Evolución de un linfoma no Hodgkin "triple expresor" en un paciente trasplantado renal con quimioterapia DA-R-EPOCH. Caso clínico / Triple expressor lymphoma in a kidney transplant patient

Patients transplanted from solid organs have an increased risk of cancer, especially lymphomas. Lymphomas correspond to 4 to 5% of malignant neoplasms in the general population and in solid organ transplant patients it reaches an incidence of 21%. The incidence of non-Hodgkin lymphomas is 10 times higher than in the non-transplanted population. We report the case of a 68-year-old man with a kidney transplant who 6 years after transplantation, developed a non-Hodgkin diffuse large cells B lymphoma with lymph node and pulmonary involvement, with markers of very poor prognosis (triple MYC expressor, BCL2 and BCL6). and its evolution with chemotherapy with DA R EPOCH.

Linfoma difuso de células grandes B rectal en un paciente con colitis ulcerosa / Rectal diffuse large B cell lymphoma appearing after immunosuppression for ulcerative colitis: report of one case

Primary colorectal lymphoma is a rare form of presentation of gastrointestinal tract lymphomas. Inflammatory bowel disease and its treatment are risk factors for its development. We report a 47-year-old male patient with Ulcerative Colitis of two years of evolution, treated initially with azathioprine and later on with infliximab. Due to a relapse in symptoms after the second dose of infliximab, a new coloncoscopy was performed showing a rectal ulcerative lesion, corresponding to a large cell Non-Hodgkin's Lymphoma. The patient was successfully treated with RCHOP chemotherapy (Rituximab cyclophosphamide doxorubicin vincristine prednisone). He is currently in disease remission.

Linfoma difuso de células B grandes tipo piernas de presentación facial / Diffuse large B-celllymphoma-Ieg type, facial presentation

El linfoma difuso de células B grandes es el subtipo más común de los linfomas no Hodking. La presentación clínico-patológica es heterogénea, los exámenes de inmunohistoquímica y moleculares genéticas son pieza clave en el diagnóstico. Entre las presentaciones cutáneas de este linfoma, la más común es la tipo piernas. Sin embargo, en el presente artículo se reporta un caso de una mujer con presentación facial y compromiso grave _ El diagnóstico definitivo se da por suma de criterios patológicos y por inmunohistoquímica. La paciente recibió esquema CHOP (ciclofosfamida, doxorrubicina, vincristina, prednisona), y en los dos primeros meses presentó una excelente respuesta.

Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphomas. The clinical-pathological presentation is heterogeneous, immunohistochemistry and molecular genetics test are so important in diagnosis. Among the cutaneous presentations of this lymphoma, the most common is in the leg, however, on this occasion we reported a case of facial presentation with severe compromise. The definitive diagnosis is given by the sum of pathological and immunohistochemical criterias, the patient received CHOP scheme, which in the first two months had an excellent response.

Linfoma difuso de grandes células B en pacientes con infección por virus de hepatitis C / Diffuse large B-cell lymphoma in hepatitis C virus positive patients

El linfoma difuso de grandes células B (LDGCB) ha sido relacionado con la infección por virus de la hepatitis C (VHC) en algunas áreas geográficas. En una publicación anterior describimos los resultados y la tolerancia a la quimioinmunoterapia estándar en 156 pacientes consecutivos con LDGCB, VHC positivos, de tres instituciones del norte de Italia. La presentación clínica de los pacientes con LDGCB VHC positivos es diferente de sus contrapartes VHC negativas, dado que el hígado y el bazo se encuentran habitualmente comprometidos y los niveles de LDH frecuentemente están elevados en el momento del diagnóstico. Solamente una minoría de los pacientes debe interrumpir el tratamiento debido a una insuficiencia hepática grave, y el agregado de rituximab parece no afectar la tolerancia de los pacientes al tratamiento. La coinfección por el virus de la hepatitis B, un estadio Ann Arbor avanzado y el origen ganglionar del tumor, son los factores adversos más importantes para el pronóstico de estos pacientes. Demostramos en esta investigación que la supervivencia global de los pacientes VHC positivos es significativamente mejor comparada con la de 224 pacientes consecutivos con LDGCB, VHC negativos, de similar grupo etario, tratados y seguidos en el Departamento de Hematología de Vicenza durante el mismo lapso (5 años, 72% vs. 56%, p = 0.004). Resulta posible ahora realizar una evaluación prospectiva de linfomas de alto grado VHC positivos.

Diffuse large B-cell lymphoma (DLBCL) has been correlated to hepatitis C virus (HCV) infection in some geographical areas. We have previously described theoutcome, and the tolerance to standard chemoimmunotherapy of 156 previously untreated consecutive HCV-positive patients with DLBCL observed in threeInstitutions from Northern Italy. Clinical presentation of HCV-positive DLBCL differs from their HCV-negative counterpart, with spleen and liver frequently involved at diagnosis, and LDH that is often elevated. Only a minority of patients have to discontinue chemotherapy due to severe liver function impairment, and the addition ofRituximab does not seem to affect patients’ tolerance to treatment. Hepatitis B virus co-infection, advanced Ann Arbor stage, and nodal origin of the tumor are the strongest adverse prognostic factors in these patients.We show here that long-term overall survival (OS) of HCVpositive patients is significantly better when comparedto 224 consecutive HCV-negative, age-matched patients with DLBCL treated and followed up in Vicenza Hematology Department in the same time period (5-year OS 72% vs. 56%, p = 0.004). A prospective evaluation of HCV-positive high grade lymphomas is now warranted.

Clinical Characteristics and Outcomes of Posttransplant Lymphoproliferative Disorders Following Allogeneic Hematopoietic Stem Cell Transplantation in Korea

Between 1995 and 2003, seven cases of posttransplant lymphoproliferative disorder (PTLD) were identified among 1,116 patients who received allogeneic hematopoietic stem cell transplantations (HSCT) at Catholic HSCT Center (overall incidence 0.6%). Five (71.4%) patients had episodes of acute graft-versus-host-disease (GVHD) and were treated with steroids. Cervical lymphadenopathy was observed in most cases (71.4%), but clinical symptoms varied depending on the involved sites. Pathologic findings varied: 1 case of plasmacytic hyperplasia, 3 of polymorphic PTLD, 2 of diffuse large B-cell lymphoma, 1 of large T-cell lymphoma, which proved to be associated with Epstein-Barr virus (EBV). The proportion of EBV-negative PTLD was 33.3%. Five patients demonstrated a good response to treatment (treatment response rate 71.4%). The overall mortality was 42.8%, and one death was directly attributable to PTLD. The incidence of PTLD is expected to increase, based on the rising use of grafts from alternative donors and recent clinical features of PTLD manifested by a disseminated and fulminant nature. It is necessary to have a high level of suspicion when monitoring patients and readily adopt prompt and effective cellular immunotherapy for PTLD.

Induction of lymphomas on implantation of human oral squamous cell carcinomas in nude mice.

Cancer cells from five oral cancer patients and pleomorphic adenoma cells from one individual were inoculated as single cell suspension into subcutis of 30 Swiss nude mice and tail vein of additional 30 mice. Further, tumor tissue pieces from three oral cancer patients were xenografted s.c. in 18 nude mice, and 10 mice were kept as controls. In animals implanted with tumor pieces, 7/18 (39%) mice, developed squamous cell carcinoma at the site of inoculation within 8-15 days, while tumors were not observed in mice inoculated with single cell suspension, up to 60/90 days. In 8/68 (12%) mice, white foci were observed in several tissues, with hepatomegaly and splenomegaly noted in 27/68 (39%) mice. Histopathological examination of various tissues revealed presence of large cell lymphoma in several organs in 14/68 (21%) mice. No regional or distant metastasis of the implanted oral tumor cells was detected. Mice injected with cells from pleomorphic adenoma, also demonstrated large cell lymphoma in 2/10 (20%) mice, whereas none of the 10 control animals showed any gross abnormalities or microscopic abnormalities in several organs. 2/16 (12%) lymphomas exhibited positive reaction with mouse B cell antibodies illustrating the murine origin of the lymphomas, and these were immunophenotyed as B cell lymphomas. The lymphomas were also examined with mouse T cell antibodies and none reacted positively with the mouse T cell antibodies. The lymphomas also failed to react with human T cell, B cell and human Leucocyte common antigen (LCA) antibodies, indicating that the induced lymphomas were not of human origin. The tumor specimens from seven of eight oral cancer patients and the pleomorphic adenoma patient induced lymphomas in nude mice. Thus it appears that xenografting oral tumor cells into nude mice may cause induction of the murine lymphomas, and this needs further investigation.

Linfoma gástrico primario

El linfoma gastrico primario, entidad relativamente infrecuente, viene aumentando su incidencia como resultado de las mejores técnicas endoscópicas que permiten la toma de suficiente material de biopsia para el diagnóstico histopatológico. El diagnóstico diferencial histológico se hace con el carcinoma gastrico y con el pseudolinfoma gastrico. La clasificación del estadio de la enfermedad es necesaria para planear el tratamiento y valorar el pronóstico. La resección quirúrgica como modalidad terapéutica ha venido siendo reemplazada por esquemas de quimioterapia y radioterapia combinadas con menores ratas de morbimortalidad y mejores tasas de sobrevida.