherapy, lymphoma cells were increased in peripheral blood and he expired.