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@#Discordant lymphoma (DL) is the coexistence of two or more distinct subtypes in separate anatomic sites. There are limited reports on DL cases especially involving more than two subtypes in more than two sites. We report a 76-year-old man who presented with constitutional symptoms, flank mass and painless lymphadenopathies for six months. Laboratory tests revealed moderate anaemia, markedly elevated serum IgM (13400 mg/dL), IgM Lambda paraproteinemia and Lambda light chain paraproteinuria with unmeasurable serum lactate dehydrogenase due to hyperviscous sample. CT scan showed multiple subcutaneous masses over chest wall and retroperitoneum, with lytic bone lesions, and hepatosplenomegaly. Further biopsy findings with morphological, immunohistochemical and molecular analysis of the tissue sections revealed diffuse large B-Cell lymphoma in the chest wall mass, follicular lymphoma in the inguinal lymph node and lymphoplasmacytic lymphoma in the bone marrow. This case highlights the rare DL. The importance of histopathological evaluation of lymphoma despite the availability of PET-CT scans for disease staging is undeniable.
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ANTECEDENTES: El linfoma no Hodgkin durante el embarazo es una entidad rara, el tipo difuso de células grandes es aún menos frecuente y se caracteriza por una alta tasa de progresión tumoral con poca expresión clínica. Su diagnóstico y tratamiento representan un reto clínico debido a la baja incidencia de la enfermedad y a las posibles repercusiones fetales a causa del tratamiento. CASO CLÍNICO: Gestante secundípara de 31 años que ingresa por cuadro de dolor abdominal y cifras elevadas de lactato deshidrogenasa. Durante la gestación precisa varios ingresos por pancreatitis aguda de repetición y cuadro de colestasis intrahepática. Tras el parto evoluciona tórpidamente con aparición de edema en esclavina en cuello y miembros superiores, siendo diagnosticada de gran masa torácica cuya biopsia es informada como Linfoma No Hodgkin tipo B difuso de células grandes primario mediastinal. Se administran dos ciclos de tratamiento quimioterápico tras lo cual remite completamente la enfermedad. Se induce el parto con prostaglandinas intravaginal, con recién nacido de 3350 gramos y APGAR 8/10. Tras un año la paciente permanece en remisión completa.
BACKGROUND: During pregnancy, Non-Hodgkin's lymphoma is a rare entity; the diffuse large cell lymphoma is still less common, and it has a high rate of tumor progression with a little clinical expression. Diagnosis and treatment is a huge challenge due to the low incidence of the condition and to the possible fetal effects because of the treatment. CLINICAL CASE: A 31-year-old woman -in her second delivery- was admitted with abdominal pain and elevated lactate dehydrogenase levels. During pregnancy, she was required several admissions reporting repeated acute pancreatitis and intrahepatic cholestasis. After delivery, it evolves into facial and upper extremity oedema, diagnosed with a large chest mass, resulting in the diagnosis of primary mediastinal large B-cell lymphoma through the biopsy. The disease goes into remission completely after two cycles of chemotherapy treatments are given. Labor is induced with intravaginal prostaglandins, with a newborn of 3350 g and Apgar 8/10. After a year, the patient remains in complete remission.
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Humans , Female , Adult , Pancreatitis/etiology , Pregnancy Complications, Neoplastic , Lymphoma, Large B-Cell, Diffuse/complications , Lymphoma, Large B-Cell, Diffuse/pathology , Biopsy , Lymphoma, Non-Hodgkin , Cholestasis, Intrahepatic , Lymphoma, B-Cell/therapy , Labor, Induced , L-Lactate DehydrogenaseABSTRACT
Objective To investigate the expression and clinical significance of interleukin -6 (IL -6)in aggressive and indolent lymphoma patients.Methods Serum specimens obtained from 1 07 non -Hodgkin's lympho-ma (NHL)patients and 50 healthy controls were collected.Chemiluminescence immunoassay was used to assess the expression of IL -6 in the serum.Results The level of serum IL -6(1 8.54 ±4.53)ng/L in aggressive lymphoma group was significantly higher than (6.90 ±1 .78)ng/L in the inert lymphoma group,and the serum IL -6 levels of two groups were significantly higher than the healthy control group (3.87 ±0.76)ng/L.The lymphoma patients,with B symptoms,elevated CRP or bone marrow involvement presented higher IL -6 level than the other patients (P <0.05).IL -6 level of the IPI high -risk group was higher than the intermediate -risk group and low -risk group, with significant difference (P <0.05 ).The correlation study showed that IL -6 and CRP,IPI /FLIPI,Ann Arbor stage,B symptoms,bone marrow involvement had significantly positive correlation (P <0.05);Through analysis of the effect of the patients with aggressive lymphoma,the serum level of IL -6 in patients with complete remission was sig-nificantly higher than the non complete remission group.By Logistic regression analysis,IL -6 was one of the inde-pendent risk factors affecting the treatment effect of NHL,and the difference was statistically significant (P <0.05). Conclusion The serum IL -6 was significantly elevated in NHL patients,in association with tumor invasion,progno-sis and therapeutic effect.IL -6 may help the diagnosis and prognosis of NHL.
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El Linfoma no Hodgkin (LNH) extraganglionar es una neoplasia maligna que corresponde al 40% de los casos de LNH, siendo el tracto gastrointestintal (TGI) la localización más común. Dentro del TGI es el estómago el órgano más afectado (60%). Presentamos el caso de un hombre de 52 años trabajador en empresa minera por más de 10 años, el cual es derivado al Servicio de Gastroenterología por presentar un cuadro de epigastralgia, náuseas y baja de peso. La endoscopía digestiva mostró una lesión ulcerada en cuerpo gástrico a la cual se le tomaron múltiples biopsias. El estudio histológico y el posterior análisis inmunohistoquímico permitieron realizar el diagnóstico de LNH B difuso de células grandes. Asimismo, el paciente presentó compromiso de múltiples órganos en relación a exposición crónica de metales pesados, lo cual fue comprobado en el mineralograma, siendo las de mayor concentración el uranio, talio, arsénico, plomo y mercurio. En la literatura se ha descrito la asociación de exposición laboral crónica a Uranio y Arsénico con la presentación de LNH de compromiso gastrointestinal. Por tal motivo, el compromiso gástrico no se puede considerar como un daño aislado, sino más bien parte del compromiso sistémico asociado a concentraciones elevadas de metales. La minería constituye el principal motor de ingresos económicos para el Perú, sin embargo, no existen reportes hasta la fecha de la asociación de LNH de compromiso gastrointestinal en relación a exposición laboral a metales pesados.
Primary extranodal Non-Hodgkin lymphoma (NHL) is a non epithelial tumours that accounts for 40% of cases of NHL. Spread of nodal lymphomas to the gastrointestinal tract (GIT) is the most common location. Within the GIT is the stomach the most affected organ (60%). We report the case of 52-year- old man, mining company worker for over 10 years, which is derived to the Service of Gastroenterology with history of epigastric pain, nausea, vomiting and weight loss. Upper gastrointestinal endoscopic examination revealed an ulcerated lesion on greater curve of stomach and histopathological examination and subsequent immunohistochemical analysis showed diffuse large B cell gastric NHL. Also, the patient had multiple organ involvement in relation to chronic exposure to heavy metals, which was found in the mineralograma, with the highest concentration of uranium, thallium, arsenic, lead and mercury. The literature has described the association of chronic occupational exposure to uranium and arsenic with NHL presenting gastrointestinal involvement. Therefore, gastric commitment can not be considered as an isolated injury, but rather part of systemic involvement associated with elevated concentrations of metals. Mining is a key driver of income for Peru; however, there are no reports to date of the association of gastrointestinal NHL commitment regarding occupational exposure to heavy metals.
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Humans , Male , Middle Aged , Carcinogens, Environmental/adverse effects , Lymphoma, Large B-Cell, Diffuse/diagnosis , Metals, Heavy/adverse effects , Occupational Diseases/diagnosis , Occupational Exposure/adverse effects , Stomach Neoplasms/diagnosis , Lymphoma, Large B-Cell, Diffuse/chemically induced , Mining , Occupational Diseases/chemically induced , Stomach Neoplasms/chemically inducedABSTRACT
ObjectiveThis study aimed to compare the clinical characteristics and prognoses of primary Waldeyer's ring diffuse large B-cell lymphoma (DLBCL) and extranodal nasal-type NK/T-cell lymphoma ( ENKTCL).MethodsFrom 2000 to 2008,122 patients with primary Waldeyer's ring DLBCL and 44 patients with primary Waldeyer' s ring ENKTCL consecutively diagnosed were retrospectively compared.Patients with DLBCL usually received 4-6 cycles of CHOP-based chemotherapy followed by involved-field radiotherapy.Patients with early stage ENKTCL usually received extended-field radiotherapy with or without subsequent chemotherapy,or short courses ( 1 - 3 cycles ) of chemotherapy followed by radiotherapy.Kaplan-Meier method was used for survival analysis.Logrank method was used for univariate analysis.ResultsThe follow-up rate was 82％.The number of patients followed 5 years were 32 and 15 in DLBCL and ENKTCL.DLBCL mainly presented with stage Ⅱ tonsillar disease with regional lymph node involvement.ENKTCL occurred predominately in young males,as nasopharyngeal stage I disease with B symptoms and involving adjacent structures.The 5-year overall survival (OS) and progression-free survival (PFS) rates were 74％ and 67％ in DLBCL,and 68％ and 59％ in ENKTCL (x2=0.53,1.06,P=0.468,0.303),respectively.In stage Ⅰ and Ⅱ diseases,the 5-year OS and PFS rates were 79％ and 76％ for DLBCL compared to 72％ and 62％ for ENKTCL (x2 =1.20,2.46,P=0.273,0.117).On univariate analysis,age ＞ 60 years,elevated lactate dehydrogenase,eastern cooperative oncology group performance status ＞ 1,international prognosis index ( IPI ) score ≥ 1,stage Ⅲ/Ⅳ diseases and bulky disease were associated with unfavorable survival for DLBCL (x2=9.40,12.72,6.15,10.36,12.48,5.53,P=0.002,0.000,0.013,0.001,0.000,0.019),and only age＞60 years and IPI score ≥ 1 were associated with poor survival for ENKTCL (x2 =3.98,8.41,P =0.046,0.004).ConclusionsThese results indicate that remarkable clinical disparities exist between DLBCL and ENKTCL in Waldeyer's ring. Different treatment strategies for each can result in similarly favorable prognoses.
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Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous group of tumors composed of large B cells. It is the most common type of non-Hodgkin lymphoma. As its variety of clinical, morphological and genetic characters, the classification and prognosis are still debated. This article aims to elucidate t(14;18) translocation and c-myc gene rearrangement is of great significance to the clinical diagnosis, classification, treatment and prognosis of DLBCL.
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Objective To analyze the clinical features and treatment outcomes of extranodal diffuse large B-cell lymphoma(DLBCL). Methods Ninety-nine consecutively diagnosed patients with extranodal DLBCL were reviewed. All patients were confirmed by a combination of morphologic and immunohistochemi-cal evaluation. The primary sites of extranodal DLBCL were the gastrointestine(n = 32) ,central nerve system (CNS)/testis(n=14) ,and other sites (n = 53). Results Extranodal DLBCL was characterized by a pre-dominance in old males,less frequency of B symptorns,a large proportion of stage Ⅰ-Ⅱ disease and low in-ternational prognostic factor(IP1) score. The 5-year overall survival(OS) rate for all patients was 78.9%. The corresponding OS rate was 82.5% for gastrointestinal origin, 37.0% for CNS and testis origin and 74.6% for other organ origin, respectively. On univariate analysis, performance status, IPI score and more than one extranedal site involvement were the prognostic predictors for 5-year OS. Conclusions Being a heterogeneous group of lymphomas, extranedal DLBCL has good prognosis except those derived from the CNS and testis.