Retroperitoneal malignant lymphoma showing follicular type: report of a case]

We report a case of retroperitoneal follicular malignant lymphoma. A 59-year-old man visited the hospital with the chief complaint of a loss of body weight and left epigastric tumor. CT revealed a tumor, 9 x 6 cm, with non-homogeneous density in the left retroperitoneum. Since no clinical metastasis was identified, the tumor and the left kidney were resected en bloc with para-aortic lymph node dissection. Pathological diagnosis was non-Hodgkin follicular lymphoma of mixed small cleaved and large cell type with lymph node metastasis (2/23). The CHOP adjuvant chemotherapy (cyclophosphamide, adriamycin vincristine, Prednisolone) and the radiation therapy were performed after the operation. Recurrence in the mediastinal lymph node occurred 7 months after operation and radiation and the same adjuvant chemotherapy were performed and resulted in complete remission. The patient remained free of the tumor for 27 months at present.     

Malignant lymphoma differentiated to plasma cell of the testis: report of a case

Malignant lymphoma of the left testis was seen in a 53-year-old man. Pathologically, the tumor cell showed malignant lymphoma of the diffuse, small cell type, especially, of lympho-plasmacytoid in LSG classification. Clinically, no other lesions were found. At 26 months following orchiectomy with chemotherapy (CHOP regimen: cyclophosphamide, hydroxydaunomycine, vincristine and prednisone) as well as post-operative irradiation (60Co, 30 Gy.), the patient has been doing well without any clinical evidence of recurrence generalization of the tumor.     

Situs Inversus Totalis with Malignant Lymphoma of the Stomach: Report of a Case

Situs inversus totalis is a rare congenital anomaly that often occurs concomitantly with other disorders. We report a case of situs inversus totalis with malignant lymphoma of the stomach, which was successfully treated by surgery followed by chemotherapy and irradiation. The patient was a 51-year-old woman who present with colicky pain in the left upper quadrant of her abdomen. Chest X-ray showed a right-sided heart, and ultrasonography and computed tomography (CT) of the abdomen showed a situs inversus totalis with multiple gallstones in the gallbladder. Tree-dimensional reconstructed CT of the abdomen showed no other malformations coexisting with situs inversus totalis, but a barium upper gastrointestinal series found an inverted stomach and an elevated tumor with ulceration in the center, localized in the antrum of the stomach. First, we performed a cholecystectomy, followed by a total gastrectomy with dissection of the lymph nodes and splenectomy, and Roux-en-Y reconstruction. Histopathological examination confirmed a diagnosis of malignant lymphoma of the stomach (diffuse large B-cell type) with metastasis to the regional lymph nodes. Chemotherapy using the CHOP regimen was given three times, starting 1 month postoperatively. A follow-up CT scan showed enlargement of one lymph node around the abdominal aorta and irradiation was delivered to the area of the inverted Y in the abdomen. At the time of writing, 10 months after surgery, the patient is well with no signs of recurrence and leading a normal life. Careful preoperative assessment is very important for determining the most appropriate surgical procedure in patients with situs inversus totalis associated with a malignancy. Received: April 25, 2002 / Accepted: November 19, 2002 RID="*" ID="*" Reprint requests to: S. Murakami     

Lymphoma of the cecum: a case report

Non-Hodgkin lymphomas present a wider systemic diffusion than Hodgkin lymphomas. Superficial and internal nodes, the tracheobronchial tree, and the digestive tract are almost always affected. The gastrointestinal tract is affected in 50% of the cases; the stomach is the first organ, followed by the small intestine and large intestine. The colon is affected in only approximately 0.4% of cases. The clinical picture of our patient showed abdominal pain, palpable mass, and anemia. Colonoscopy showed a tumor in the cecum (diameter, approximately 10 cm) and the biopsy indicated lymphoma. Through computed tomography, bone marrow biopsy, and measurement of beta2-microglobulin, complete staging was obtained. Right hemicolectomy was immediately performed because the large tumor could determine intestinal occlusion. Definitive diagnosis was non-Hodgkin lymphoma, type mucosa-associated lymphatic tissue B cells with a low grade of malignancy. After surgery the patient underwent six courses of chemotherapy according to the CHOP scheme (750 mg/m2 cyclophosphamide, 1.4 mg/m2 vincristine, 50 mg/m2 adriamicin, and 80 mg prednisone). Two years after surgery the patient shows no sign of the disease.     

肾脏原发性淋巴瘤一例报告并文献复习

目的 提高肾脏原发性淋巴瘤的诊治水平.方法 回顾性分析1例肾脏原发性淋巴瘤患者的临床病理资料,结合文献复习讨论.患者,女,61岁.因左侧腰痛2周入院.查体:左上腹压痛,左肾区叩击痛.B超检查见左肾正常结构未显示,集合系统分离,最宽处约1.0 cm,左肾区可探及一巨大低回声肿物,大小9.7cm×5.3cm,边界模糊.CT检查见左肾中下极肿物,大小9.8 cm×8.9 cm ×8.8 cm,边界不清,平扫CT值为39 HU,增强后为61 HU,强化不明显.术前诊断:左肾恶性肿瘤.结果 患者行根治性左肾切除术.病理报告:左肾大部分被肿瘤组织占据,中下极见10.0cm×9.5 cm ×8.5 cm类圆形肿物,质硬,肿物切面呈灰白色,质地细腻.镜下瘤细胞呈弥漫性浸润,卵圆形或多边形,略大于正常淋巴细胞,核大深染呈不规则形.病理诊断:肾弥漫性大B细胞性淋巴瘤.骨髓穿刺检查未见异常.行环磷酰胺+吡喃阿霉素+长春新碱+泼尼松+利妥昔单抗方案化疗6周期.术后每3个月复查胸部X线片、腹部B超及CT等.随访20个月,未见肿瘤复发.结论 肾脏原发性淋巴瘤临床罕见,症状与肾癌相似,影像学检查无特征性改变,确诊需依靠病理学检查.本病预后不良,手术切除患肾联合规范的全身化疗,可延长患者的生存期.     

Testicular malignant lymphoma: a case report

We report a case of malignant lymphoma arising from the testicle in a patient who had been on chemotherapy for a long period after orchiectomy. A 54-year-old male presented with indolent swelling in the right scrotum. Diagnosed as having a testicular tumor by ultrasonography and MRI, he underwent orchiectomy. According to the histopathological diagnosis, the tumor was classified as non-Hodgkin's lymphoma, diffuse large cell type, B cell type. Diagnosis of Stage I eA was made by the Arr Arbor classification. Four courses of cycrophosphamide, adriamycin, vincristin and prednisolone (CHOP) therapy were administered. COP (CHOP minus adriamycin) therapy has been given every four months on an out-patient basis. At present, 28 months after the operation, no evident recurrence has been found.     

A case of giant perirenal malignant lymphoma: a case report

We report a case of malignant lymphoma arising as a giant perirenal mass in a 62-year-old woman who presented with an enlarging abdominal mass. Computed tomography (CT) revealed a large homogeneous mass with a diameter of 20 cm arising in the retroperitoneum. It surrounded the left kidney without renal infiltration and accompanied with para-aortic lymph node enlargement. Compared with the renal cortex, the tumor showed a homogeneous isodense mass by plain CT and only slight enhancement by the contrast-enhanced CT. On the basis of these imaging studies, the tumor was diagnosed as lymphoma. Then, a US guided percutaneous biopsy was performed and the tumor was diagnosed as malignant B-cell lymphoma by the histopathological analysis. This patient was treated by systemic chemotherapy since tumor cells were also disseminated in the bone marrow. The tumor responded well to the chemotherapy and about 70% of regression was achieved after six courses of chemotherapy.     

A collision cancer between urothelial carcinoma and malignant lymphoma of the urinary bladder: a case report

A man in his 70's visited the Department of Internal Medicine due to lumbago that had first appeared two months previously. Abdominal computed tomography showed a low-density area in the liver and swelling of lymph nodes surrounding the abdominal aorta. Four months later, he was hospitalized on an emergency basis in a urology ward in order to control bladder tamponade. Cystoscopy revealed massive blood clots and a papillary tumor at the left wall of the urinary bladder. He underwent transurethral resection of a bladder tumor, and the pathological diagnosis was a collision tumor between urothelial carcinoma (G2, pTa) and malignant lymphoma (B cell type). He underwent a liver biopsy soon thereafter, and the pathological diagnosis was malignant lymphoma (as for the one found in the urinary bladder). Bladder tamponade was repeated, which was relieved after one course of chemotherapy for malignant lymphoma. He underwent six courses of chemotherapy (THP-CO), and he was well without recurrence of either malignant lymphoma or urothelial carcinoma with 3 years' follow-up. To our knowledge, this is the 14th reported case of a collision tumor in the urinary tract.     

Primary malignant lymphoma of the urinary bladder: a case report

We report a case of primary malignant lymphoma of the urinary bladder. A 72-year old woman complaining of low abdominal pain was admitted to the Tone Central Hospital in February, 2001. Macrohematuria appeared, and the submucosal tumor was observed by cystoscopy, and A Transurethral bladder biopsy led to a histopathological diagnosis of non-Hodgkin's malignant lymphoma (diffuse lymphoma, large-sized cell type, B-cell type). Clinical stage was IE, but as soon, she was get bilateral hydronephrosis and bladder-ileum fistula. The administration of 6-course CHOP chemotherapy had an excellent effect of disappearing the tumor, bilateral hydronephrosis, and bladder-ileum fistula. She remained free of disease until now.     

A case of primary testicular malignant lymphoma associated with contralateral testicural recurrence after a seven-year interval

A 70-year-old male presented to our hospital in October 1999 complaining of right scrotal swelling. Right high ligation of testis was performed. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the right testis. He underwent four courses of adjuvant chemotherapy consisting of CHOP (cyclophosphamide, doxorubicin, vincristin, prednisone) together with 40 Gy radiotherapy to the contralateral testis. Following this treatment he achieved complete remission. Seven years later in March 2006, he developed swelling of the left scrotum. He underwent left high orchidectomy based on the suspicion of a contralateral testicular malignant lymphoma. Pathological examination of the testicular specimen confirmed a diagnosis of DLBCL. He underwent chemotherapy and has survived without evidence of recurrence. We have summarized the cases of bilateral asynchrony primary testicular lymphoma.     

A case of primary malignant lymphoma of the bladder

A case of primary malignant lymphoma of the bladder is reported. A 61-year-old female visited our outpatient clinic with the chief complaints of asymptomatic grosshematuria and was recognized as having a bladder tumor by abdominal ultrasonography. On cystoscopic examination, the tumor was non-papillary and dome-like in shape. Computed tomography revealed that the bladder tumor was invading into the bladder wall. The histopathological study of endoscopic biopsy specimen revealed malignant lymphoma. After further examinations, it was diagnosed as primary malignant lymphoma of bladder, stage IE (Ann Arbor classification). Four courses of CHOP regimen (cyclophosphamide, vincristine, doxorubicin, predonisolone) was performed and no lymphoma cell was found by re-biopsy at the primary site. No local or distant recurrence was found during the 15 months' follow up.     

A case of primary malignant lymphoma of the pararectal space

A 16-year-old man presented with lumbago, perianal pain and constipation. A large tumor was palpable by digital rectal examination. Then, transrectal needle biopsies of the tumor were performed. Histopathological diagnosis was non-Hodgkin's malignant lymphoma (diffuse large B-cell type according to the new WHO classification). The results of some examinations were compatible with the diagnosis of primary lymphoma of the pararectal space. The patient underwent 2 courses of combination chemotherapy CHOP (consisting of cyclophosphamide, doxorubichin, vincristine, and prednisolone), and high-dose chemotherapy (ranimustine, etoposide, ifosfamide) with peripheral blood stem cell transplantation. After high-dose chemotherapy, radiation therapy was performed since there was a possibility of residual tumor, and complete remission was achieved. Now, 12 months after completion of the radiation, he remains free of the disease. This is probably the first clinical case of malignant lymphoma of the pararectal space ever reported in the Japanese literature.     

Primary malignant lymphoma of the trigeminal region treated with rapid infusion of high-dose MTX and radiation: case report and review of the literature

BACKGROUND: Extra-axial primary CNS lymphoma, considered rare, mainly arise in the white matter of the brain. Though the tumor responds well to radiation and chemotherapy, the prognosis of primary CNS lymphoma remains poor. We report a case of primary lymphoma of Meckel's cave mimicking a trigeminal schwannoma radiographically, which achieved complete remission through use of rapid high-dose MTX therapy and radiation therapy. CASE DESCRIPTION: The patient, a 55-year-old Japanese male, presented left trigeminal neuralgia. Magnetic resonance imaging (MRI) revealed a mass lesion in the left side of Meckel's cave, with extension into the cerebellopontine angle and the infratemporal fossa through the foramen ovale, suggesting trigeminal schwannoma. However, the patient suffered radiologically inexplicable progressive cranial nerve palsy, which suggested malignant disease. MRI and CSF disclosed malignant tumor dissemination; biopsy revealed malignant lymphoma. The treatment, composed of the rapid infusion of high-dose MTX and whole brain and spine radiation, resulted in complete remission. CONCLUSIONS: This case, which included atypical presentation of malignant lymphoma, illustrates the importance of including malignant lymphoma in the differential diagnosis of CP-angle and Meckel's cave tumor. The results also confirmed the usefulness of combined rapid high-dose MTX therapy and radiation.     

A Collision Tumor Composed of Adenocarcinoma and Malignant Lymphoma in the Remnant Stomach After Pancreatoduodenectomy: Report of a Case

The occurrence of a collision tumor in the stomach, consisting of adenocarcinoma and malignant lymphoma, is extremely rare. We report herein the case of a patient who had undergone a pancreatoduodenectomy for bile duct cancer 5 year earlier, in whom an ulcerating tumor of the remnant stomach developed and grew rapidly within 5 months. Surgical exploration revealed a tumor in the remnant stomach, multiple liver metastases, and multiple lymph node metastases. Total resection of the remnant stomach was performed, and pathological examination revealed a collision tumor consisting of adenocarcinoma and malignant lymphoma. The patient died of liver metastases and lymph node metastases 7 months after his second operation. The coexistence of both adenocarcinoma and malignant lymphoma of the remnant stomach and the etiology of this unusual combination, never previously reported, is discussed. Received: December 20, 1999 / Accepted: November 20, 2000     

Combined Modality Management of Sinonasal Anaplastic Lymphoma Kinase Negative Anaplastic Large Cell Lymphoma in a Geriatric Patient-Report of a Rare Case

Sinonasal anaplastic lymphoma kinase(ALK)-negative anaplastic large cell lymphoma(ALCL) without nodal involvement is exceedingly rare and the rarity of this tumor often engenders diagnostic dilemma. It has been mostly reported in pediatric, adolescent and young adult patients, mostly of Asian origin. A 70-year-old female patient presented with a mass in the left nasal cavity causing nasal obstruction for 5 months. On clinical and radiological examination, there was a 5.7 cm mass in the left nasal cavity, completely obliterating the left ethmoid sinus. Biopsy from the nasal mass showed a poorly differentiated malignant tumour with large cells arranged in sheets. On immunohistochemistry, the tumour cells were positive for leukocyte common antigen(LCA), CD30, CD43, BCL6 and focally for CD5, TIA1, granzyme B and epithelial membrane antigen(EMA), and were negative for CD56, EBV-LMP1, CD79a, PAX5, myeloperoxidase, CD34, CD7, CD4, CD8, CD138, ALK and p63, suggestive of ALK-negative ALCL. Rest of the lymphoma work-up was essentially normal and she had stage IE disease. She was treated with prephase chemotherapy (Vincristine and Prednisolone) followed by 4 cycles of CEOP[Cyclophosphamide, Etoposide (from 2nd cycle onwards), Vincristine and Prednisolone] regimen and local radiotherapy (36 Gy/20 fractions/4 weeks) by intensity modulated radiotherapy(IMRT) technique resulting in complete clinical and radiological response. At last follow-up visit, 15 months from the initial diagnosis, she was alive and disease free. Sinonasal ALK-negative ALCL is a rare tumor which can be effectively treated with a combination of multi-agent CHOP/CHOP-like regimen and local conformal radiotherapy in geriatric patients.     

Primary cardiac lymphoma: clinical, histologic, immunophenotypic, and genotypic features of 5 cases of a rare disorder

Primary lymphomas of the heart are rare and frequently are diagnosed at autopsy. Modern imaging technology now permits early diagnosis and treatment. This report describes the clinical, histologic, immunophenotypic, and molecular genetic findings for 5 patients with malignant lymphoma restricted to the cardiac muscle, with or without pericardial involvement. All patients were women, with ages ranging from 40 to 68 years (median 55 y). The right atrium was involved in all cases with the left atrium, right ventricle, and pericardium affected in 1 case each. Clinical presentation included pericardial effusions associated with precordial pain, dyspnea, and bradycardia. Electrocardiographic changes included junctional rhythm, incomplete right bundle branch block and ST and T waves abnormalities, and ST segment elevation and first-degree atrioventricular block with intermittent complete heart block. In all cases, biopsy or resection of the lesion or cytologic examination of the pericardial fluid established a diagnosis. All tumors were of B-cell phenotype and included 4 cases of large cell lymphoma and one unclassifiable small cell lymphoma. In 2 cases, a follicular center cell origin was supported by reactivity of the neoplastic cells for CD10 and bcl-6 and by bcl-2 gene rearrangement by molecular analysis. One patient died shortly after diagnosis due to cerebral infarction. Two patients are alive without disease after chemotherapy with CHOP after 120 and 192 months. One patient underwent chemotherapy with CHOP and rituximab, and shows persistent cardiac involvement by lymphoma but with a decrease in tumor burden at 7 months of follow-up. One patient was lost to follow-up. Clinical outcome is variable; however, early diagnosis in conjunction with effective treatment (surgery and/or chemotherapy) may result in an excellent prognosis. Primary cardiac lymphoma should be included in the differential diagnosis of a right atrial mass.     

A case of malignant lymphoma in the skull after head injury associated with multiple bone tumors

A case of malignant lymphoma in the skull after head injury associated with whole bone metastasis is reported. The patient was a 66-year-old man who was admitted to Almeida Memorial Hospital because of headache and general fatigue 2 months after head injury. After admission tumors appear in the frontal and occipital region and grew rapidly. Plain craniogram revealed large map-like bone destructions and multiple punched out lesions. Bone scintigram with 99mTc-MDP revealed multiple accumulations of RI in the skull, vertebrae, ribs and pelvis. CT scan revealed destructive, markedly enhancing bone tumor which was compressing the brain as an extradural mass in the left frontal and occipital regions. Pathological examination of the tumor revealed malignant lymphoma of non-Hodgkin type and diffuse pleomorphic type. Though combination chemotherapy with ACNU, FT 207, PSK, CHOP (Cyclophosphamide, Adriamycin, Vincristine and Predonisone) and Acracinomycin A was performed after operation, and brought forth regression of tumor size and improvement of clinical symptoms transiently, he died 6 months after the onset because of recurrence in many bones with pathological fracture and complications such as pneumonia, DIC and acute renal failure. At autopsy the tumors were found to be localized only in the bones, but in none of lymphnode or visceral organs. Malignant lymphoma appearing initially as a skull tumor is rare, and its diagnosis and treatment were discussed.     

Fournier's gangrene in a patient with malignant lymphoma: a case report

We report a case of Fournier's gangrene. An 83-year-old man underwent biopsy of left inguinal tumor as an outpatient. Pathological diagnosis was malignant lymphoma (diffuse large cell type). Three weeks later, he developed reddened scrotal swelling accompanied with high fever (> 39 degrees C). On admission, antibiotic chemotherapy was initiated. Although his general condition was improved, scrotal necrosis had developed. A computed tomography scan demonstrated thickened subcutaneous tissue over the left lumbar region. Excision of necrotic tissue and sequential irrigation using povidone iodine liquid were effective. The patient then underwent chemotherapy for malignant lymphoma at the internal department. Nine months after the operation, the scrotal skin had completely recovered.     

Primary T-cell lymphoma of the duodenum: Report of a case

A case of primary non-Hodgkin's T-cell lymphoma of the duodenum is presented. A 41-year-old man was hospitalized in 1984 complaining of abdominal distention and vomiting. Hypotonic duodenography showed an encircling filling defect in the second portion of the duodenum, and a biopsy specimen revealed features of malignancy suggestive of either undifferentiated carcinoma or malignant lymphoma. Radical surgery (pancreaticoduodenectomy) was performed, after which chemotherapy was administered. A histological evaluation of the duodenal tumor showed it to be non-Hodgkin's lymphoma. It was a diffuse, large-cell type, which immunohistochemically suggested it to be of T-cell origin. Currently the patient is doing well, with no evidence of disease recurrence 13 years after surgery.     

CHOP方案术前动脉介入化疗治疗胃恶性淋巴瘤的回顾性临床研究

目的探讨CHOP化疗方案行术前区域性动脉灌注治疗原发性胃恶性淋巴瘤(PGML)的可行性。方法回顾性研究1995～2010年期间我院收治的74例PGML患者,其中41例术前接受胃区域性动脉灌注化疗即术前动脉介入化疗组,方案选用CHOP联合化疗方案:环磷酰胺600mg/m2,第1天;表阿霉素50mg/m2,第1天;长春新碱1.4mg/m2,第1天;强的松60mg/m2口服,第1～5天。14～21d后接受手术。同期33例PGML患者行常规手术治疗即常规手术组。比较动脉介入化疗后肿瘤的缓解情况、毒副反应及2组间的疗效差异。结果常规手术组24例(72.7%)获得根治性切除,5年生存率为58.3%(14/24)。术前动脉介入化疗组全部完成术前区域性动脉化疗,毒副作用主要为胃肠道反应22例(53.7%)和骨髓抑制14例(34.1%),均属可控范围内(Ⅰ～Ⅱ级);其中37例(90.2%)获得根治性切除,较常规手术组提高17.5%(P=0.041);5年生存率为67.7%(21/31),与常规手术组比较差异无统计学意义(χ2=0.517,P=0.471)。结论针对PGML患者,术前以CHOP方案行动脉介入化疗是安全、有效的,它能提高根治手术切除率,提高近期疗效,但并不改善远期生存。