Neurolymphomatosis of the median nerve, optic nerve, L4 spinal nerve root and cauda equina in patients with B-cell malignancies: a case series.

BACKGROUND: Neurolymphomatosis is rare. Neoplastic lymphocytes are seen to invade nerves (cranial or peripheral), nerve roots or other related structures in patients with hematological malignancy. It is a separate entity from central nervous system lymphoma. Neurolymphomatosis has most commonly been described in association with B-cell non-Hodgkin lymphoma. Neurolymphomatosis in the context of Burkitt lymphoma and the post-renal transplant setting has not been described before. CASE REPORTS: We report for the first time in the Arabian Gulf countries and nearby Arab states four cases of neurolymphomatosis (one Asian, and the other 3 are from Arabic nationals) occurring between 2012 and 2017 involving the median nerve, optic nerve, nerve root and cauda equina in patients with Burkitt lymphoma, Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma. CONCLUSIONS: Neurolymphomatosis is rare and can be difficult to diagnose by biopsy but reliably confirmed by a combined imaging approach. Prior treatment with high-dose dexamethasone might suppress 18F-fluorodeoxyglucose (FDG) activity and decrease the sensitivity of positron emission tomography/computed tomography (PET/CT). The prognosis is generally poor but using high-dose methotrexate as well as high-dose chemotherapy and autologous stem cell transplantation may be an effective way to treat neurolymphomatosis.

[NK/T-Cell lymphoma of nasopharynx]. / Lymphomes T/NK du nasopharynx.

OBJECTIVE: Discussion of the clinical and paraclinical features of a rare tumor in the nasopharynx, the NK/T-cell lymphoma, with an emphasis on the implications of Epstein Barr Virus (EBV) in its pathogenesis and prognosis. CASES REPORT: We report the cases of a woman and a man aged 34 and 48, respectively. Clinical presentation was non-specific and diagnosis was established with deep biopsies under general anesthesia. Immunochemistry and in situ hybridization were positive for Epstein Barr virus in tumor cells in both cases. The patients were first treated with chemotherapy (CHOP regimen), then underwent radiotherapy. The first patient achieved complete response at twenty months follow-up. The second patient presented two recurrences which were treated by chemotherapy. He died from acute renal failure during treatment of the second recurrence. CONCLUSION: Diagnosis of NK/T-cell lymphoma may be delayed in the event of non-specific symptoms. Deep biopsies outside necrotic tissue must be obtained. Search for EBV is important as its presence is a factor of poor prognosis.

[HPA-5b neonatal allo-immune thrombocytopenia: two cases described in Tunisia]. / Thrombopénies néonatales dues à un allo-anticorps anti-HPA-5b: à propos de deux cas observés en Tunisie.

UNLABELLED: Alloimmune thrombocytopenia is due to feto-maternal incompatibility in the HPA systems and is usually considered in the diagnosis of neonatal thrombocytopenia after other causes have been excluded. We report on two Tunisian observations of alloimmune neonatal thrombocytopenia due to anti-HPA-5b (Bra) antibodies. CASE REPORT: Two neonates presented at birth with a thrombocytopenic purpura unexplained by usual causes of neonatal thrombocytopenia. Alloimmune neonatal thrombocytopenia was diagnosed by the determination of parental and neonatal platelets antigens phenotypes and by the presence of HPA-5b (antiBra) antibodies in maternal sera. A favourable evolution was obtained after maternal platelet transfusions. CONCLUSION: Alloimmune neonatal thrombocytopenia is a serious affection, which exposes to intracranial haemorrhage. These observations of HPA-5 neonatal alloimmunisation in Tunisia provide additional information on the geographic distribution of the disease and its prognosis.

[Primary lymphoma of bone: imaging features]. / Lymphomes osseux primitifs: apport de l'imagerie médicale.

Primary lymphoma of bone (PLB) has benefited from recent advances in medical imaging and immunohistochemical study that are of prognostic and therapeutic value. From 3 case reports of PLB involving the iliac bone and the skull base, we review the definition of PLB and their main features. The importance of complete initial workup for staging in order to exclude secondary bone lymphomas, more frequent and of worse prognosis, is emphasized. Diagnosis of PLB involving the skull base is more difficult to obtain and nearly always requires neurosurgical biopsy unlike PLB of peripheral bones that are more readily amenable to percutaneous biopsy.