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Objective To investigate the feasibility of histogram analysis in differentiating brain high-grade glioblastomas,primary lymphoma from metastatic tumor.Methods 26 cases of brain high-grade glioblastomas,22 cases of primary lymphoma and 18 cases of metastatic tumor confirmed by postoperative pathological were analyzed retrospectively.Delineation of ROI and extraction of texture parameters were performing by using Mazda software.The histogram parameters,including Mean,Variance,Skewness,Kurtosis,Perc0.1%,Perc10%,Perc50%, Perc90% and Perc99% were analyzed statistically,and the ROC was then established.Results Mean,Perc0.1%,Perc10%and Perc50% exhibited statistically significant differences (P＜0.05).The best diagnostic parameters for differentiation between brain high-grade glioblastomas and primary lymphoma,primary lymphoma and metastatic tumor,and brain high-grade glioblastomas and metastatic tumor were Perc0.1%,Perc0.1%and Kurtosis.The AUC for these preferred diagnostic parameters were 0.937,0.879 and 0.7 1 8,respectively,with optimal thresholds of 50,70 and －0.43,sensitivity and specificity of 90.9% and 88.5%,77.3% and 88.9%,and 61.5% and 77.8%.Conclusion The histogram analysis of MRI images contributes to differentiate quantitatively between brain high-grade glioblastomas,primary lymphoma and metastatic tumor.
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Objective@#To investigate the atypical computed tomography (CT) features of primary small intestinal lymphoma (PSIL), and its correlation with pathology.@*Methods@#From July 2007 to June 2018, at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, the clinical features and CT imaging data of 29 histopathologically diagnosed PSIL with atypical CT features were retrospectively analyzed.@*Results@#A total of 29 cases were all confirmed as Non-Hodgkin′s lymphoma including 23 cases of B cell lymphoma and six cases of peripheral T cell lymphoma. In 24 PSIL patients, the intestinal wall was unevenly thickened. While five cases had intra- and extra-intestinal masses. Images of four PSIL patients showed heterogeneous density at unenhanced CT scan, five cases presented with heterogeneous mild to moderate enhancement and five cases demonstrated with obvious enhancement at portal venous phase. Multiple ulcers in mucosa were found in 20 cases, and obviously abnormal mucosal enhancement was found in five cases, and 13 cases showed rough serosa layer of intestinal wall and the fat gap around the intestinal wall disappeared. Adjacent organs were involved in four cases and intestinal obstruction occurred in eight cases.@*Conclusion@#The atypical imaging of PSIL can be heterogeneous density of the lesion, heterogeneous or obvious enhancement at enhanced scan, multiple ulcers on the mucosal surface, thickening of the mucosal surface, blurred peripheral fat space, involvement of adjacent organs and intestinal obstruction.
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Objective To investigate the atypical computed tomography (CT) features of primary small intestinal lymphoma (PSIL),and its correlation with pathology.Methods From July 2007 to June 2018,at Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,the clinical features and CT imaging data of 29 histopathologically diagnosed PSIL with atypical CT features were retrospectively analyzed.Results A total of 29 cases were all confirmed as Non-Hodgkin's lymphoma including 23 cases of B cell lymphoma and six cases of peripheral T cell lymphoma.In 24 PSIL patients,the intestinal wall was unevenly thickened.While five cases had intra-and extra-intestinal masses.Images of four PSIL patients showed heterogeneous density at unenhanced CT scan,five cases presented with heterogeneous mild to moderate enhancement and five cases demonstrated with obvious enhancement at portal venous phase.Multiple ulcers in mucosa were found in 20 cases,and obviously abnormal mucosal enhancement was found in five cases,and 13 cases showed rough serosa layer of intestinal wall and the fat gap around the intestinal wall disappeared.Adjacent organs were involved in four cases and intestinal obstruction occurred in eight cases.Conclusion The atypical imaging of PSIL can be heterogeneous density of the lesion,heterogeneous or obvious enhancement at enhanced scan,multiple ulcers on the mucosal surface,thickening of the mucosal surface,blurred peripheral fat space,involvement of adjacent organs and intestinal obstruction.
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Objective To investigate the value of MR on diagnosis of intracranial primary lymphoma in immunocompetent patients.Methods The MR features of 28 cases with pathology proved intracranial primary lymphoma were analyzed retrospectively.Conventional MRI scans,enhanced MRI scan were observed.Immunohistochemical staining were done and the results were compared with the MR imaging signs. Results Twenty-eight cases were all B-cell type Non-Hodgkin's lymphoma,16 cases were single lesion (57%)and 12 cases were multiple lesions (43%).The tumors mainly located in the deep white matter,7 cases in callus corpus and grew crossing the midline supratentorial.The lesions presented mass or node (20/28),11 cases showed massive edema.On T1WI,lesions were mostly hypo-or iso-intense to gray matter.On T2WI,tumors showed iso-or hyper-intense.All lesions presented hyper-or iso-to hyper-intense on diffusion weighted imaging(DWI).Most lesions show marked mass-like or nodular-like contrast enhancement on MR imaging,8 cases presented"incision sign",5 cases showed"fist sign"and 7 cases showed"butterfly-like".Immunohistochemical staining showed that GFAP(-) was 78.6% (22/28),as well as CD20 (+)96.4% (27/28),CD79α(+)67.9% (19/28),CD10(+)10.7% (3/28),Bcl-6 (+)75% (21/28),Mum1 (+)89.3% (25/28).Ki-67 was greater than or equal to 50% (22/28).Among the 28 patients,25 cases (89.3%) showed an"activated non-germinal center B-cell(non-GCB)"in origin and 3 cases(10.7%)were considered as a"GCB"subset.Conclusion The imaging features of marked mass-kike or nodular-like on MRI enhancement scan and hyper-or iso-to hyper-intense on DWI are helpful in the diagnosis and the differential diagnosis of intracranial primary lymphoma.
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Primary extranodal bone lymphoma involving the peripheral extremities is extremely rare. Here, we report a definitive case of diffuse large B-cell lymphoma involving the phalangeal bone of the 3rd finger. Systemic evaluation revealed the lesion as the only site of lymphoma involvement.
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Extremities , Fingers , Lymphoma , Lymphoma, B-CellABSTRACT
@#Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-hodgkin’s lymphoma (NHL), which has a wide range in age of onset, and has obvious heterogeneity in clinical features, invasive areas, histomorphology, molecular genetics and immune phenotype. In addition, with the improvement of the diagnosis and treatment of malignant tumor, the report of multiple primary malignant tumors (MPMT) in the same patient is on the rise. This paper reports a case of DLBCL combined with thyroid neoplasms with paraplegia as the clinical manifestation.
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Los linfomas cutáneos de células B son un grupo heterogéneo de linfomas que se presentan en piel sin evidencia de compromiso extracutáneo al momento del diagnóstico y corresponden entre 20% al 25% de los linfomas cutáneos primarios. Presentamos un caso de un linfoma primario cutáneo difuso de células B grandes, tipo pierna en una anciana, con mala respuesta al tratamiento (AU)
Primary cutaneous B-cell lymphomas are a heterogeneous group of lymphomas occurring in the skin without extracutaneous involvement at time of diagnosis and constitute about 20-25% of primary lymphomas. A case of primary cutaneous diffuse large B-cell lymphoma, leg type, in an elderly woman with a poor response to treatment is reported (AU)
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Humans , Female , Middle Aged , Skin Neoplasms/pathology , Lymphoma, Large B-Cell, Diffuse/diagnosis , Palliative Care , RadiotherapyABSTRACT
Background and purpose:Primary thyroid lymphoma (PTL) is uncommon in clinic with quite different treatment from that of other malignant thyroid tumors. Therefore, to achieve complete understanding of PTL has crucial signiifcance. This study aimed to investigate the clinical and computed tomography (CT) characteristics of PTL.Methods:The clinical and imaging data from 22 patients with PTLs conifrmed by pathology were collected. The clinical symptoms of patients, the site, size, shape, margin, CT value and enhancement pattern, relation with surround-ing tissues of PTLs and cervical lymph nodes were summarized retrospectively.Results:All the 22 patients including 8 males and 14 females had an average age of 60 years (range: 39-77 years). Twelve PTLs rapidly progressed in short term and the rest expanded slowly. The tumors involved bilateral thyroid in 11 cases, unilateral thyroid in 8 cases and both right lobe and isthmus in the remaining 3 cases. The long and short ranges were (12-104) mm and (11-71) mm. The solitary, multiple and diffuse nodules distributed in 5, 5 and 12 patients, respectively. In axial plain CT scans, low density appeared in 15 patients, isodensity in 7 patients, calciifcation inside the lesion in 0 patient, and necrosis in 5 patients. Nineteen PTLs manifested slight or moderate enhancement, and 3 marked enhancement in contrast-enhanced axial CT images. Homogeneous density and mixed density were demonstrated in 13 and 9 cases, respectively. Trachea and esophagus was pushed in 17 and 5 cases, tumors were involved into superior mediastinum in 12 cases and enlarged lymph nodes were demonstrated in 8 cases.Conclusion:If a solid thyroidal mass in an old female patient rapidly pro-gresses in short term and CT scans show homogeneous and low density, slight or moderate enhancement, and diffusive swelling with compression and invasion of surrounding tissues, it has a high possibility of PTL.
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To explore the clinic characters,treatments and prognosis of patients with primary bone lym-phoma( PLB ) .The clinical symptoms, signs, X -ray features, pathological morphology, immunophenotype and treatment of 7 patients with PLB were analyzed retrospectively and the pertinent literatures were reviewed.The re-sults showed that the main complains of 7 cases of PBL were local pain.The CT showed osteolytic bone destruc-tion and soft tissue swelling.There were 3 cases of diffuse large B cell lymphoma,1 case of Burkitt-type lympho-ma,1 case of periferal T-cell lymphoma,1 case of anaplastic large cell lymphoma,and 1 case of Hodgkins lym-phoma.2 patients presented with stageⅠ,4 with stageⅡ,and 1 with stage 3.The therapeutic procedure includes local radiotherapy combined with chemotherapy and targeted therapy.The clinical presentation of PLB is not spe-cial.The diagnosis and identification of histological type of PLB should be established by histopathological and im-munohistochemistry examinations.Early diagnosis and active therapy could improve the prognosis of PLB.Combi-nation therapy including radiotherapy and chemotherapy is the optimal treatment for PLB.
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Purpose To investigate the clinicopathological and immunohistochemical features of primary renal lymphomas ( PRL) , and to discuss the diagnosis, differential diagnosis, treatment and prognosis of the tumors. Methods Clinical data of 19 patients with PRL from January 2005 to October 2014 were retrospectively analyzed. Result The 19 patients in this study, there were 11 males and 8 females and the age ranged from 37 to 85 years old (averaged 55). Patients were mainly presented with unilateral renal masses, with lumbodynia as the main symptom. 13 patients underwent nephrectomy, 6 patients underwent renal biopsy and 17 patients received CHOP or R-CHOP chemotherapy. All of them were diagnosed as non-Hodgkin’ s lymphoma, with 14 cases of diffuse large B cell lym-phoma (DLBCL) (73. 684%, 14/19), 4 cases of B cell small cell lymphoma (21. 053%, 4/19), and 1 cases of T cell lymphoma (5. 263%, 1/19). Follow-up information was available in 15 patients. 12 were still alive and survived for 1~78 months, while the other 3 were dead with 1 case who died of cerebral infarction, and survived for 3~38 months ( averaged 23 months) . Conclusion PRL is an extranodal lymphoma which is rare in kidney and is often misdiagnosed as renal carcinomas due to its nonspecific clinical manifestations. The diagnosis of PRL can be confirmed by histopathological examination, immunohistochemistry and molecular analy-sis. The majority of the lymphomas are B cell lymphomas and most of them are DLBCL. The recommended treatment is surgery com-bined with chemotherapy and the prognosis is associated with the age, clinicopathological characteristics, tumor types and treatment.
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Objective To study MRI and CT manifestations and characteristics of primary intracranial lymphoma,and improve the diagnosis and differential diagnosis.Methods Imaging features of primary intracranial lymphoma in 1 1 patients proved by pathology were analyzed retrospectively.Results 9 cases were solitary tumor and 2 cases multiple lesions.Tumors were located in the frontal lobe in 2 cases,the corpus callosum 2 cases,near meningeal 2 cases,the occipital lobe 3 cases.Tumors presented as isodensity or slight hyper density on CT and equal or slight long T1 and T2 signal on MRI.All the lesions were found with obvious homogenous en-hancement;in which 2 cases were found meningeal strengthened;1 case room tube film strengthened.There were slight space occup-ing effect,mostly mild to moderate edema,severe edema in 2 cases.7 typical cases presented “umbilicus sign”,“notch sign”,“lobu-lated”,“incision sign (fist sign)”,and “half month”and so on.Conclusion Imaging manifestations of primary intracranial lymphoma has certain specificity and MRI plays an important role in making accurate diagnosis in the position and qualitative diagnosis.
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Objective:To investigate the clinical characteristics, diagnosis, and treatment of primary pancreatic lymphoma (PPL). Methods:Clinical data of six PPL cases diagnosed and treated in the Tianjin Medical University Cancer Hospital were retrospectively analyzed. Results:In all cases, the primary clinical manifestations were abdominal pain, jaundice, and weight loss. The tumor marker level, including CA19-9, of all the cases was within the normal range, with five of the cases misdiagnosed as pancreatic cancer and one misdiagnosed as stomach cancer. In three cases, the pancreatic mass was located at the head of the pancreas, whereas in the other three, the mass was located at the body or tail. Pancreaticoduodenectomy was conducted in one case, laparotomy and biopsy in three cases, and B ultrasound-guided biopsy in the other two cases. All cases were diagnosed as PLL (B cell type non-Hodgkin's lymphoma). Ex-cept for one patient who left the hospital after surgery, the other five underwent chemotherapy. In addition to the death in one case be-cause of postoperative gastrointestinal bleeding, the survival times were 133, 73, 35, 12, and 10 months in the remaining cases. Conclu-sion:PPL is extremely rare in clinical practice, and the treatment methods and prognosis for the disease significantly differ from those for pancreatic cancer. PPL is easily misdiagnosed in clinical practice, which results in unnecessary treatment measures.
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Bone involvement is a common finding in many types of lymphomas, particularly in advanced stages. However, cranial vault affliction has been regarded as an exceedingly rare presentation. Here, we report the case of a patient with cranial vault lymphoma who presented with a scalp mass. An 81-year-old woman presented with a gradually growing and non-painful frontal scalp mass that she noticed one month before admission. It was a flatly elevated, round mass measuring about 6x4x4 cm. Computed tomography and magnetic resonance imaging of the brain revealed a contrast-enhancing intracranial extradural mass at the counter-location of the scalp mass. The superior sagittal sinus was involved at the tumor site. Cerebral angiography showed that the tumor feeding vessels originated from the bilateral external carotid arteries. An operation was performed and the tumors were removed together with the involved bone. The pathologic diagnosis was malignant diffuse large B-cell type lymphoma. The patient was transferred to the Hemato-Oncology department for chemotherapy. Primary lymphoma of the cranial vault with scalp mass is very rare but it should be considered in the differential diagnosis of scalp masses. Although the results of reported cases are variable, the combination of surgery, radiation, and chemotherapy appears to offer favorable outcomes.
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Aged, 80 and over , Female , Humans , B-Lymphocytes , Brain , Carotid Artery, External , Cerebral Angiography , Diagnosis , Diagnosis, Differential , Drug Therapy , Lymphoma , Magnetic Resonance Imaging , Scalp , Superior Sagittal SinusABSTRACT
El linfoma no Hodgkin primario de la mama es una entidad poco frecuente en pediatría y representa el 0,4 al 0,5 por ciento de todos los tumores mamarios malignos. Debido a que carecen de características propias, tanto clínicas, citológicas como ecográficas, resulta muy difícil establecer el diagnóstico preoperatorio. Se presenta el caso de un linfoma no Hodgkin primario de la mama en una paciente de 3 años que llegó en estadio avanzado de la enfermedad, y se subraya la importancia del tratamiento en un equipo multidisciplinario
The primary non-Hodgkin breast lymphoma is a not frequent entity in children and account for the 0,4 to 0,5 percent of the malignant breast tumors. Due to they lack of own clinical, cytological and echography features, it is very difficult to made the preoperative diagnosis. This is the case of a primary non-Hodgkin breast lymphoma in a patient aged 3 with an advanced stage of disease, emphasizing the significance of treatment in a multidisciplinary staff
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El linfoma primario del sistema nervioso central es una neoplasia rara que se encuentra con relativa frecuencia en pacientes con inmunosupresión. Se presenta el caso de una mujer de 38 años sin antecedentes relevantes, a quien se le resecó un tumor de ángulo ponto-cerebeloso izquierdo, cuya anatomopatología reportó un linfoma B de célula grande muy maligno. Se hicieron estudios en busca de inmunosupresión, los que fueron negativos. La paciente no se encontraba en el rango de edad de presentación de este tipo de tumor y sólo estudios moleculares genéticos podrían dar alguna explicación a este caso...
Primary central nervous system lymphoma is a rare condition which commonly presents in immunosuppressed patients. We present the case of a 38 year old female with no relevant previous medical history who underwent surgery for the removal of a mass located in her left cerebello pontine angle. Final pathology report was consistent with B cell lymphoma (large cell variant). A survey for hidden conditions which could predispose the patient to immunodeficiency was negative. The age of presentation for this case was also atypical. Further genetic and molecular testing could provide a possible explanation for this rare event...
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Adolescent , Cerebellar Diseases , Lymphoma , Central Nervous System , Cerebellopontine AngleABSTRACT
El linfoma primario de recto es un tumor intestinal, poco frecuente, que está constituido, principalmente, por el tipo no Hodgkin extraganglionar y corresponde de 0,2% a 0,6% de todos los tumores de colon y recto. Se presenta el caso de una mujer de 79 años que consultó por una masa en recto de varios meses de evolución y rectorragia crónica. Se le tomó una biopsia, cuyo reporte histopatológico fue indicativo de linfoma no Hodgkin. El linfoma no Hodgkin de recto es un tumor raro, con pobre pronóstico, cuyo pilar de tratamiento es la cirugía. A continuación, se presenta el caso y una breve revisión de las características clínicas e imaginológicas de esta neoplasia poco frecuente.
Primary lymphoma of the rectum is an intestinal tumor, uncommon, that consists mainly of the extranodal non-Hodgkins type and represents for 0.2 to 0.6% of all colorectal tumors. One report the case a 79-year-old woman who presented with a history of several months evolution of the occurrence of chronic rectal bleeding and rectal mass. He took a biopsy, conwhich was indicative histopathologic NHL the histopathologic report was compatible with non-Hodgkins lymphoma. Non-Hodgkins lymphoma of the rectum is a rare tumor with poor prognosis, the mainstay of treatment is surgery. A below is present the case and review of clinical and imaging characteristics of this rare neoplasm.
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Lymphoma , Lymphoma, Non-Hodgkin , Rectal NeoplasmsABSTRACT
Lymphoid infiltrates of the salivary gland can be either reactive or neoplastic. The reactive lesion, lymphoepithelial sialadenitis (LESA) may be associated with Sjogren's syndrome (SS) or may occur as an isolated salivary gland enlargement. Patients with LESA/SS have a particularly high risk of subsequently developing lymphoma, which is a low-grade mucosa-associated lymphoid tissue (MALT) type lymphoma of the salivary gland. We document a rare case of primary non-Hodgkin's lymphoma of the parotid gland arising in the background of LESA and with a rare example of transformation from low grade to high-grade B cell lymphoma of MALT type.
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Objective: To study the prevalence and characterization of primary non Hodgkin's lymphoma of bone in a major referral center of Pakistan. Methodology: All cases of primary non Hodgkin's lymphoma of bone, diagnosed at a referral center in Pakistan from January 1998 to July 2008 have been included. Patients with diagnosis of lymphoma at some other site prior to diagnosis in bone biopsy were excluded from the study. Results: Sixty cases of primary non Hodgkin's lymphoma of bone were received, with a male to female ratio of 7: 3 (42 males and 18 females). Overall, 52/60 (86.6 %) patients were diagnosed with Diffuse large B-cell non-Hodgkin's lymphoma. The largest fraction of patients was found in the pediatric group i.e. 33/60(55%) followed by elderly group i.e.15/60 (15%) and adults i.e. 12/60 (20%). The commonest sites of involvement were femur (28.3 %), hip bone (16.6%) and humerus (10%). Conclusion: Diffuse large B-cell lymphoma is the commonest type of primary non Hodgkin's lymphoma of bone in the Pakistani population. It is common in all ages. The sites most often involved are femur followed by hip bone. Primary non Hodgkin's lymphoma of bone appears to be more common in males. Our results are comparable to international data with various studies also showing that diffuse large B cell non Hodgkin lymphoma is the commonest primary bone lymphoma. However, primary Bone Lymphoma is more common in children and young adults.
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Objective To discuss the clinical features, diagnosis and therapy of primary adrenal lymphoma (PAL) . Methods Two patients (65-year old and 52-year old respectively) who complained vague pain were analyzed. Occupying lesions in adrenal gland were discovered by computed tomography (CT) and diagnosed by needle biopsy and laparoscopic surgery. Results The two patients in our hospital were diagnosed as nonHodgkin's lymphoma. They were treated with chemotherapy and one of them was partial response. Literatures on PAL were reviewed. In the literature, 7 of the 65 patients achieved complete response, 15 partial response, 43 death or unspecified and the survival duration was 3 days to 26 months. Conclusions Most of PAL are bilateral, without specific clinical characters. Neele biopsy is the first choice to make the diagnosis. The therapeutic modalities for PAL include surgery, chemotherapy, surgery followed by chemotherapy as well as radiation therapy. The prognosis of PAL is poor if other organs are involved.
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The vast majority of ampullary tumors are epithelial in nature and are either adenoma or adenocarcinoma. Rarely lymphoma or mucinous and squamous elements may be found. Primary lymphoma of pancreaticobiliary region are exceedingly rare, and mostly nodal. Recently, we have experienced a 29-year-old woman with primary malignant lymphoma of the ampulla of Vater with recurrent acute pancreatitis and jaundice. On duodenoscopy, bulging ampulla with normal overlying duodenal mucosa was observed. Endoscopic sphincterotomy was done and tumor inside the ampulla was exposed. ERCP showed high grade biliary and pancreatic ductal strictures extending from the papillary orifice, with upstream ductal dilatation, respectively. With endoscopic biopsy alone, the tumor was confirmed as B-cell lymphoma histologically.