Non-Hodgkin's lymphoma of T lymphoblastic type of mediastinum and breast, mimicking thymoma

T cell lymphoblastic lymphoma (T-LBL) is a common variant of Non-Hodgkin’s tumor of mediastinum which presents late due to aggressive spread. Immunohistochemical studies are conclusive in their diagnosis. We present a rare case of mediastinal tumor with left breast mass which mimicked thymoma on computed tomography guided biopsy but was diagnosed T-LBL on immunohistochemistry after surgical excision.

Autologous hematopoietic stem cell transplantation treatment for T cell lymphoblastic lymphoma / 中华血液学杂志

Objective: To investigate the efficacy and predictors of autologous hematopoietic stem cell transplantation (auto-HSCT) in the treatment of T lymphoblastic lymphoma (T-LBL) . Methods: 41 patients with T-LBL who underwent auto-HSCT from April 2006 to July 2017 in the Department of Hematology, the First Affiliated Hospital of Soochow University and the Department of Lymphoma, Peking University Cancer Hospital were analyzed retrospectively. Results: ①Among 41 patients, there were 30 males and 11 females with median age of 24 (11-53) years old. According to the Ann Arbor staging, 33 (80.5%) patients were in stage Ⅲ/Ⅳ. 12 (29.3%) patients have mediastinal involvement, and 20 (48.8%) patients have bone marrow (BM) involvement. Before transplantation, there were 26 (63.4%) patients who achieved first complete remission (CR(1)) , the other 15 (36.6%) patients were in the non-CR(1) group, and there were 29 (70.7%) patients in the low-intermediate risk group (IPI<3 scores) , the other 12 (34.1%) patients were in the middle-high risk group (IPI≥3 scores) . ②The median follow-up was 29 (3-98) months. The 3-year overall survival (OS) and progression-free survival (PFS) for 41 patients were (64.3±8.2) % and (66.0±7.8) %, respectively. 3-year cumulative recurrence rate (CIR) was (30.7±7.4) %, and 3-year non-recurring mortality (NRM) was (4.8±4.6) %. ③The 3-year OS of the CR(1) group and the non-CR(1) group were (83.4±7.6) % and (38.9±12.9) % (P=0.010) , and the 3-year PFS of two groups were (83.8±7.4) % and (40.0±12.6) % (P=0.006) , respectively. The 3-year CIR of these two groups were (16.2±7.4) % and (53.3±12.9) % (P=0.015) , and the 3-year NRM were 0 and (14.3±13.2) % (P=0.157) , respectively. ④The 3-year OS of the IPI low-intermediate risk group and the high-intermediate risk group were (76.9±8.4) % and (35.7±15.2) % (P=0.014) and the 3-year PFS were (77.4±8.2) % and (40.0±14.6) (P=0.011) , respectively. The 3-year CIR of these two groups were (18.1±7.3) % and (60.0±14.6) % (P=0.006) , and the 3-year NRM were (5.6±5.4) % and 0 (P=0.683) , respectively. The OS and PFS of patients with low-intermediate risk group were significantly higher than the other group. Conclusion: Auto-HSCT could improve the survival of T-LBL. Pre-transplant status and IPI score are important predictors for survival T-LBL patients with auto-HSCT.

Cutaneous Involvement of T-cell Lymphoblastic Lymphoma / 대한피부과학회지

Lymphoblastic lymphoma is classified as non-Hodgkin's lymphoma with high tendency of rapid progression to acute leukemia. Cutaneous involvement of this condition is rare. The clinical feature of skin lesions usually present single or multiple papular or nodular lesions preferentially located on the head and neck. Herein, we report a case of an 18-year-old man presenting skin involvement of T cell lymphoblastic lymphoma. The lesions manifested as asymptomatic, multiple, round, slightly pinkish nodules on the scalp and trunk. Histological examination showed dense, diffuse infiltration of medium-sized lymphoid cells throughout the entire dermis. The neoplastic cells had scant cytoplasm and nuclei characterized as round or slightly irregular with expression of CD3, CD5, CD45, TdT and Ki-67.

VPDL Chemotherapy for T-cell Lymphoblastic Lymphoma (T-LBL) in Adults: Comparison with Upfront Autologous Stem Cell Transplantation in a Single Center

BACKGROUND: Treatment of T-cell lymphoblastic lymphoma (T-LBL) with CHOP or CHOP-like chemotherapy has resulted in poor long-term outcomes. High-dose chemotherapy followed by ASCT has been applied for this dreaded disease. However, the efficacy is still controversial. T-LBL is considered the nodal/extranodal presentation of acute lymphoblastic leukemia. Favorable results with VPDL chemotherapy have been reported in the setting of adult lymphoblastic leukemia. We, therefore, treated T-LBL patients with modified VPDL chemotherapy and compared the outcomes with those achieved using upfront ASCT. METHODS: We retrospectively reviewed the outcomes of 24 T-LBL patients treated either with upfront ASCT (n=11) or VPDL chemotherapy without ASCT (n=13) between January 1996 and October 2005. RESULTS: The median follow-up duration for surviving patients was 17 months (range, 5~109 months). The two-year event-free survival (EFS) rates were 83.1% in the VPDL group and 27.3% in the upfront ASCT group (P=0.008). The two-year overall survival (OS) rates were 83.9% in the VPDL group and 27.3% in the upfront ASCT group (P=0.006). CONCLUSION: This study suggests that VPDL chemotherapy is very effective and may be superior to upfront ASCT in the treatment of T-LBL patients.

A Case of Cutaneous Involvement of T-cell Lymphoblastic Lymphoma / 대한피부과학회지

Lymphoblastic lymphoma is a malignant neoplasm of precursor lymphocytes with a B- or T cell phenotype. T cell lymphoblastic lymphoma is a clinically aggressive disease with frequent involvement of extranodal sites, but the involvement of the skin is rare. The clinical appearance of skin lesions usually includes single or multiple papular or nodular lesions preferentially located on the head and neck. Herein, we report the case of a 31-year-old man presenting with skin involvement of T cell lymphoblastic lymphoma. The lesions manifested as asymptomatic, multiple, round, reddish brown macules, and patches on both extremities. Histology examination showed dense, diffuse infiltration of medium sized lymphoid cells into the entire dermis. The tumor cells had irregular nuclei, finely dispersed chromatin, inconspicuous nucleoli, scant cytoplasm, and expressed TdT, CD3 and CD5.

Two Cases of Cytomegalovirus Pneumonia after CD34 Selected Autologous Stem Cell Transplantation

Cytomegalovirus (CMV) pneumonia is an important cause of treatment related mortality after allogeneic stem cell transplantation (SCT) and autologous SCT, particularly in a CD34 selected setting. There is little known about the immune reconstitution pertaining to the CMV after CD34 selected SCT. However, several studies have suggested there is more profound immunodeficiency early in the CD34 selected population compared with the unselected population. We encountered two fatal cases of CMV pneumonia at the CD34 selected SCT for T-cell lymphoblastic lymphoma and high-risk breast cancer that was confirmed through a lung biopsy and bronchoalveolar lavage. In conclusion, autologous CD34 selected CMV seropositive recipients need to be monitored in a similar manner to allogeneic recipients.

A Case of T-cell Lymphoblastic Lymphoma Involving the Skin / 대한피부과학회지

Lymphoblastic lymphoma(LBL) is non-Hodgkin's lymphoma with a high tendency of rapid progression to acute leukemia, but cutaneous infiltration is rare. Cutaneous lesions in LBL were largely red papules and nodules. We herein report a case of 24-year-old woman with T-cell LBL(TLBL) involving the skin. The lesions revealed 1~3 cm-sized, multiple confluent scaly patches on her face and back, and subsided about 4 weeks later during the period of follow-up and combination chemotherapy. Histologically there were perivascular, periadnexal and perineural infiltrates of medium-sized lymphoid cells in mid to deep dermis. The neoplastic cells had scant cytoplasm, very fine chromatin, and inconspicuous nucleoli and expressed CD5, CD45, CD45RO and TdT.