RESUMO
BACKGROUND: B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (BCLu-DLBCL/cHL), also referred to as gray zone lymphoma (GZL), is known to share features with cHL and DLBCL. However, GZL is often difficult to diagnose. There is no consensus regarding the optimal therapeutic regimen. Most reported cases of GZL have been in Caucasian and Hispanic individuals, and its incidence is lower in African-American and Asian populations, including the Japanese population. CASE SUMMARY: A 69-year-old female presented at our hospital with a growing mass on the right side of her neck. An elastic, soft mass measuring 9 cm × 6 cm was palpable in the right cervical region. Laboratory analyses showed pancytopenia, increased serum lactate dehydrogenase levels, and markedly increased levels of soluble interleukin-2 receptor. Enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography (PET)/CT revealed multiple lesions throughout her body. She was diagnosed with GZL based on the characteristic pathological findings, the immunophenotype [CD20+, PAX5+, OCT2+/BOB1 (focal+), CD30+, CD15-], and the strong positive expression of neoplastic programmed cell death protein ligand 1 (PD-L1) in her lymphoma cells. The lymphoma was stage IV according to the Lugano classification and high-risk according to the International Prognostic Index for aggressive non-Hodgkin lymphoma. The patient received cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (R-CHOP) chemotherapy because the tumor cells were CD20+. She has remained in complete remission for 3 years. CONCLUSION: GZL was diagnosed based on histopathology and immunophenotyping with ancillary PD-L1 positivity. R-CHOP chemotherapy was an effective treatment.
RESUMO
Background: Obsessive-compulsive disorder (OCD) is often resistant to treatment and may be complicated by tardive dystonia (TDt) with the use of neuroleptics. Furthermore, patients with TDt often have an inadequate response to pharmacotherapy. Although electroconvulsive therapy (ECT) is considered a common treatment option for both TDt and OCD, its efficacy has not been well established for either condition. Case Presentation: Our case was a 37-year-old Japanese woman who showed improvement in both refractory TDt and severe OCD following ECT. A total of 12 ECT sessions resulted in an improvement in both diseases. To the best of our knowledge, this is the first report of a case in which ECT was effective for both TDt and OCD. Conclusion: Our report highlights the following two points: when TDt is associated with severe OCD, and the effect of pharmacotherapy is inadequate, ECT may be considered as a treatment option; given the common mechanism of frontal cortex-basal dysfunction reported in both dystonia and OCD, ECT may have an effect on this pathway.
