Incidental and concurrent malignant lymphomas discovered at the time of prostatectomy and prostate biopsy: a study of 29 cases

The incidence and histologic features of malignant lymphomas discovered at the time of prostate biopsy, transurethral resection, and prostatectomy are not well documented. We searched our surgical pathology files for malignant lymphomas identified from prostate surgical specimens from 1989 to 2004. Of 4,831 cases of prostate specimens (3,405 biopsies, 266 transurethral resections, 1,160 prostatectomies) examined at the City of Hope during this period, 29 cases of malignant lymphomas involving the prostate and pelvic lymph nodes were identified (0.6%). These malignant lymphomas can be divided into two groups: 1) 18 incidental cases (0.37%) without prior history of malignant lymphoma; and 2) 11 cases (0.23%) with concurrent known malignant lymphoma. For the first group, the patients with pelvic node involvement ranged in age from 59 to 78 years (mean, 69.2 years; median, 70 years), and the patients with prostate involvement ranged in age from 45 to 78 years (mean, 64.6 years; median, 67.5 years). For the second group, the patients ranged in age from 53 to 80 years (mean, 66.8 years; median, 69 years). Diagnoses of all cases were confirmed by immunohistochemistry or molecular analysis. Ten of 18 cases in the first group involved pelvic nodes only, and the other 8 cases were primary prostatic lymphoma. Of 18 cases in the first group, 13 were small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL), 3 were marginal zone B-cell lymphoma, and 1 was mantle cell lymphoma. These lymphomas were not readily apparent in most cases by histologic examination, and may be confused with chronic prostatitis when the prostate was involved or with reactive lymphoid hyperplasia when pelvic nodes were involved. Immunohistochemistry and molecular studies may be necessary to confirm the diagnosis. For the second group, prostate and pelvic lymph nodes were involved as part of systemic dissemination of concurrent malignant lymphoma. The diagnosis was usually easily established in these cases. Of 11 cases, 4 were SLL/CLL, 4 were follicular lymphoma, 2 were mantle cell lymphoma, and 1 was diffuse large B-cell lymphoma.     

Malignant lymphoma of the spinal epidural space. Report of three cases

Three patients with non-Hodgkin's lymphoma involving the spinal epidural space are reported. All three patients, a 3-year-old boy (Case 1), a 63-year-old female (Case 2), and a 64-year-old male (Case 3), manifested signs and symptoms of neurological involvement before the diagnosis of malignant lymphoma was established by tissue examination. The tumors were located in the thoracic (Case 3) and thoracolumbar regions (Cases 1 and 2). The initial signs and symptoms of all cases were low back pain and progressing myelopathies. Bony abnormalities of the vertebrae, seen on both plain X-rays and computed tomographic scans, were unremarkable except for bilateral L1 pedicle erosion observed in Case 2. Total or subtotal tumor removal was followed by radiation therapy with or without chemotherapy in all cases. The primary lesion in Case 1 was a paravertebral lymphoma that had invaded the adjacent thoracolumbar epidural space through the intervertebral foramina. In Case 2, the primary lesion, documented by post-mortem examination, was a submucosal lymphoma of the stomach. In Case 3, the site of primary lesion could not be determined, although splenic and retroperitoneal nodal involvement was found at autopsy. The authors take a skeptical view of the existence of "primary" spinal epidural lymphoma, which has been reported a few times. Each of the three patients reported here presented with an epidural mass as the initial clinical manifestation of malignant lymphoma.     

Primary malignant B-cell-type dural lymphoma: Case report

BACKGROUND: The primary malignant dural lymphoma of B-cell type is rare. Our review of the literature (24 cases) indicated that patients with this tumor had female predominance, immunocompetency, and longer survival compared with those with primary malignant intracerebral lymphomas. Based on its clinicopathological features, this dural lymphoma may be classified differently from other types of malignant lymphomas in the central nervous system. CASE DESCRIPTION: The authors report an example of a patient who had a favorable course of malignant dural lymphoma. A 59-year-old woman presented with primary malignant dural lymphoma in the frontal area. Histological diagnosis was a diffuse large B-cell-type lymphoma of intermediate malignancy, but MIB-1 index was extremely high. Subtotal tumor removal was followed by 4 courses of chemotherapy. Thirty months after surgery, the patient is asymptomatic with no MRI evidence of recurrence. A combination of subtotal resection and chemotherapy for a primary malignant dural lymphoma is an effective means to attempt cure of this tumor. CONCLUSION: These rare tumors may be managed successfully by subtotal resection and postoperative treatment. We believe that chemotherapy is the treatment of choice after subtotal resection of malignant dural lymphomas, as experienced in our case.     

Cervical lymph node extirpation for the diagnosis of malignant lymphoma

Purpose

Lymph node enlargement in the neck is a common presentation of malignant lymphoma (ML) and requires tissue sampling for accurate diagnosis. Although delayed diagnosis may be critical for some patients, unnecessary biopsy should be avoided wherever possible. This study examined the process for determining the necessity to perform a biopsy and evaluated the value of an open biopsy as a diagnostic tool to enable definite subclassification of the disease.

Methods

The subjects included 20 patients with suspected ML who underwent cervical lymph node extirpation at Okayama Saiseikai general hospital between 2007 and 2010. The decision to perform a biopsy was made based on the results of sonographic evaluation, fine needle aspiration cytology (FNAC), and serum levels of lactate dehydrase (LDH) and soluble interleukin-2 receptor (sIL-2r).

Results

The diagnosis was ML in 15 patients (75%), Castleman??s disease in 1 (5%), and benign lymphadenopathy in 4 (20%).

Conclusions

A lymph node biopsy remains the gold standard for the diagnostic evaluation of ML. Sonographic evaluation combined with serum levels of LDH and sIL-2r is useful in determining the need for biopsy. Many of the cases of ML where it was difficult to determine whether a biopsy should be performed were relatively low grade and critical conditions could be avoided by close observation of the patient.     

Primary extranodal soft tissue lymphoma of the extremities

Since true primary lymphomas of soft tissues are extremely rare and there are few well-documented cases in the literature, we report eight cases to help define the clinical and pathologic features of this type of extranodal lymphoma. Among 7,000 malignant lymphomas seen at Mayo Clinic over a 10-year period, we found eight cases of Stage IAE extranodal malignant lymphoma that presented as a soft tissue mass in the upper or lower extremities. The tumors occurred in the following sites: thigh (n = 4), upper arm (n = 2), ankle (n = 1), and calf (n = 1). Two cases had low-grade histology: small lymphocytic lymphoma and follicular mixed small-cleaved and large-cell lymphoma. An intermediate-grade histology was present in two cases: diffuse mixed small- and large-cell lymphoma and diffuse large-cell (cleaved) lymphoma. Half of the patients had a high-grade lymphoma: diffuse large-cell (n = 3) and large-cell, immunoblastic (n = 1). The results of immunohistochemistry and electron microscopy in selected cases are discussed in the context of the differential diagnosis with other small, round-cell cancers. Four patients died of recurrent lymphoma, one at 7 months, two at 15 months, and one at 4 years. Three patients are alive without evidence of disease at 3, 8, and 13 years. One patient is alive and is receiving chemotherapy for locally recurrent lymphoma 6 months after diagnosis.     

Impact of malignant hematological disorders on cardiac surgery

BACKGROUND: Patients suffering from malignant hematological disorders may be at increased risk, when undergoing cardiac surgery. We report on our experiences with ten cardiac procedures in nine patients (3 males, 6 females, 19-85 yr old, mean age 61 yr). METHODS AND RESULTS: There were two patients with Hodgkin's lymphoma and one patient each with Waldenstrom's syndrome, multiple myeloma, polycythemia, myelodysplasia, chronic lymphocytic leukemia, non-Hodgkin's lymphoma and idiopathic aplastic anemia. Cardiac diseases included coronary artery disease in six, aortic stenosis in two, and mitral insufficiency in one patient. Consecutively, cardiac procedures were coronary artery bypass grafting in six, aortic valve replacement in two, and mitral valve replacement in one patient. No patient died. Postoperatively, one patient suffered from a pericardial tamponade requiring surgical removal and 5 months later from a prosthetic endocarditis necessitating change of the bioprosthesis. One patient developed a superficial wound infection, which was treated conservatively. Four patients received no blood products. Altogether, we transfused 32 packed red blood cells, seven units of fresh frozen plasma and 16 platelet concentrates. Total drainage loss was 883 ml (250-1510 ml). CONCLUSIONS: Cardiac surgery in patients suffering from malignant hematological disorders may be performed, but carries an increased morbidity. Therefore, indications for cardiac procedures must be carefully considered.     

A case of secondary malignant lymphoma of the urinary bladder

A 56-year-old man was admitted to our hospital for salvage chemotherapy of recurrent diffuse large B cell malignant lymphoma at clinical stage IIIb and which had been treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Computed tomography showed multiple tumors in the bladder after a cycle of ifosfamide, etoposide and mitoxantrone (MINE), but cystoscopy after the second cycle revealed a single non-papillary tumor about 1cm in diameter. After 3 cycles of MINE therapy, transurethral resection of bladder tumor was performed. At the time of the operation, the protruded lesion disappeared and there remained only a scar. Biopsy of the scar revealed malignant lymphoma infiltrated into the submucosal layer. Although the rate of the bladder involvement of malignant lymphoma reaches 3-20% in autopsy cases, it is very rare for a secondary malignant lymphoma of the urinary bladder to be diagnosed clinically. The prognosis of the secondary bladder lymphoma is much poorer than that of the primary one, because of the widespread dissemination of the disease at the time of diagnosis.     

Bilateral malignant lymphoma of the breast in patients with a familial history of cancer: A report of three cases

We report three cases of bilateral malignant lymphoma of the breast in patients with a familial history of cancers. All the patients had B-cell malignant lymphoma and were treated by a radical mastectomy and polychemotherapy. Bilateral tumors were detected synchronously in one case, whereas the second tumors in the other cases occurred 4 years and 8 years after the initial treatment. Although the patients had no relevant past history, these cases were notable for the fact that all were associated with a familial history of cancers. One patient had a definite familial history of breast cancer, that is to say, her mother, sister and brother all suffered from this disease. The brother of another patient died of gastric cancer while two of her uncles each suffered from sarcoma of the lower extremities and a brain tumor, respectively. As for the remaining patient, one of her maternal uncles and an aunt also died of prostate cancer and leukemia, respectively. However, only one out of seven patients with unilateral malignant lymphoma of the breast used for comparison had a familial history of cancer. A possible relationship between bilateral primary malignant lymphoma of the breast and a familial history of cancer is suggested.     

原发性胃肠道恶性淋巴瘤的诊治体会

目的探讨原发性胃肠道恶性淋巴瘤的临床特征、诊断和治疗。方法对广东省普宁市人民医院1999年1月～2009年12月普外科所收治22例原发性胃肠道恶性淋巴瘤患者临床资料进行回顾性分析。结果本组22例中,男性13例,女性9例,所有患者均经手术或内窥镜病理活检证实为恶性淋巴瘤,病理均为非霍奇金淋巴瘤（NHL）。病灶位于胃14例,肠道8例。给予手术、放疗、化疗等综合治疗。本组随访19例,3年生存率52.6%（10/19）,5年生存率26.3%（5/19）。结论原发性胃肠道恶性淋巴瘤发病率低,临床表现复杂,易漏诊、误诊,应早期诊断,合理治疗。治疗以手术、化疗、放疗综合治疗效果良好。     

Cord compression as the presenting symptom of extradural malignant lymphoma

Six patients with spinal cord compression as the presenting symptom of malignant lymphoma are described. These patients suffered from back pain for several months and were diagnosed after sudden paraparesis appeared. Five patients were treated by operative decompression followed by local irradiation, and all regained their motor function. A sixth patient presented with a more insidious paraparesis. A bone marrow aspiration established the diagnosis of malignant lymphoma, and this patient recovered with radiation and steroids alone. Thus, we recommend considering malignant lymphoma as a possible cause of acute cord compression, attempting to establish the diagnosis on an emergency basis within several hours, and attempting to achieve decompression with local radiotherapy and intravenous dexamethasone.     

Cord compression as the presenting symptom of extradural malignant lymphoma

Summary Six patients with spinal cord compression as the presenting symptom of malignant lymphoma are described. These patients suffered from back pain for several months and were diagnosed after sudden paraparesis appeared. Five patients were treated by operative decompression followed by local irradiation, and all regained their motor function. A sixth patient presented with a more insidious paraparesis. A bone marrow aspiration established the diagnosis of malignant lymphoma, and this patient recovered with radiation and steroids alone. Thus, we recommend considering malignant lymphoma as a possible cause of acute cord compression, attempting to establish the diagnosis on an emergency basis within several hours, and attempting to achieve decompression with local radiotherapy and intravenous dexamethasone.     

原发性胃恶性淋巴瘤诊治分析

目的　总结原发性胃恶性淋巴瘤的有效诊治方法。方法　 1990～ 1999年对 32例原发性胃恶性淋巴瘤的临床治疗作回顾性分析。结果　患者以上腹部不适、腹部肿块、呕血或黑便为临床表现 ,均经手术治疗 ,其中术前明确诊断 2 5例 ,均为胃镜下确诊。其中 2 6例获得随访 ,5年生存率为46 1%,病理类型均为非何杰金氏淋巴瘤 ,其中B小淋巴细胞性淋巴瘤 2 4例 ,T小细胞性淋巴瘤 4例。2 8例行辅助性CHOP化疗 ,总有效率 93.4%。结论　胃镜活检特别是超声胃镜下活检最有诊断价值。手术方式与胃癌相似 ,术后化疗与手术治疗同等重要 ,病理类型是判断预后的重要指标。     

肠道NK／T细胞淋巴瘤4例诊治分析

目的：探讨肠道NK／T细胞淋巴瘤的临床特点、诊断及治疗。方法：回顾性分析4例肠道NK／T细胞淋巴瘤的临床资料,对其发病特点、临床表现、实验室检查、诊断和治疗方法进行总结分析。结果：3例为小肠NK／T细胞淋巴瘤,CD45RO（＋）,cD3（＋）,CD56（＋）,CD20（-）,TIA（-）。1例为结肠NI/T细胞淋巴瘤,CD45RO（＋）,CD3（＋）,CD56（＋）,CD20（-）,TIA（＋）。4例患者术后分别存活61、58、14、7d。结论：肠道NK／T细胞淋巴瘤确诊需依赖术后病理组织学及免疫组织化学检查,早期诊断、尽早实施合理的治疗是降低死亡率的关键。     

The results of off-pump coronary artery bypass grafting for patients with malignant disease

We performed off-pump coronary artery bypass grafting (OPCAB) operations in 95 patients between April 2007 and September 2010, 6 of whom had malignant disease. The malignancies were multiple myeloma (1 patient), malignant lymphoma (1 patient), lung cancer (1 patient), breast cancer (1 patient), stomach cancer (1 patient), and liver cancer (1 patient). The mean number of distal anastomoses was 5. The mean length of postoperative intensive care unit (ICU) stay was 3.7 days, and postoperative hospital stay was 20.0 days. There was no hospital death, but we experienced uncontrollable ventricular tachycardia (VT) and ventricular fibrillation (VF) in the case of multiple myeloma. He was treated by implantation of implantable cardioverter defibrillator (ICD) before discharge. All cases underwent treatment of malignancies early after OPCAB except liver cancer case. Because the patient was diagnosed with liver cancer just before the OPCAB, he was examined on cancer after OPCAB. We conclude that OPCAB is safety performed in a patient with malignant diseaes.     

A case of malignant lymphoma (lymphosarcomatous type) of the brain (author's transl)

A relatively rare case of malignant lymphoma of the brain was reported. A 64-year-old male was admitted to our hospital, October 2, 1976, complaining of right hemiparesis and expressive aphasia. Neurological and radiological examinations revealed a huge space-occupying lesion in the left frontoparietal region. An external decompressive surgery and biopsy were performed. The excised specimens was diagnosed as malignant lymphoma (lymphosarcoma type) histologically. Radiation (5000 rad of 60Co) and chemotherapy with anticancer drugs were carried out after the operation. The patient, however, died at seven months after the onset. On necropsy the tumor was infiltrated extensively in the left frontal, parietal, temporal and occipital lobes, but extended not to the thalamus, basal ganglia and ventricular system. This case was suggested primary malignant lymphoma of the brain, according to the physical and radiological examinations of the whole body, although the autopsy was performed only about the brain. The nomenclature, clinicopathological and immunological problems of malignant lymphomas of the nervous system were also discussed, reviewing the previously reported cases.     

Langerhans' cell granulomatosis (histiocytosis X) associated with malignant lymphomas

We present six patients in whom Langerhans' cell granulomatosis (histiocytosis X) was found in lymph nodes also harboring malignant lymphomas: Hodgkin's disease in five and non-Hodgkin's lymphoma in one. This brings to 12 the total number of such reported cases. Whether this represents a chance association of the two processes or a peculiar reaction of Langerhans' cells to the lymphoma is unknown. The focal intimate intermingling of the two processes and the inability to identify LCG as an incidential finding in other cancers suggests that this phenomenon may represent a peculiar reaction to the lymphoma.     

Cutaneous lymphomas with prominent granulomatous reaction: a potential pitfall in the histopathologic diagnosis of cutaneous T- and B-cell lymphomas

The presence of a granulomatous reaction in lesions of cutaneous lymphomas has been described in the past in several cases. Especially in mycosis fungoides, a "granulomatous" variant of the disease has been well characterized. We studied the clinicopathologic features of cutaneous lymphomas with prominent granulomatous reaction, including both cutaneous T-cell lymphomas and B-cell lymphomas (primary cutaneous lymphoma 22, secondary cutaneous lymphoma one). Biopsies of 23 patients with histopathologic features of cutaneous T-cell lymphoma or cutaneous B-cell lymphoma with prominent granulomatous reaction were included in this study. A prominent granulomatous reaction was defined as the presence of a granulomatous component exceeding 25% of the dermal infiltrate. There were 14 cases of mycosis fungoides, two of subcutaneous panniculitis-like T-cell lymphoma, four of small/medium pleomorphic T-cell lymphoma, one of follicle center cell lymphoma, one of large B-cell lymphoma, and one of secondary cutaneous peripheral T-cell lymphoma. Altogether, a prominent granulomatous reaction could be observed in 1.8% of all patients with cutaneous lymphoma (primary or secondary) registered in the files of the Department of Dermatology of the University of Graz (Graz, Austria), demonstrating that there is a distinct, albeit small, proportion of cases revealing this peculiar reaction pattern. In seven cases a misdiagnosis of granulomatous dermatitis preceded the correct diagnosis for a period of 1-216 months, suggesting that sequential biopsies and complete phenotypic and molecular genetic analyses should be carried out in cases of "unusual" granulomatous dermatitis.     

Abdominal computed tomography findings of malignant tumors in patients with solid organ transplants

AIMS: Incidence of malignancy in solid organ transplant recipients is higher compared to the general population. The aim of this study was to characterize distribution and appearance of abdominal malignant tumors detected with spiral computed tomography (CT) examination in patients with solid organ transplantation. MATERIALS AND METHODS: Between July 1994 and April 2006, 198 patients underwent liver transplantation and 568 patients underwent renal transplantation in our center. The abdominal CT studies were reviewed to determine the presence or absence of abdominal malignancy. All abdominal CT examinations were performed prior to immunomodulation or chemotherapy. RESULTS: Eleven renal and one liver transplantation patient developed an abdominal malignancy. Among 11 renal transplantation patients eight were diagnosed as abdominal Kaposi's sarcoma (KS) and three as posttransplantation lymphoproliferative disorder (PTLD) upon spiral CT examination. In two patients the transplanted organ itself had malignant tumors: one patient had PTLD with Burkitt lymphoma in the transplanted liver and the other a renal cell carcinoma in the transplanted kidney. Abdominal PTLD and KS showed imaging findings and the site of organ involvement somewhat different from nontransplant patients. The most common pathologies in KS were liver lesions (n=6) and lymphadenopathy (n=6). But in abdominal PTLD, the spleen (n=3) was the most involved organ. CONCLUSIONS: The early diagnosis of abdominal malignancies after solid organ transplantation is crucial for the patient's prognosis, especially under immunosuppression. The abdominal spiral CT examination was an effective modality to depict a malignancy among patients with solid organ transplantation.     

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目的 探讨原发性甲状腺恶性淋巴瘤的诊断和治疗方法.方法 回顾性分析2000年1月至2006年4月中国医科大学附属第一医院普通外科收治的5例原发性甲状腺恶性淋巴瘤临床资料.结果 5例病人术前均诊断为甲状腺癌,1例行双侧甲状腺切除术,2例行患侧甲状腺及峡部切除术、对侧甲状腺大部切除和气管切开术,该3例病人术后给予化疗.2例因呼吸困难急诊手术,其中1例术后死亡.术后病理均证实为甲状腺恶性B细胞非何杰金淋巴瘤.结论 原发性甲状腺淋巴瘤诊断较困难,治疗应采用综合治疗.     

Surgical treatment of neurogenic tumors of the chest.

BACKGROUND: Neurogenic tumors are commonly found in the mediastinum, especially in the posterior mediastinum or in the chest wall, and have a variety of clinical and histological features. We reviewed our experience with these types of tumors and assessed diagnostic and therapeutic approaches. PATIENTS AND METHODS: A series of 60 consecutive patients with a neurogenic tumor of the chest, all seen at a single institute, was retrospectively reviewed. RESULTS: The mean age of the 60 patients was 40 years, including 32 males and 28 females. Preoperative symptoms were present in seven patients (11.7%). Median tumor size was 5.3 cm, ranging from 1.4 to 20 cm. The major location of the tumor was the posterior mediastinum in 38 cases (63.3%) and the chest wall in 16 cases (26.7%). The operative procedure performed was tumor extirpation in 58 cases (96.7%), in which video-thoracoscopic procedure was performed in nine patients and chest wall resection in two cases. The major histological type was neurilemmoma in 51 patients (85%), and malignant tumor was only diagnosed in one patient with malignant schwannoma. Tumor related death occurred in only one case with malignant schwannoma. Ten patients with neurilemmoma were precisely diagnosed by magnetic resonance imaging. CONCLUSION: Almost all cases of intrathoracic neurogenic tumors were benign in nature. Therefore, surgical indications may be carefully determined in cases with no symptom and with imaging that indicate benign neurilemmoma.