原发乳腺非霍奇金淋巴瘤的预后分析

目的 分析原发乳腺非霍奇金淋巴瘤(PNHLB)的临床特点与预后.方法 回顾性分析45例PNHLB的临床特点.5例行乳房改良根治术,5例行患侧乳房单纯切除术.43例行CHOP或CHOP样联合化疗,其中6例加用利妥昔单抗.19例化疗后行局部放疗,1例仅行单纯放疗.45例患者均获随访,随访时间6～180个月.结果 45例PNHLB患者中,弥漫大B细胞性淋巴瘤(DLBCL)37例,T细胞型淋巴瘤4例,黏膜相关淋巴组织样淋巴瘤(MALT)4例.一线化疗的有效率为90.7%.中位总生存期(OS)为6.82年,中位无进展生存期(PFS)为4.25年.Cox比例风险模型分析结果显示,IPI(RR=5.682,P=0.002)、Ann Arbor分期(RR=1.836,P=0.040)是PNHLB患者OS的独立影响因素,中枢神经系统浸润(RR=1.107,P=0.005)是PFS的独立影响因素.结论 国内PNHLB发病年龄较早,以DLBCL最常见.IPI和Ann Arbor分期是PNHLB患者预后的独立影响因素.     

Primary non-Hodgkin's lymphoma of the female breast masquerading as a breast abscess

We report the case of a primary non-Hodgkin's lymphoma of the breast, masquerading as a breast abscess.     

Definitive irradiation for localized non-Hodgkin's lymphoma of breast

A diagnosis of primary non-Hodgkin's lymphoma (NHL) confined to the breast or breast and ipsilateral lymph nodes was biopsy proven in 19 patients who presented to our institution between 1970 and 1984. Four patients were treated with a modified radical mastectomy, and one with chemotherapy only. The remaining 14 patients comprise the basis of this study. All patients were clinically staged. There were 12 patients with 1A-E disease and two with IIA-E disease. All patients were treated with breast radiation. The axillary nodes were included in seven of the patients and two, in addition, received "mantle" irradiation. The majority of the patients received between 3500-4400 cGy, but four received lower doses. One patient, with Stage IIA-E disease, received 6 months of systemic chemotherapy, followed by 3500 cGy to the breast and axilla. Three of the 14 patients relapsed within the treated area, with a local control rate of 78%. One was salvaged with a mastectomy and remains alive and well 15 years after diagnosis. Seven of the 14 patients relapsed distantly, including two with local failures, but only three have died of disease. An additional two patients have died of other causes without evidence of disease, for a survival of 66% at 48 months (Kaplan-Meier Calculations).     

HIV-related non-Hodgkin's lymphoma

Non-Hodgkin's lymphoma (NHL) is the second most prevalent malignancy in patients infected with HIV. Approximately 30,000 new cases of NHL are diagnosed annually, and individuals with immunodeficiencies have a greater likelihood than the general population of developing NHL. Moreover, individuals who are seropositive for HIV have a fourfold greater risk of acquiring NHL. Most of these individuals will manifest NHL as a high-grade B-cell lymphoma with extranodal presentation. Response to standard chemotherapy and/or irradiation occurs frequently. However, because of opportunistic infections, overall survival is approximately five months. The expert nurse's role in assessment and management of symptoms associated with infection and side effects of therapy is critical.     

Classification of non-Hodgkin's lymphoma

This article provides an overview of the pathology and classification of non-Hodgkin lymphomas. Key histologic features are described for the common entities including both B-cell and T/NK-cell lineages. Additionally, details of the characteristic immunophenotypic findings, molecular genetic results, and common or clinically relevant cytogenetic alterations are described. Helpful tables are included that outline the key diagnostic features.     

Cytogenetics of non-Hodgkin's lymphoma

In the non-Hodgkin's lymphoma (NHL), recurring cytogenetic abnormalities have been identified, and significant correlations among them and morphology, immunophenotyping, and parameters of clinical outcome have been recognized. The structural involvement of the 14q32 band is substantially more frequent than are other common abnormalities, which include del(6q), i(17q), +3, +7, +12, +18, and +21. Twenty-two recurring translocations have been identified. Almost three-fourths of all breakpoints in NHL occur at sites to which lineage-determining, transformation-related genes, or fragile sites have been mapped. Besides the well-known association of the t(14;18) (q32;q21) with the follicular histologies and t(8;14)(q24;q32) with small non-cleaved cell lymphoma, several other associations between recurring cytogenetic abnormalities and morphologic subtypes have been found. Similarly, several associations between cytogenetic abnormalities and the B or T immunophenotype have been delineated. Trisomy 3 or duplications of 3p predict a favorable clinical outcome; trisomy 2 or duplication 2p and abnormalities of chromosome 17 predict a poor prognosis. Common sequential changes include a (second) 14q32 break and abnormalities of chromosomes 1 and 2. Continuing work in these areas will serve to identify more clearly those regions of the genome important to transformation, differentiation, clinical aggressiveness, and progression in NHL.     

Primary non-Hodgkin's lymphoma of the rectum

BACKGROUND: Primary rectal lymphoma is a very uncommon disease, therefore, it has received little attention in the literature. Because of their rarity, rectal lymphomas are generally included in the group of large intestine lymphomas. CASE REPORT: We report here a case of primary rectal B-cell lymphoma in a 67-year-old woman. The tumor was originally located in the rectum without evidence of any other lymphoma-involved organ. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IE according to the Ann Arbor system. International prognostic index (IPI) was I (low-intermediate risk). We preferred a non-surgical, organ-sparing treatment which started with chemotherapy followed by radiation. 12 months after the end of therapy, there is no sign of tumor recurrence in our patient. CONCLUSION: We suggest that histology-specific multidrug chemotherapy followed by radiotherapy seems to be a therapeutic approach that is appropriate fort this rare tumor.     

Primary non-Hodgkin's lymphoma of the liver

A patient with irresectable primary non-Hodgkin's lymphoma of the liver (histiocytic type, Rappaport classification) is presented. Systemic chemotherapy combined with local irradiation were successful in achieving a disease-free interval in a follow-up of 36 months. Review of the literature disclosed 19 other patients previously reported, with considerable variations in extent of disease at presentation. Criteria for the diagnosis of primary non-Hodgkin's lymphoma are proposed, and 11 patients met these criteria. Hepatic resection is advocated for localized tumour, while systemic chemotherapy and local irradiation in patients with irresectable tumours were found effective in achieving local and systemic control in a mean follow-up of 37 months.     

Immunotherapy for non-Hodgkin's lymphoma

The first attempt at using monoclonal antibodies in lymphoma therapy, reported in 1980, was unsuccessful. Since that time, several immunotherapeutic approaches to treating non-Hodgkin's lymphoma have been developed, with varying degrees of success. These approaches are largely based on the fact that each lymphoma is a clone of identical cells with a unique immunoglobulin on its surface. This unique portion of the immunoglobulin--the idiotype--is an ideal target for therapy. Clinical trials with antibodies have mostly targeted CD20, which is present on 95% of all B-cell lymphomas, as well as CD19 and CD22. This concept of using the idiotype to broaden the antilymphoma effect and to use it as a vaccine model has recently been evaluated. This approach would theoretically produce an active immunization with induction of humoral and cellular responses that would be longer acting than passive antibodies alone. The response is heterogeneous and polyclonal, which may be an advantage. Studies of these approaches will be outlined in this article.     

Radioimmunotherapy for non-Hodgkin's lymphoma

Radioimmunotherapy (RIT) treatment for lymphoma is a novel targeted therapeutic approach. Several years of development of radioimmunotherapeutic compounds came to fruition in February of 2002 when the US Food and Drug Administration (FDA) approved yttrium 90 ((90)Y)-ibritumomab tiuxetan ((90)Y-IT) for the treatment of relapsed or refractory, low-grade, or transformed B-cell lymphoma. (90)Y-IT uses a monoclonal anti-CD20 antibody to deliver beta-emitting (90)Y to the malignant B cells. Clinical trials have demonstrated its efficacy, which is largely independent of the intrinsic activity of the anti-CD20 antibody. A similar anti-CD20 radiotherapeutic compound, iodine 131 ((131)I)-tositumomab ((131)I-T), is also under consideration for approval. The advantages of increased efficacy compared to the native antibody are gained at the expense of myelotoxicity, which is dose-limiting but reversible. Other radioimmunoconjugates (RIC), including products for Hodgkin's lymphoma, are in earlier stages of development. Studies exploring expanded applications of RIT are under way. RIT has been shown to be an effective and clinically relevant complementary therapeutic approach for patients with lymphoma.     

Procarbazine for non-Hodgkin's lymphoma

Procarbazine hydrochloride is an oral alkylating agent with activity against lymphoma. It is most commonly used in the treatment of Hodgkin's disease. The use of procarbazine-containing chemotherapeutic regimens in non-Hodgkin's lymphoma fell out of favor with the advent of CHOP. We report two patients with relapsed and/or refractory follicular lymphoma that achieved a complete and durable remission with a prolonged course of daily procarbazine.     

Primary pulmonary non-Hodgkin's lymphoma

BACKGROUND: Primary pulmonary non-Hodgkin's lymphoma is a very rare neoplasm. It is represented most commonly by marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) type. Although there have been a few reviews of this lymphoma, clinical features, diagnostic procedure, optimal management and prognostic factors have not been well defined. METHODS: We reviewed the medical records of 24 patients who were pathologically and clinically diagnosed as primary pulmonary lymphoma between September 1995 and June 2003. RESULTS: There were 13 patients with MALT lymphoma and two with MALT lymphoma accompanied by large B-cell lymphoma, seven with diffuse large B-cell lymphoma and two with anaplastic large cell lymphoma. Half the patients were asymptomatic at presentation; 46% had respiratory symptoms and 16.7% had B-symptoms. Initial radiological findings were variable including nodules, masses, infiltrates or consolidation. The majority of patients (66.7%) needed surgical approaches (open thoracotomy or video-assisted thoracoscopy) for definite diagnosis. Bronchoscopy was performed in 83%, but only 30% showed a diagnostic yield. The 13 patients with MALT lymphoma were treated with a variety of modalities such as observation, surgery and single or combination chemotherapy, and combination chemotherapy was administered to 11 patients with non-MALT lymphoma regardless of surgery. The overall survival rate at 3 years for all 24 patients was 86% with a median follow-up of 32 months. CONCLUSION: Although this entity of lymphoma appears to have a good prognosis, further clinical experience and long-term follow-up are needed to identify prognostic factors.     

Peripheral T-cell non-Hodgkin's lymphoma

T-cell non-Hodgkin's lymphoma (T-NHL) are uncommon malignancies accounting for 10% to 15% of all NHL. Geographic variation has been well documented, but the geographic variation may reflect exposure to specific pathogenic viruses, such as Epstein Barr Virus and Human T-cell leukemia virus-1 in Asian countries. The World Health Organization classification specifies 16 major subtypes of T-NHL. Each of the major subtype of peripheral T-NHL has unique characteristics and are addressed separately in this article.     

原发性睾丸非霍奇金淋巴瘤

原发性睾丸非霍奇金淋巴瘤(NHL)极少见,仅占所有NHL的1%～2%,弥漫大B细胞淋巴瘤是最常见的病理类型.多发于60岁以上老年人.对侧睾丸受侵率高,易侵及中枢神经系统、皮肤等结外器官.ⅠE/ⅡE期病人睾丸切除术后综合治疗可降低复发率,提高生存率.晚期病人以化疗为主.对侧睾丸预防照射可降低其复发率,但中枢神经系统的预防性鞘内注药是否降低复发率还有争议.该病复发率高,预后差,国际预后指数与其预后相关.     

Treatment of non-Hodgkin's lymphoma.

Many of the advances in the management of non-Hodgkin's lymphomas have been based on more precise understanding of the various cell types that constitute these disorders. During the past year, we have seen some dramatic changes in the therapeutic approach to low-grade lymphomas. Until recently, the usual approach to these disorders was a purely palliative one, but a number of publications from the past year describe a more intensive approach with the goal of developing a curative modality. The use of combination chemotherapy in addition to radiation therapy for the early Ann Arbor stages as well as the use of high-dose chemotherapy with bone marrow transplantation in patients with high-risk factors has been reported recently. In the area of intermediate-grade lymphomas, most of the recent publications have described prognostic factors associated with various chemotherapy protocols. One of the most interesting recent developments is related to the dose-intensity issue. A consensus appears to be developing in regard to the correlation of dose intensity with clinical outcome. Despite the fact that new third-generation regimens have been associated with cures in 50% to 66% of the patients, a significant fraction of patients require salvage chemotherapy. Some of the new salvage regimens are discussed, as is the use of calcium channel blockers to reverse multiple-drug resistance. Finally, management of the high-grade lymphomas, specifically the small noncleaved cell type, has been associated with a cure rate in the range of 50% in two recently published studies. Patients who are human immunodeficiency virus-positive with small noncleaved cell lymphoma can be cured of their underlying malignancy, but many of them later develop complications of acquired immunodeficiency syndrome, to which they usually succumb.