Clinical characteristics of the patients with Hodgkin’s lymphoma involving extranodal sites

Differences between Hodgkin's lymphoma (HL) patients in China and Western countries are known to exist, but data on Chinese patients with HL are limited. It is not clear whether there are clinical and histological differences in patients with HL involving different extranodal sites. This is the first study to analyze Chinese patients with HL involving different extranodal sites. We selected 22 HL patients with extranodal involvement from more than 250 previously untreated HL patients. Most patients were young males, and 20 of the 22 patients had stage IV disease. The major pathologic types were nodular sclerosis classical HL (NSCHL) and mixed cellularity classical HL(MCCHL). At diagnosis, the most commonly involved extranodal sites were the liver and lung, followed by the bones. There was no significant association between the international prognostic score(IPS) and survival in patients with different extranodal sites. Our data showed the overall survival (OS) and disease-free survival (DFS) rates of low-risk group (IPS = 0-2) were relatively higher than those of high-risk group (IPS ≥ 3), but the IPS did not show predictive power for survival. Although HL with extranodal involvement is rare, it should be considered as a unique form of HL.     

Isolated renal relapse of a case with non-Hodgkin’s lymphoma

A 29-year-old woman with left pleural effusion and a mass in anterior mediastinum was admitted. Transthoracic needle aspiration from the mass revealed findings consistent with nodular sclerosis variety of Hodgkin’s disease. The patient was in remission after six cycles of ABVD followed by mediastinal radiotherapy. Ten months later CT scan showed three hypodense masses in the right kidney. Ultrasound guided renal biopsy revealed diffuse large B cell lymphoma. Retrospective re-evaluation of the archival specimens of the mediastinal mass was also consistent with diffuse large B cell lymphoma. After induction chemotherapy (four cycles of DHAP) she underwent high dose chemotherapy (BEAM) and autologous peripheral blood stem cell transplantation. She is still in remission for 7 years after transplantation. In conclusion, renal involvement during advanced lymphoma is quite common but isolated renal relapse in NHL is a rare situation. Although renal infiltration generally shows a poor prognosis, long-term survival may be achieved with high dose chemotherapy and autologous peripheral blood stem cell transplantation.     

A case of rapid growing colonic NK/T cell lymphoma complicated by Crohn’s disease

A 37-year-old man developed abdominal pain and bloody diarrhea 11 months before admission. The colonoscopy revealed multifocal ulcers in the colon. Histology showed active chronic inflammation. Although anti-tuberculosis medication was effective, his symptoms repeated 2 months later. The subsequent colonoscopy revealed more extensive irregular ulcers than before, and he was clinically suspected with intestinal malignant lymphoma. He underwent subtotal colectomy and was histologically suggested Crohn’s disease, then 5-aminosalicylic and a combination of prednisone and azathioprine were administered in succession postoperatively, but they achieved minimal relief of symptoms for a period of 7 months. The third colonoscopy showed a large irregular ulcer in the ileocolon stomas, and primary colonic NK/T cell lymphoma was diagnosed through histological and immunophenotypic studies. Malignant lymphoma should be taken into consideration when clinically diagnosed Crohn’s disease was refractory to medication or when its clinical course became aggressive.     

Primary non-hodgkin’s lymphoma of the male breast: a case report

A 69-year-old Japanese man presented with bilateral gynecomastia and a soft, mobile and clearly defined mass beneath the left nipple. A round radiopaque mass was revealed on mammography. The tumor was homogeneous, hypoechoic and measured 2.4X3.9 cm on ultrasonography. Based on a diagnosis of malignant lymphoma by needle aspiration cytology, a modified radical mastectomy with ipsilateral axillary lymph node dissection was performed. Malignant diffuse large B-cell type lymphoma was diagnosed histologically. Whole body examinations revealed no evidence of other tumors. Three courses of adjuvant CHOP therapy were subsequently performed. The patient is free of recurrence 12 months after surgery. Primary non-Hodgkin’s lymphoma (NHL) of the male breast is extremely rare. The occurrence of lymphoma in this patient could be related to elevated estrogen levels.     

Neurologic complications of non-Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma (NHL) can affect the nervous systems in several ways. The neurologic complications of this disease may be related to direct involvement of any part of the nervous system by metastasis or direct invasion, paraneoplastic involvement, or as a consequence of neurotoxicity from treatment(s) for the lymphoma. In addition, patients may develop infectious complications in the nervous system from immunosuppression related to the disease or its treatment. This review discusses direct involvement of the peripheral nervous system by lymphoma and paraneoplastic disease and briefly addresses some nervous system infections in lymphoma patients.     

Primary effusional lymphoma: A new non-hodgkin’s lymphoma entity

A distinct non-Hodgkin s lymphoma (NHL) entity that grow in the body cavities as lymphomatous effusions in the absence of clinically identifiable tumor masses has been defined as primary effusional lymphoma (PEL). This lymphoma characterized by distinetive morphology, immunophenotype, genotype and association with Kaposi s sarcoma-associated herpesvirus (KHSV)/human herpesvirus-8 (HHV-8) infection. In this minireview, the clinico-pathological and biological characteristics of PELs are summarized.     

Primary non-Hodgkin’s lymphoma of the bone

Primary non-Hodgkin’s lymphoma of the bone is an unusual entity. Twenty-five patients with diffuse large cell lymphoma of the bone were registered at the Tata Memorial Hospital (TMH) from August, 1991, to May, 2002. Pain at the local site and soft tissue swelling were the commonest symptoms. Involvement of the bones in the lower half of the body was more frequent than the bones in the upper half. Osteolytic lesions and an associated soft tissue mass were the common radiological findings. Nineteen patients received CHOP chemotherapy and five received COP chemotherapy. Twenty-three patients received involved field radiotherapy. The overall response to therapy was 96%. On follow-up, two patients had a nodal relapse. One patient died of progressive disease, and one patient died of cryptococcal meningitis. There were no deaths due to treatment-related toxicity. The mean progression free survival was 9.39 yr and the overall survival was 11.66 yr. The median overall survival has not been reached. At last follow-up, 21 patients were being following up at TMH and are free of disease. Conclusion: Primary bone lymphoma is a malignancy that is highly curable with a combination of chemotherapy and radiotherapy.     

Metastatic neurologic complications of non-Hodgkin’s lymphoma

Neurologic complications of non-Hodgkin’s lymphoma represent challenging diagnostic and therapeutic issues. Leptomeningeal, epidural, and brain metastases are the most common neurologic complications, and each is associated with a poor prognosis. However, early recognition and intervention often result in improved quality of life and, for a subset of patients, an opportunity for longer survival.     

Pediatric non-Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma (NHL) accounts for 7% of cancer in children and adolescents in the United States, or approximately 1000 cases annually. NHL in the pediatric population differs from that observed in adult patients with respect to staging systems, histologic subtypes of disease, treatment, and outcomes. Although more than 90% of pediatric NHL is of high-grade histology, more than 80% of patients achieve long-term event-free survival with modern therapy. This review focuses on current treatments for pediatric NHL and some of the differences between NHL observed in pediatric and adult patients.     

Successful management of a non-Hodgkin’s lymphoma of the gallbladder by chemotherapy: a case report

Introduction

Non-Hodgkin’s lymphoma of the gallbladder is a rare location of lymphoma.

Case presentation

We report a case of T cell non-Hodgkin’s lymphoma (NHL) of the gallbladder in a 39-year-old man in whom cholecystectomy made the diagnosis. Abdominal ultrasound did not reveal gallbladder stones. At this time, our patient had no lymph nodes. Histopathology of gastric and pulmonary biopsy and cholecystectomy made a definite diagnosis of non-Hodgkin’s T cell lymphoma. Our patient had eight cycles of chemotherapy CHOP 21 (cyclophosphamide 750 mg/m² intravenously (IV) on day 1, doxorubicine 50 mg IV on day 1, vincristine 1.4 mg/m² IV on day 1, and prednisone 40 mg/m² per day from day 1 to day 5 per os) with good response. He was free of disease 12 months after completion of chemotherapy. Gallbladder location of NHL is rare and has to be suspected every time when lymph nodes are associated, and we postulate that delays in making the diagnosis may lead to underdiagnosis of lymphoma of the gallbladder.

Conclusion

Review of the literature shows the existence of non-Hodgkin’s lymphoma of the gallbladder, its rarity, and its general dismal prognosis. Our case illustrated that the prognosis could be improved by correct chemotherapy.     

Use of bortezomib in B-cell non-Hodgkin’s lymphoma

The ubiquitin–proteasome pathway plays a critical role in the regulated degradation of proteins involved in cell cycle control and tumor growth. Bortezomib (Velcade^®, formerly known as PS-341) is a potent proteasome inhibitor. In preclinical studies, bortezomib has demonstrated activity against a variety of B-cell malignancies by inducing apoptosis and sensitizing tumor cells to radiation or chemotherapy. Based on these findings, clinical trials have been conducted with bortezomib in B-cell non-Hodgkin’s lymphoma. In these studies, bortezomib was generally well tolerated with manageable toxicities and showed promising clinical activity. Mantle cell lymphoma was significantly more sensitive to bortezomib than other non-Hodgkin’s lymphomas. Bortezomib may have far-reaching potential in the treatment of B-cell non-Hodgkin’s lymphoma.     

Treatment of primary CNS lymphoma (PCNSL) following successful treatment of systemic non-Hodgkin’s lymphoma (NHL): a case series

Management of PCNSL occurring after successful treatment of systemic non-Hodgkin’s lymphoma (NHL) is poorly defined. Illustrate a treatment approach for PCNSL following prior treatment of a systemic NHL. A retrospective case series of 6 patients (mean age 60 years; range 46–65) diagnosed with a diffuse large B cell lymphoma of the CNS following prior successful treatment of a systemic NHL (low-grade in 2; high-grade in 4). Mean interval to diagnosis of PCNSL after diagnosis of systemic NHL was 12 months (range 7–18). In 4/6 patients in whom genetic analysis could be performed, the PCNSL and NHL differed. Treatment utilized high-dose methotrexate and rituximab (immunochemotherapy) followed in patients with a radiographic complete response by autologous peripheral stem cell transplant (ASCT) with total body irradiation (TBI) and multi-agent conditioning chemotherapy (BEAM: carmustine, etoposide, cytarabine, melphalan). 5/6 patients had a radiographic complete response to immunochemotherapy and were treated with ASCT. 4/5 patients were free of disease following ASCT with a mean follow-up of 3 years (range 0.5–4 years). There were no toxic deaths and all patients transplanted successfully engrafted within 28 days (mean 18). Using a treatment paradigm similar to that utilized for recurrent systemic NHL (induction chemotherapy followed by ASCT) for PCNSL occurring metachronously after successful treatment of systemic NHL appears safe and effective.     

Current management of AIDS related non Hodgkin’s lymphoma

Non Hodgkin’s lymphoma is the AIDS defining illness in 3-3.5% of patients and is increasing in incidence as the survival of HIV infected people improves. The incidence of these intermediate/high grade B cell malignancies is sixty times higher than in the general population. The most important prognostic factors are a CD4 positive lymphocyte count of <100 cells/mm3, a prior AIDS defining diagnosis, an ECOG performance status >2 and primary cerebral origin. Patients with any of these factors are most likely to benefit from palliative rather than radical treatment. Good prognosis patients have a 30-40% chance of cure from their lymphoma with carefully administered intensive chemotherapy.     

Lifestyle factors and risk of leukemia and non-Hodgkin’s lymphoma: a case–control study

Purpose

Risk factors for leukemia and lymphomas in adults are largely unknown. This study was aimed at evaluating the association between lifestyle factors and the risk of hematological malignancies in an adult population.

Methods

Data were drawn from a population-based case–control study carried out in Italy and included 294 cases (199 lymphoid and 95 myeloid) and 279 controls. Analyses were performed using standard multivariable logistic regression.

Results

Hair dye use for at least 15 years was associated with a higher risk of lymphoid malignancies among females (OR 2.3, 95 % CI 1.0–4.9, p = 0.036, test for trend). Furthermore, a protective effect of a moderate to heavy tea consumption on the risk of myeloid malignancies was observed (OR 0.4, 95 % CI 0.2–0.9, p = 0.017). No association was found for the use of alcoholic beverages and tobacco smoking.

Conclusions

Our results confirm the potential carcinogenic effect of prolonged hair dye use observed in previous investigations. The excess risk could be explained by exposure to a higher concentration of toxic compounds in hair products used in the past. The protective effect of regular tea consumption observed in an area with a very high prevalence of black tea consumers deserves further investigation.

     

A case report of pigmented mammary Paget’s disease mimicking nevus of the nipple

A 43-year-old Japanese woman consulted our hospital for a pigmented lesion on her right nipple. Two years later, the lesion became enlarged, measuring 5 × 5 mm. It was dark brown, had an irregular shape and relatively clear borders. Incisional biopsy yielded a pathological diagnosis of junctional nevus of the skin. An additional 2 years later, a small mass developed under the right nipple area and core needle biopsy yielded a pathologic diagnosis of invasive ductal carcinoma. Partial resection of the right EC areas included the skin of the nipple and sentinel lymph node biopsy was performed. Histologically, the skin of the nipple demonstrated small clusters of pigmented carcinoma cells that were low molecular weight cytokeratin (CAM5.2) positive. Most of the carcinoma cells were small and did not have abundant cytoplasm, but nuclear enlargement and prominent nucleoli indicated malignancy, and the cytoplasm was pale compared with that of the surrounding squamous epithelial cells. Scattered dendritic melanocytes were identified by S-100 protein and HMB-45 immunohistochemically. In the upper dermis, carcinoma cells also involved the lactiferous ducts. A small focus of carcinoma cells that invaded the fat tissues did not contain melanin pigment. The final diagnosis was pigmented mammary Paget’s disease. Pigmented lesions on the nipple should be carefully examined, because pigmented mammary Paget’s disease sometimes mimics malignant melanoma or junctional nevus.     

Classical Hodgkin’s lymphoma presenting as acute hepatic failure—One case report

A 20-year-old boy presenting daily febrile episodes was suspected to have developed acute hepatic failure. Serologic tests ruled out infectious and autoimmune causes apart from drug toxicity. During clinical examinations, he was found to have generalized enlarged lymph nodes that were then taken biopsy. It was diagnosed as classical Hodgkin’s lymphoma based on histological examination of the lymph node. A bone marrow biopsy showed marrow infiltration by Hodgkin’s lymphoma with hemophagocytosis and secondary myelofibrosis. A percutaneous liver biopsy demonstrated hepatic involvement of the same disease. After an extensive work-up, the cause of liver failure was figure out to be only attributed to the involvement of the lymphoma. Hodgkin’s lymphoma as a cause of hepatic failure is rare and young patients diagnosed as Hodgkin’s lymphoma causing hepatic failure has been reported very rarely so far.     

Ibritumomab tiuxetan for non-Hodgkin’s lymphoma

Targeted radiation therapy, or radioimmunotherapy, has been an important recent advancement in the treatment of patients with B-cell non-Hodgkin's lymphoma (NHL). ⁹⁰Y ibritumomab tiuxetan comprises the murine monoclonal antibody ibritumomab, the linker chelator tiuxetan and the radiolabeled isotope ⁹⁰yttrium. ⁹⁰Y ibritumomab tiuxetan has been demonstrated to be efficacious in the treatment of B-cell NHL. Initial Phase I/II trials established the therapeutic dose of ibritumomab tiuxetan for low-grade NHL to be 0.4 mCi/kg, or 0.3 mCi/kg for patients with mild thrombocytopenia. Currently, there are many ongoing trials of ibritumomab tiuxetan with different dose schedules and intensities, in combination with chemotherapy and with stem cell transplantation, in an attempt to improve response rate and duration and to study its effectiveness in other B-cell lymphomas, including diffuse large B-cell lymphoma and mantle cell lymphoma. Radioimmunotherapy has great promise and the safe incorporation of ⁹⁰Y ibritumomab tiuxetan into treatment will hopefully result in improved survival for patients with NHL.     

Cladribine in indolent non-Hodgkin’s lymphoma

Before the advent of rationally designed targeted antineoplastic therapies, cladribine was identified as a lymphocyte-specific cytotoxic agent. Cladribine is a purine nucleoside analogue that is resistant to cellular catabolism. Through diverse mechanisms, cladribine is equally toxic to dividing and nondividing cells, making it highly active in indolent lymphoproliferative diseases. In clinical practice, cladribine is mostly used in the treatment of hairy cell leukemia and Waldenström’s macroglobulinemia. However, its remarkable activity in follicular lymphoma and other indolent non-Hodgkin’s lymphoma subtypes has not been more widely appreciated. Cladribine compares favorably to other standard treatments for these conditions. Future Phase III clinical studies should incorporate cladribine into multiagent chemotherapy programs to more fully evaluate its potential in indolent non-Hodgkin’s lymphoma.