Reporte preliminar de las características sociodemográficas y clínicas de los pacientes con hemopatías malignas: experiencia de un hospital universitario

Introducción: debido a su amplia diversidad clínica y biológica, es de gran importancia para el médico conocer cómo se presentan los pacientes diagnosticados con una hemopatía maligna. Objetivo: describir las características sociodemográficas y clínicas de los pacientes con diagnóstico de una hemopatía maligna que consultaron en un Hospital Universitario de Paraguay. Metodología: estudio observacional, retrospectivo, descriptivo, de corte transversal, con muestreo no probabilístico, de casos consecutivos. Se incluyó a pacientes adultos, de ambos sexos, registrados en el archivo de Hematología del Hospital de Clínicas de la Facultad de Ciencias Médicas de la Universidad Nacional de Asunción (Paraguay), con diagnóstico confirmado por anatomía patológica de una neoplasia hematológica, según la clasificación de la Organización Mundial de la Salud, durante el periodo comprendido entre enero 2019 y agosto de 2021. Se estudiaron variables sociodemográficas y clínicas. Resultados: se estudió a 129 pacientes. El 58 % correspondía al sexo masculino. La edad promedio de los pacientes fue de 50,3±17,38. La mayoría de los pacientes procedía del Departamento Central de Paraguay (56,58 %). La mayoría de los pacientes (n=37) fue diagnosticado con un linfoma de tipo no Hodgkin o con una neoplasia con origen en células plasmáticas (n=32). El tiempo promedio de aparición de los síntomas hasta la consulta fue de 3,5 meses. El síntoma más reportado fue la astenia (35 %). La palidez fue el hallazgo positivo más frecuente al examen físico. Las comorbilidades más frecuentes fueron la hipertensión arterial (39,44 %) y la diabetes mellitus (15,59 %). Discusión: el paciente típico con una hemopatía que consulta en el Hospital de Clínicas es hombre, mayor de 50 años, proveniente del Departamento Central, consulta por astenia, presenta palidez al examen físico y ha tardado más de 3 meses en consultar. Se le ha diagnosticado un linfoma no Hodgkin y tiene comorbilidades cardiovasculares o metabólicas.

Introduction: due to their wide clinical and biological diversity, it is of great importance for the physician to know how patients diagnosed with a hematological malignancy present. Objective: to describe the sociodemographic and clinical characteristics of patients diagnosed with a hematological malignancy who consulted at a University Hospital in Paraguay. Methods: observational, retrospective, descriptive, cross-sectional, retrospective, descriptive, cross-sectional study, with non-probabilistic sampling of consecutive cases. We included adult patients, of both sexes, registered in the Hematology file of the Hospital de Clínicas of the Faculty of Medical Sciences of the National University of Asunción (Paraguay), with diagnosis confirmed by pathological anatomy of a hematological neoplasm, according to the classification of the World Health Organization, during the period from January 2019 to August 2021. Sociodemographic and clinical variables were studied. Results: 129 patients were studied. Fifty-eight percent were male. The mean age of the patients was 50.3±17.38. Most of the patients were from the Central Department of Paraguay (56.58 %). Most of the patients (n=37) were diagnosed with a non-Hodgkin's lymphoma or a neoplasm with plasma cell origin (n=32). The average time from symptom onset to consultation was 3.5 months. The most reported symptom was asthenia (35%). Pallor was the most frequent positive finding on physical examination. The most frequent comorbidities were arterial hypertension (39.44%) and diabetes mellitus (15.59%). Discussion: the typical patient with a hemopathy who consults at the Hospital de Clínicas is male, over 50 years of age, from the Central Department, consults for asthenia, presents pallor on physical examination and has taken more than 3 months to consult. He has been diagnosed with non-Hodgkin's lymphoma and has cardiovascular or metabolic comorbidities.

Análisis estadístico implicativo para identificar factores pronósticos de mortalidad por linfomas en niños y adolescentes

Fundamento: el análisis estadístico implicativo surgió en los años 80 para resolver problemas de la didáctica de las matemáticas. Recientemente se fundamentó su empleo en las Ciencias Médicas para identificar factores de riesgo y pronósticos. Objetivo: evaluar la utilidad del análisis estadístico implicativo en la identificación de los factores pronósticos que más inciden en la mortalidad por linfomas en niños y adolescentes. Método: se realizó un estudio de casos y controles en niños y adolescentes con diagnóstico de linfoma Hodgkin y no Hodgkin atendidos en el Hospital Docente Pediátrico Sur Dr. Antonio María Béguez César de Santiago de Cuba en el período de enero 2008 a enero 2021. Se analizó como variable dependiente el estado del paciente fallecido o vivo al momento del estudio y como covariables se tomaron: el estadio de mal pronóstico, la presencia de síntomas B, el subtipo histológico, la presencia de tres o más sitios extraganglionares, la metástasis, edad y presencia de masa tumoral. Se aplicaron dos técnicas estadísticas, la regresión logística binaria y el análisis estadístico implicativo. Resultados en los casos fue más frecuente el linfoma no Hodgkin mientras que en los controles predominó el Hodgkin. Ambas técnicas reconocieron el subtipo histológico y la afectación extraganglionar como factores pronósticos desfavorables. El análisis estadístico implicativo reconoció además el estadio y la presencia de metástasis. Conclusión: el análisis estadístico implicativo es una técnica que complementa la regresión logística binaria en la identificación de factores pronósticos, lo que permite mejor comprensión de la causalidad.

Background: the implicative statistical analysis arose in the 80s to solve problems in the didactics of mathematics. Its use in the Medical Sciences to identify risk factors and prognoses was recently founded. Objective: to evaluate the usefulness of the implicative statistical analysis in the identification of the prognostic factors that most affect mortality from lymphomas in children and adolescents. Method: a case-control study was carried out in children and adolescents diagnosed with Hodgkin and non-Hodgkin lymphoma treated at the Dr. Antonio María Béguez César Sur Pediatric Teaching Hospital in Santiago de Cuba from January 2008 to January 2021. The state of the deceased or alive patient at the time of the study was analyzed as the dependent variable and the following were taken as covariates: poor prognosis stage, presence of B symptoms, histological subtype, presence of three or more extranodal sites, metastasis, age and presence of tumor mass. Two statistical techniques were applied: binary logistic regression and implicative statistical analysis. Results: non-Hodgkin's lymphoma was more frequent in the cases, while Hodgkin's lymphoma predominated in the controls. Both techniques recognized the histological subtype and extranodal involvement as unfavorable prognostic factors. The implicative statistical analysis also recognized the stage and the presence of metastases. Conclusion: the implicative statistical analysis is a technique that complements the binary logistic regression in the identification of prognostic factors, which allows a better understanding of causality.

Diffuse large B-cell lymphoma of thyroid invading the superior mediastinum with hashimoto's thyroiditis: a case report and literature review / 临床耳鼻咽喉头颈外科杂志

This article reports a case of primary thyroid diffuse large B-cell lymphoma involving the superior mediastinum with Hashimoto's thyroiditis admitted to the Department of Otolaryngology and Head and Neck Surgery, First Hospital of Jilin University. This patient underwent right thyroid lobectomy and was transferred to the Department of Hematology of the Oncology Center for 6 courses of chemotherapy with R-CHOP protocol. The postoperative recovery was good, and the patient was regularly followed up for 12 months after the operation. The patient's condition was stable, and CT showed no abnormally high metabolism in the operation area indicating the inhibition of tumor activity, superficial lymph nodes and peripheral blood cells were normal. The case encountered many difficulties in the diagnosis process, and the diagnosis was not confirmed after puncture in two Grade III Class A hospitals in China. There are few patients with primary thyroid diffuse large B-cell lymphoma complicated with Hashimoto's thyroiditis, and it is particularly rare to invade the mediastinum. There is no report in China and abroad in the literature we reviewed. Therefore, this article reports the case and retrospectively analyzes the etiology, clinical symptoms, diagnosis and treatment of primary thyroid lymphoma.

CD8+ Mycosis Fungoides in Peripheral Blood; A Rare Finding

Cutaneous T cell lymphomas are mature lymphomas of T lymphocyte presenting with skin lesions and/or systemic manifestations. Majority of these cases show CD4+ phenotype and are classified as Mycosis Fungoides (MF)/Sezary syndrome (SS) spectrum.Here we present a case of 74-year-old male patient, having no known comorbid, presented in Dr. Ziauddin Hospital, Karachi OPD with complains of generalized skin lesions, itching for 2 years, generalized weakness for 4 months and no lymphadenopathy or visceromegaly. CBC showed absolute lymphocytosis and absolute eosinophilia. Some lymphocytes exhibited cerebriform nuclei. CT scan neck, chest and abdomen showed bilateral enlarged superficial inguinal lymph nodes and multiple enlarged bilateral axillary lymph nodes. Skin biopsy was inconclusive. Immunophenotyping of peripheral blood was then performed which showed an aberrant T cell population showing positivity for CD3, CD8, CD2, CD25 and negative for CD4, CD45, CD5, CD30, CD56 with variable expression of CD7. Case was finalized as CD8+ Mycosis Fungoides with peripheral blood involvement.These findings are very rare and highlight the importance of integrated approach to clinical course, morphological findings and other ancillary tests to be used in correlation with each other. These findings also highlight the diversity present in T cell malignancies in terms of immunophenotype.

Evaluation of cytokine levels as possible predicting elements in patients with chronic lymphocytic leukemia

SUMMARY OBJECTIVE: This study aimed to assess the patterns of serum cytokines in chronic lymphocytic leukemia patients at baseline and post-chemotherapy and investigate their association with response to treatment and chronic lymphocytic leukemia prognosis. METHODS: Blood samples were taken from 32 subjects at their first medical visit after being diagnosed with chronic lymphocytic leukemia and 1 year after chemotherapy. Then, levels of cytokines and blood parameters in peripheral blood were measured. Correlation analysis was used to assess the indexes before and after chemotherapy as well as at different disease stages. RESULTS: Most of the patients (45.80%) had stages I and III before initiation of treatment and after treatment, respectively. There were significant differences between levels of interleukin (IL)-6 (p=0.006) and IL-10 (p=0.009) before and after treatment. Notably, the difference in IL-10 levels before and after treatment was significantly higher in the advanced stages compared to that in the non-advanced stages (p=0.007). IL-6 and IL-10 were also higher in the expired patients compared to the survived cases. CONCLUSIONS: Cytokines such as IL-6 and IL-10 may be considered predicting factors for chronic lymphocytic leukemia prognosis.

Peritoneal lymphomatosis. A case report

ABSTRACT Introduction: Involvement of the peritoneum occurs very rarely and is exceptional as an exclusive extranodal presentation of lymphomas. In most cases lymphomas associated with this rare entity are high-grade ones. PL secondary to high-grade nodal lymphoma is more frequent than primary peritoneal lymphoma, and there are only a few cases of the latter described in the literature. Description of the case: We present the case of a patient with constitutional syndrome and imaging findings suggestive of peritoneal carcinomatosis who was finally diagnosed with a Diffuse Large B-cell Lymphoma (DLBCL) by an ultrasound-guided core needle biopsy (CNB) of peritoneum. The patient received one polychemotherapy cycle; however tumor lysis syndrome occurred with death of the patient in the following days. This case tries to show the existence of a PL without other radiological findings of lymphoma, a fact that is very exceptionally described in the literature. Discussion: The differential diagnosis between PL and others peritoneum diseases such as peritoneal carcinomatosis, malignant primary peritoneal mesotheliomas, tuberculous peritonitis, sarcomatosis, diffuse peritoneal leiomyomatosis or benign splenosis, constitutes a major problem in imaging techniques. An exhaustive analysis of the radiological characteristics as well as a clinical-analytical context allows the differential diagnosis against peritoneal carcinomatosis and the rest of the entities previously referred although the final diagnosis will always be a biopsy. Conclusion: PL usually manifests as an aggressive histological subtype of high-grade lymphomas leading to a rapid progression and deterioration of the patient. It is crucial for the radiologist and the clinician to be aware of this rare entity providing the earliest possible diagnosis and optimal treatment to prolong the patient's life.

Late-Onset Hematological Toxicity (LOHT) in Patients with B-Cell Lymphomas: A Survey in 758 Cases

ABSTRACT Background: The increasing survival of patients with non-Hodgkin lymphoma has allowed the diagnosis of long-term complications, including late-onset hematological toxicity (LOHT), transitory cytopenias, or therapy-related myeloid neoplasm (t-MDS/t-AML). Objective: The objective of the study was to determine the frequency and clinical evolution of LOHT in patients with lymphoproliferative malignancies. Materials and Methods: Two cohorts of patients B-cell lymphomas were reviewed. Patients who achieved full hematologic recovery at the end of treatment, and thereafter developed any degree of cytopenia were included in the study. Clinical and biochemical parameters were compared between patients with and without cytopenias with X2 test. Bi- and multivariate analyses were performed to evaluate factors associated with the development of late-onset cytopenias. Results: Of 758 patients enrolled, 19 developed cytopenias (2.5%). Transitory cytopenia was documented in 6 cases, 3 developed ICUS, 8 t-MDS, and 2 t-AML. In patients with FL, only hemoglobin < 12 g/dL (p = 0.032) and >6 nodal areas (p = 0.037) at diagnosis were factors statistically significant for the development of cytopenia. During cytopenias, 55% of patients died. Conclusions: LOHT constitutes a cause of morbidity and mortality in 2.5% of lymphoma patients treated with different therapy regimens.

Linfoma cutáneo primario de células B. Presentación de un caso / Primary skin lymphoma of cells B. Presentation of a case / Linfoma de células da pele primária B. Apresentação de um caso

RESUMEN Introducción: el Linfoma cutáneo primario del centro folicular es indolente; la supervivencia es de 95% a cinco años; es el más común de los LCCB (35%). Tiene predilección por varones adultos mayores. Se manifiesta con pápulas, placas y tumores solitarios o agrupados principalmente en la piel cabelluda, la frente y el tronco. El objetivo de este trabajo es la presentación del caso por lo inusual de aparición en esta localización y ser el 1ero en nuestro servicio y provincia. Caso clínico: paciente JVL de 58 años de edad, que se interconsulta con los médicos del servicio de Dermatología por presentar lesiones en cuero cabelludo de 3 meses de evolución. Examen físico: Presenta lesiones localizadas en el cuero cabelludo, tumorales en número de 4 redondeadas eritemato violáceas de centro ulcerado con secreción serohemáticas y telangiectasias en su superficie las cuales eran dolorosas. Adenopatías múltiples, pequeñas, movibles en región cervical bilaterales. Se le realizó estudio histopatológico de los tumores para confirmar el diagnóstico clínico planteado. Discusión: los linfomas son tumores malignos del sistema linforreticular, representan un 25% del total de los LCP. Esta neoplasia aparece fundamentalmente entre los 40 y 60 años y es 2,2 veces más frecuente en el sexo masculino que en el femenino, en nuestro caso la paciente tenía 58 años de edad. Si bien es cierto que esta patología es infrecuente, en nuestro caso aparece en mujer con lesiones en cuero cabelludo en una de las localizaciones menos reportada, pero con las lesiones clásicas de los linfomas cutáneos primarios de células B, la tendencia a las ulceraciones se pueden encontrar en la forma centro folicular y en los linfomas difuso de células B como en nuestro caso. Conclusiones: realizamos esta presentación de linfoma cutáneo primario de células B enfermedad infrecuente que se ve mayormente en sexo masculino sin embargo en su variedad difuso se observa más frecuente en mujer en cuero cabelludo de forma ulcerada como apareció en nuestro caso y por ser el primero diagnosticado nuestra provincia.

ABSTRACT Introduction: the primary cutaneous lymphoma of the follicular center is indolent; 95% survival over five years; is the most common LCCB (35%). They have a predilection for larger adult males. It manifests with papules, plaques and solitary tumors or grouped mainly in the skinned hair, in front of the trunk. The purpose of this work is the presentation of the case due to the unusual appearance in this location and to be the first in our service and province. Clinical case: JVL patient of 58 years of age, who is consulted with doctors at the Dermatology service for presenting injuries in the hair of 3 months of evolution. Physical examination: There are lesions located in the hair, tumors in the number of 4 rounded violet erythema of the ulcerated center with serohemic secretion and telangiectasias on their surface that are painful. Multiple, small adenopathies, movable in bilateral cervical region. The histopathological study of the tumors was carried out to confirm the planted clinical diagnosis. Discussion: lymphomas are malignant tumors of the lymphorecticular system, representing 25% of the total PCL. This neoplasm appears fundamentally between 40 and 60 years and 2.2 times more often in men than in women, in case the patient had 58 years of age. If I believe that this pathology is unheard of, in one case it appears in many with lesions in the hair in one of the least reported locations, but with the classic lesions of primary cutaneous B-cell lymphomas, the tendency to ulcers is reduced. find in the form of follicular center and diffuse B-cell lymphomas as in this case. Conclusions: we present this presentation of primary cutaneous B-cell lymphoma that is infrequently ill, seen mostly in men, but in a diffuse variety, it is observed more frequently in the hair in an ulcerated form as it appears in our case and because it is the first diagnosed in our province.

RESUMO Introdução: o linfoma cutâneo primário do centro folicular é indolente; a sobrevivência é de 95% em 5 anos; é o mais comum dos LCCBs (35%). Ele tem predileção por homens adultos mais velhos. Manifesta-se na forma de pápulas, placas e tumores, solitários ou agrupados, principalmente no couro cabeludo, testa e tronco. O objetivo deste trabalho é apresentar o caso devido à sua peculiaridade neste local e ser o primeiro em nosso serviço e província. Caso clínico: paciente JVL, 58 anos, que é consultado pelos médicos do serviço de Dermatologia por apresentar lesões no couro cabeludo com 3 meses de evolução. Exame físico: Apresenta lesões localizadas no couro cabeludo, tumores em número de 4 eritematosos violáceos arredondados com centro ulcerado com secreções cerimônicas e telangiectasias dolorosas na superfície. Linfadenopatia múltipla, pequena e móvel na região cervical, bilateral. O estudo histopatológico dos tumores foi realizado para confirmação do diagnóstico clínico. Discussão: linfomas são tumores malignos do sistema reticular linfático, correspondendo a 25% de todos os LCP. Essa neoplasia surge principalmente entre 40 e 60 anos e é 2,2 vezes mais frequente em homens do que em mulheres, em nosso caso o paciente tinha 58 anos. Embora seja verdade que essa patologia não seja frequente, em nosso caso ela aparece em mulheres com lesões no couro cabeludo em uma das localizações menos relatadas, mas com as lesões clássicas dos linfomas cutâneos primários de células B, a tendência à ulceração é pode ser encontrado no centro folicular e nos linfomas difusos de células B, como em nosso caso. Conclusões: apresentamos esta apresentação do linfoma cutâneo primário de células B, uma doença rara observada principalmente no sexo masculino, mas em sua variedade difusa é observada mais frequentemente em mulheres no couro cabeludo de forma ulcerada como apareceu em nosso caso e por seja o primeiro diagnóstico em nossa província.

Mandible lymphoma: an aggressive osteolytic lesion

Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-hodgkin's lymphoma. In oral cavity represents approximately 2% of all malignancies. Case presentation: This report describes a rare mandibular involvement of DLBCL. A 56 year-old man was referred for evaluation of left mandible pain. In the anamnesis, the patient informed to be treating tooth pain in lasting 6 months. On oral evaluation, an intense mobility of the left mandibular second molar and a swelling in posterior left mandible were observed. Computed tomography showed a large osteolytic lesion affecting both mandibular body and ramus. An incisional biopsy was performed and according to histopathological and imumnohistochemical features, DLBCL was diagnosed. The treatment consisted of 8 cycles of R-CHOP and adjuvant radiotherapy. He is asymptomatic after 6 years. Conclusion: This case showed a rare bone presentation of DLBCL and such tumor should be considered as differential diagnosis of osteolytic lesion of the mandible.

Brentuximab vedotin demonstrates an objective response in a patient with refractory CD30+ primary mediastinal B-cell lymphoma

Diffuse large B-cell lymphomas (DLBCL) with MYC translocations combined with translocations involving BCL-2 or BCL-6 are referred to as double-hit lymphomas. These lymphomas are generally refractory to currently available therapies and have a poor prognosis. Primary mediastinal B-cell lymphoma (PMBL) is a rare subtype of DLBCL, which shares clinical, pathologic, and genetic similarities with classical Hodgkin's lymphoma. Unlike DLBCL, rearrangements involving MYC, BCL-2, and BCL-6 are typically absent in PMBL. We present a patient with PMBL who had increased gene copy numbers of MYC and BCL-2 along with increased protein expression of BCL-2 (c-Myc expression was about 15%–20% by immunostain). The disease was refractory to standard and salvage chemotherapies. The lymphoma, however, responded to brentuximab vedotin, a CD30-directed chemoimmunoconjugate

T-cell lymphomas in a tertiary care center of Mangalore

Background: The clinicomorphology and immunohistochemical features of T-cell lymphomas have been documented. Aim: The aim of the study was to evaluate the spectrum of clincopathological features of T-cell lymphoma with immunohistochemistry correlation in a tertiary care center. Materials and Methods: The present study was conducted on 19 biopsy specimens received from the Department of Pathology, Kasturba Medical College, from referral hospitals of Mangalore city. Cases of nodal and extranodal T-cell lymphomas diagnosed between January 2012 and December 2015 were selected with evaluation of clinical data, histomorphological features, and immunophenotyping. Appropriate panel of antibodies was chosen after morphological evaluation of the cases. Results: Of the 19 cases of T-cell lymphomas, 14 were nodal disease and 5 were extranodal disease. Among the nodal lymphomas, five were primary peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS), four were cases of lymphoblastic lymphoma, three were cases of angioimmunoblastic T-cell lymphomas, and two were cases of anaplastic large-cell lymphoma anaplastic lymphoma kinase (ALK) negative. In extranodal disease, two were mycosis fungoides of skin, one case each of subcutaneous panniculitis-like T-cell lymphoma, T-cell lymphoblastic lymphoma of tonsil, and T-cell lymphoma of the stomach. Conclusions: The diagnosis and subclassification of PTCLs is necessary for therapeutic and prognostic purposes

Trends in the profile of non hodgkins lymphoma in North and South India: a study from two tertiary care hospitals in India

Background: A number of environmental and chemical factors have been thought to been implicated in the occurrence of Non-Hodgkin’s Lymphomas (NHLs).To fill the knowledge gap in various aspect of the disease, this study was undertaken at this tertiary care centre in Delhi and Bangalore.Methods: This was a prospective observational study conducted in two defenses medical centre in India among patients of Non Hodgkins Lymphoma, registered at Command hospital Airforce Bangalore and Army Hospital (Research and Referral), New Delhi, between March 2016 and March 2019.Results: The disease showed a bimodal onset in both centres with 26 (26%) and 24 (24%) cases occurring in the age group of 31-40 years and 24 (24%) and 25 (25%) cases occurring in the age group of >60 years at CHAF (B) and AH (RR) respectively. B cell Lymphoma was the most common type of NHL seen in 85% and 89% patients, whereas T-cell lymphomas constituted 13% and 11% at CHAF (B) and AH (RR).  32(32%) patients presented with an Ann Arbor Stage 1 or 2 disease whereas 68(68%) patients were with Stage 3 or 4 disease at both the centers. IPI score was ≥3 in 45 % and 43% patients.Conclusions: NHL in India is a homogeneous and uniform disease. But there was increased detection of hepatosplenomegaly and associated hepatitis B/C in the southern part of India. Also, the occurrence of Cutaneous T cell lymphoma was only seen in the south India centre. The early stage NHLs has better survival and increase chance of complete response.

Uncommon anatomical sites and anatomopathological presentations of lymphoma in dogs / Sítios anatômicos e apresentações anatomopatológicas incomuns do linfoma em cães

Lymphomas are the tumors most frequently associated with the death or euthanasia of dogs in most parts of the world. In dogs, they almost always occur as disseminated (multicentric lymphoma), gastrointestinal (alimentary lymphoma), or nodal mediastinal (mediastinal lymphoma) diseases. However, other uncommon presentations can occasionally occur. This study aimed to establish the prevalence of these unusual types of lymphoma and demonstrate to veterinary pathologists how they present pathologically. From a total of 100 cases of lymphoma in dogs diagnosed between 1965 and 2017, 16 cases (16/100) were considered by us as non-traditional presentations of the disease: follicular lymphoma, (5/100), peripheral T-cell lymphoma, NOS (2/100), angiocentric lymphoma (2/100), intravascular large T-cell lymphoma (2/100), lymphomatoid granulomatosis (1/100), anaplastic large-cell lymphoma (1/100), hepatosplenic T-cell lymphoma (1/100), and chronic small B-cell lymphocytic lymphoma, intermediate type (1/100). We hope that the results presented here can help veterinary pathologists to recognize such cases of "atypical lymphoma" in their diagnostic routines.(AU)

Linfomas são os tumores mais associados a morte ou eutanásia de cães na maior parte do mundo. Nessa espécie animal ocorrem quase sempre como uma doença disseminada (linfoma multicêntrico), gastrintestinal (linfoma alimentar) ou nodal mediastinal (linfoma mediastínico), entretanto, ocasionalmente, outras apresentações bem menos comuns podem ser encontradas. O objetivo deste artigo é estabelecer a prevalência desses pouco usuais tipos de linfoma e demonstrar aos patologistas veterinários como eles se apresentam anatomopatologicamente. De um total de 100 casos de linfoma em cães diagnosticados entre os anos de 1965 e 2017, 16 casos (16/100) foram considerados como apresentações não tradicionais da doença: linfoma folicular (5/100), linfoma de células T periférico inespecífico (2/100), linfoma angiocêntrico (2/100), linfoma intravascular de grandes células T (2/100), granulomatose linfomatoide (2/100), linfoma de grandes células anaplásicas (1/100), linfoma hepatoesplênico de células T (1/100) e linfoma linfocítico crônico de pequenas células B - tipo intermediário (1/100). Esperamos que os resultados aqui demonstrados auxiliem patologistas veterinários a reconhecerem tais casos de "linfomas atípicos" em suas rotinas diagnósticas.(AU)

Tomografía por emisión de positrones asociada con tomografía computarizada en la estadificación de los linfomas / Positron emission tomography combined with computed tomography for the staging of lymphomas

Introducción: Los estudios de imágenes son esenciales para la estadificación de los linfomas. La utilización de la imagen funcional que proporciona la tomografía por emisión de positrones con 18F-2-deoxi-2-fluoro-D-glucosa asociada a la tomografía computarizada ha cambiado fundamentalmente el concepto de estadificación y reestadificación de los linfomas. Constituye una prueba diagnóstica que ha ganado aceptación universal, sobre todo después de la publicación y adopción de las guías de Lugano. Objetivo: Analizar la importancia que tienen las imágenes que proporciona la tomografía por emisión de positrones con 18F-2-deoxi-2-fluoro-D-glucosa asociada a la tomografía computarizada en la estadificación actual de los linfomas. Métodos: Se realizó una revisión bibliográfica, en español y en inglés, de la última década. Se utilizaron los motores de búsqueda de Pubmed, Google y SciELO. Se recolectó y organizó la información siguiendo cronológicamente la aparición de las innovaciones para facilitar la estadificación de los linfomas. Análisis y síntesis de la información: Se hace un recorrido desde la introducción de la tomografía computarizada, la tomografía por emisión de positrones y la asociación de estas, hasta su aplicación en el estudio de los linfomas. Se describe la evolución de los sistemas de clasificación para los linfomas y la utilidad del empleo de la tomografía por emisión de positrones con 18F-2-deoxi-2-fluoro-D-glucosa asociada a la tomografía computarizada en la estadificación de los linfomas. Conclusiones: Es de gran importancia que, en el momento actual, el manejo óptimo de un paciente con linfoma ávido de 18F-2-deoxi-2-fluoro-D-glucosa incluya la estadificación inicial con tomografía por emisión de positrones asociada con tomografía computarizada. Esto permitirá hacer más precisa la etapificación inicial del paciente, optimizar su tratamiento y evaluación de la terapia implementada; así como un mejor pronóstico y evitar estudios invasivos(AU)

Introduction: Imaging studies are essential for staging of lymphomas. The usage of functional imaging provided by positron emission tomography with 18F-2-deoxy-2-fluoro-D-glucose combined with computed tomography has fundamentally changed the concept of staging and re-staging of lymphomas. It constitutes a diagnostic test that has gained universal acceptance, especially after the publication and adoption of the Lugano guidelines. Objective: To analyze the importance of the images provided by positron emission tomography with 18F-2-deoxy-2-fluoro-D-glucose combined with computed tomography in current staging of lymphomas. Methods: A bibliographic review was carried out, in Spanish and in English, within the last decade. We used the search engines of Pubmed, Google, and SciELO. The information was collected and organized by chronologically following the origin of the innovations that facilitate the staging of lymphomas. Information analysis and synthesis: An analysis is carried out from the introduction of computed tomography, positron emission tomography, and the combination of both, to their application in the study of lymphomas. We described the evolution of lymphoma classification systems and the usefulness of positron emission tomography with 18F-2-deoxy-2-fluoro-D-glucose combined with computed tomography for the staging of lymphomas. Conclusions: At the present time, it is of great importance for a patient with lymphoma needing 18F-2-deoxy-2-fluoro-D-glucose to receive optimal management of his or her condition, including initial staging with positron emission tomography combined with computed tomography. This will allow to make the initial staging of the patient more precise, to optimize his or her treatment and evaluation of the implemented therapy, as well as to obtain a better prognosis, avoiding invasive studies(AU)

HDAC inhibitors overcome immunotherapy resistance in B-cell lymphoma

Immunotherapy has been applied successfully to treat B-cell lymphomas in preclinical models or clinical settings. However, immunotherapy resistance is a major challenge for B-cell lymphoma treatment. To overcome this issue, combinatorial therapeutic strategies have been pursued to achieve a better efficacy for treating B-cell lymphomas. One of such strategies is to combine immunotherapy with histone deacetylase (HDAC) inhibitors. HDAC inhibitors can potentially increase tumor immunogenicity, promote anti-tumor immune responses, or reverse immunosuppressive tumor environments. Thus, the combination of HDAC inhibitors and immunotherapy has drawn much attention in current cancer treatment. However, not all HDAC inhibitors are created equal and their net effects are highly dependent on the specific inhibitors used and the HDACs they target. Hence, we suggest that optimal treatment efficacy requires personalized design and rational combination based on prognostic biomarkers and unique profiles of HDAC inhibitors. Here, we discuss the possible mechanisms by which B-cell lymphomas acquire immunotherapy resistance and the effects of HDAC inhibitors on tumor cells and immune cells that could help overcome immunotherapy resistance.

HDAC inhibitors overcome immunotherapy resistance in B-cell lymphoma

Immunotherapy has been applied successfully to treat B-cell lymphomas in preclinical models or clinical settings. However, immunotherapy resistance is a major challenge for B-cell lymphoma treatment. To overcome this issue, combinatorial therapeutic strategies have been pursued to achieve a better efficacy for treating B-cell lymphomas. One of such strategies is to combine immunotherapy with histone deacetylase (HDAC) inhibitors. HDAC inhibitors can potentially increase tumor immunogenicity, promote anti-tumor immune responses, or reverse immunosuppressive tumor environments. Thus, the combination of HDAC inhibitors and immunotherapy has drawn much attention in current cancer treatment. However, not all HDAC inhibitors are created equal and their net effects are highly dependent on the specific inhibitors used and the HDACs they target. Hence, we suggest that optimal treatment efficacy requires personalized design and rational combination based on prognostic biomarkers and unique profiles of HDAC inhibitors. Here, we discuss the possible mechanisms by which B-cell lymphomas acquire immunotherapy resistance and the effects of HDAC inhibitors on tumor cells and immune cells that could help overcome immunotherapy resistance.

Supervivencia de pacientes con linfoma no-Hodgkin y síntomas neurológicos según inmunofenotipo del líquido cefalorraquídeo / Survival in non-Hodgkin´s lymphoma patients with neurological symptoms according to the cerebrospinal fluid immunophenotype

Introducción: Los linfomas no-Hodgkin pueden infiltrar el sistema nervioso central y producir síntomas neurológicos, lo cual incrementa la mortalidad. El diagnóstico de esta infiltración se puede realizar mediante el estudio del líquido cefalorraquídeo por la técnica de citometría de flujo, con una mayor sensibilidad que la citología convencional. Objetivo: Estimar la supervivencia global de pacientes con Linfoma no-Hodgkin y síntomas neurológicos según el inmunofenotipo celular del líquido cefalorraquídeo. Métodos: Se realizó un estudio analítico y prospectivo en 15 pacientes con diagnóstico confirmado de linfoma no-Hodgkin y síntomas neurológicos, con citología negativa del líquido cefalorraquídeo, tratados en el servicio de oncología del Instituto Nacional de Oncología y Radiobiología, durante los años 2017 y 2018. El inmunofenotipo fue caracterizado mediante citometría de flujo multiparamétrica. Resultados: El 60,0 por ciento de los pacientes fue del sexo femenino y el 53,4 por ciento mayor de 60 años. Hubo una mortalidad del 26,7 por ciento. Se realizaron 17 inmunofenotipos, el 58,9 por ciento fue normal, el 23,4 por ciento reactivo y el 17,7 por ciento sospechoso de malignidad. La supervivencia global fue mayor en pacientes con líquido cefalorraquídeo con inmunofenotipo normal (HR. 0.04). Conclusiones: La citometría de flujo pudo discriminar células sospechosas de malignidad, en pacientes cuyas citologías fueron negativas. La presencia en el líquido cefalorraquídeo de células atípicas, de pleocitosis y de un índice de linfocito-monocito alto se asoció con una supervivencia global menor(AU)

Introduction: When non-Hodgkin lymphomas infiltrate the central nervous system increases mortality. The diagnosis of this infiltration can be made by the study of cerebrospinal fluid using flow cytometry, with a higher sensitivity than conventional cytology. Objective: To estimate the relationship between the cellular immunophenotype of the cerebrospinal fluid and the overall survival of patients with non-Hodgkin lymphoma and neurological symptoms. Methods: An analytical and prospective study was conducted in 15 patients with confirmed diagnosis of non-Hodgkin lymphoma and neurological symptoms, with negative cytology of the cerebrospinal fluid. Patients cared at Oncology Department of the National Institute of Oncology and Radiobiology, during the years 2017-2018. The immunophenotype was characterized by multiparametric flow cytometry. Results: 60.0 percent of the patients was female and 53.4 percent older than 60 years. There was an overall mortality of 26.7 percent 17 immunophenotypes were found, 58.9 percent of them was normal, 23.4 percent reactive and 17.7 percent suspected of malignancy. Overall survival advantage was obtained in patients with cerebrospinal fluid with normal immunophenotype (HR 0.04). Conclusions: Flow cytometry could discriminate cells suspected of malignancy, in patients whose cytologies were negative. The presence in the cerebrospinal fluid of atypical cells, pleocytosis and a high lymphocyte-monocyte index were associated with a lower overall survival(AU)

Canine lymphomas diagnosed in southern Brazil from 2000 to 2017: epidemiology and immunophenotype / Linfomas caninos diagnosticados na região Sul do Rio Grande do Sul de 2000 a 2017: epidemiologia e imunofenótipo

Lymphoma is a neoplasm that originates from solid hematopoietic tissues and is one of the most common tumors in dogs. The goal of the present study was to perform a retrospective study of canine lymphomas diagnosed at the "Laboratório Regional de Diagnóstico", at the "Faculdade de Veterinária" of the "Universidade Federal de Pelotas" (LRD-UFPel) from 2000 to 2017, to determine the epidemiology and anatomical distribution, and to evaluate the histopathological and immunohistochemical aspects of each case according to the adapted Kiel classification. The protocols for necropsies and biopsies in the laboratory were reviewed. Lymphoma was diagnosed in 77 dogs. Approximately 37.7% (29/77) of affected dogs had no defined breed, while dogs with defined breeds accounted for 58.4% (45/77) of the diagnoses. The occurrence in males (40/77) was slightly higher than that in females (36/77), and the mean age was 8.1 years (1.4-17 years). The most affected age group was between six and 10 years of age with 31 cases (40.2%). Regarding the anatomical classification, the multicentric form was the most prevalent, accounting for 71.4% (55/77) of the diagnoses. In 40 cases that immunophenotyping was performed, B-cell lymphomas represented 62.5% of the diagnoses (25/40), while T-cell lymphomas corresponded to 37.5% of the diagnoses (15/40). The degree of malignancy according to the modified Kiel classification was low in 35% of lymphomas (14/40) and high in 65% of cases (26/40). The multicentric form was more frequent in the region of influence of the LRD-UFPel. Identification of the immunophenotype can improve the quality of life and survival in affected dogs since it allows the most appropriate treatment for each patient.(AU)

O linfoma é uma neoplasia com origem nos tecidos hematopoiéticos sólidos e é um dos tumores mais frequentes em cães. O objetivo do presente trabalho foi efetuar um estudo retrospectivo dos linfomas caninos recebidos no Laboratório Regional de Diagnóstico, da Faculdade de Veterinária da Universidade Federal de Pelotas (LRD-UFPel) de 2000 a 2017, determinando a epidemiologia e a distribuição anatômica, bem como os aspectos histopatológicos e imuno-histoquímicos de cada caso de acordo com a classificação de Kiel adaptada. Foram revisados os protocolos de necropsias e biópsias recebidos no laboratório identificando-se 77 casos de cães com diagnóstico de linfoma. A doença afetou cães sem raça definida em 37,7% (29/77) dos casos, enquanto os cães com raças definidas tiveram 58,4% (45/77) dos diagnósticos. A ocorrência em machos (40/77) foi discretamente maior do que em fêmeas (36/77) e a idade média foi de 8,1 anos (1,4-17 anos). A faixa etária mais acometida foi entre seis e 10 anos de idade com 31 casos (40,2%). Quanto à classificação anatômica a forma multicêntrica foi a mais prevalente atingindo 71,4% (55/77) dos diagnósticos. Em 40 casos em que a imunofenotipagem foi realizada, os linfomas de células B representaram 62,5% dos casos (25/40), enquanto os linfomas de células T equivaleram a 37,5% dos diagnósticos (15/40). O grau de malignidade de acordo com a classificação de Kiel modificada foi baixo em 35% dos linfomas (14/40) e alto em 65% dos casos (26/40). Conclui-se que a forma multicêntrica é mais frequente na região de influência do LRD-UFPel e que a identificação do imunofenótipo pode melhorar a qualidade de vida e dar maior sobrevida aos cães afetados uma vez que permite o tratamento mais adequado para cada caso.(AU)

Reticulose pagetoide em um cão: relato de caso / Pagetoid reticulosis in a dog: case report

Reticulose pagetoide é a expressão utilizada para uma das mais raras formas de linfoma descritas em cães. Trata-se de um distúrbio linfoproliferativo cutâneo que emerge de linfócitos T intraepidérmicos. Descreve-se aqui um caso de reticulose pagetoide com apresentação localizada, muito semelhante à doença de Woringer-Kolopp dos humanos, que acometeu um cão, Boxer, fêmea de 10 anos de idade. O paciente foi atendido devido ao aparecimento de um nódulo na região nasolabial, com evolução clínica de cerca de 30 dias. Histologicamente o nódulo era composto por uma proliferação linfoide intraepidérmica e anexal. Os linfócitos neoplásicos, células T confirmadas por meio da imunomarcação positiva para CD3 e negativa para CD79, eram grandes células redondas e monomórficas. Apesar de rara, a reticulose pagetoide é um distúrbio linfoproliferativo de fácil suspeita com base apenas na morfologia celular. Esse neoplasma deverá ser lembrado sempre que um padrão linfoide intraepidérmico estiver presente.(AU)

Reticulosis pagetoide is an expression used for one of the rare forms of lymphoma described in dogs. It is a cutaneous lymphoproliferative disorder that emerges from intraepidermal T-cells. We describe a case of pagetoid reticulosis with localized presentation, very similar to Woringer-Kolopp's disease in humans, which affected a 10-year-old Boxer female. The patient was seen due to the appearance of a nodule in the nasolabial region with clinical evolution of about 30 days. Histologically, it was composed of an intraepidermal and annexal lymphoid proliferation. Neoplastic lymphocytes, T-cells confirmed by CD3-positive and CD79-negative immunolabeling, were large, round, and monomorphic cells. Although rare, pagetoid reticulosis is an easily suspected lymphoproliferative disorder based only on cell morphology. This neoplasm should be remembered whenever an intraepidermal lymphoid pattern is present.(AU)

OncoHodgk: Aplicación interactiva para el aprendizaje del diagnóstico y tratamiento de los Linfomas / OncoHodgk: Interactive application for learning the diagnosis and treatment of Lymphomas

Introducción: Los linfomas constituyen un grupo de enfermedades malignas, caracterizadas por la proliferación neoplásica del sistema retículoendotelial. Objetivo: Elaborar una aplicación interactiva sobre el diagnóstico y tratamiento de los linfomas para los estudiantes de 6to año de medicina de la Filial de Ciencias Médicas de Bayamo. Diseño Metodológico: La aplicación se elaboró entre febrero y marzo del 2018 en la Filial de Ciencias Médicas de Bayamo. Diseñado con el empleo de las herramientas JClic y Gimpshop 2.8 con licencia GPL/ Linux. Para determinar su efectividad se realizaron encuestas a estudiantes y profesores del centro. El universo estuvo constituido por todos los estudiantes del 6to año de la carrera de Medicina (281 alumnos) y la muestra por los estudiantes seleccionados que realizaron las dos primeras rotaciones por la sala de Medicina Interna (40 estudiantes). El grupo control, estuvo formado por la primera rotación, mientras que el experimental correspondió a la segunda rotación, ambos seleccionados por muestreo aleatorio simple. Resultados: Las mejores calificaciones comprendidas entre 4 y 5 puntos, correspondieron al grupo experimental con 20 estudiantes para el 100 por ciento, mientras que para el control esas calificaciones fueron obtenidas por 15 estudiantes, para un 75 por ciento. Conclusiones: Se constató la efectividad de la aplicación OncoHodgk para el aprendizaje del diagnóstico y tratamiento de los linfomas como alternativa para incrementar el nivel de conocimientos y la motivación en los estudiantes evaluados(AU)

Introduction: Lymphomas constitute a group of malignant diseases, characterized by the neoplastic proliferation of the reticuloendothelial system. Objective: To develop an interactive application about the diagnosis and treatment of lymphomas for the 6th year medical students of the Medical Sciences Branch of Bayamo. Methodological Design: The application was developed between February and March 2018 in the Medical Sciences Branch of Bayamo. It was designed with the use of JClic and Gimpshop 2.8 tools with GPL / Linux license. To determine its effectiveness, surveys were conducted to students and teachers of the center. The universe was constituted by all the students of the 6th year of the Medicine career (281 students) and the sample by the selected students who made the first two rotations through the Internal Medicine room (40 students). The control group was formed by the first rotation, while the experimental group corresponded to the second rotation, both selected by simple random sampling, in a period from February to March 2018, at the University Teaching Hospital Carlos Manuel de Céspedes. Results: The best grades between 4 and 5 points corresponded to the experimental group with 20 students for 100 percent, while in the control group 15 students obtained those grades for 75 percent. Conclusions: The effectiveness of the OncoHodgk application for learning about the diagnosis and treatment of lymphomas was stated(AU)