A retrospective study of clinical characteristics and prognostic factors of primary testicular lymphoma

ObjectiveTo assess the clinical characteristics, prognostic factors, and treatment outcomes of primary testicular lymphoma (PTL).Materials and MethodsWe reviewed the medical records of PTL patients diagnosed between January 2000 and May 2012 at four hospitals in Taiwan. The following data were collected and analyzed: patient age at diagnosis, B symptoms (fever, night sweats, and/or weight loss), tumor localization (diffuse or testis alone), tumor site (left, right, or bilateral), stage of disease, histological pattern, International Prognostic Index, treatment method and outcome, relapse, and survival time. Kaplan–Meier curves were constructed to assess the effects of various factors on patient survival.ResultsThirty patients with PTL were included in this study. The median age at diagnosis was 62.5 years (range: 19–89 years) and median overall survival (OS) was 44 months. The majority of the patients had unilateral lymphoma, stage I/II disease, and diffuse large B-cell lymphoma. An absence of B symptoms, limited disease stage, lymphoma localized to testis only, and orchidectomy were considered to be significantly favorable prognostic factors of OS (p < 0.05). The PTL treatment regimen varied among patients and included orchidectomy, chemotherapy, and/or radiotherapy. Interestingly, although 50% patients achieved complete remission (CR) post-treatment, relapse was observed in 42% patients during the follow-up period. Nonetheless, patients who initially underwent orchidectomy appeared to have a significantly better survival rate, whereas chemotherapy proved more advantageous for those with the diffuse-type PTL.ConclusionPTL is characterized by unique clinical features and prognostic factors. Despite differing treatment regimens, 50% of patients achieved CR. Patients with testicular localization who underwent orchidectomy may achieve better outcomes, whereas chemotherapy proved to be beneficial in those with diffuse-type PTL.     

AIDS presenting as primary testicular lymphoma.

A case of AIDS presenting as a primary testicular lymphoma is reported. Despite the lack of evident systemic disease, such a presentation in a young patient should alert the physician to the possible presence of an underlying human immunodeficiency virus infection.     

Diabetes mellitus after injury in burn and non-burned patients: A population based retrospective cohort study

Objective

To compare hospitalisations for diabetes mellitus (DM) after injury experienced by burn patients, non-burn trauma patients and people with no record of injury admission, adjusting for socio-demographic, health and injury factors.

Real-world data of HER2-low metastatic breast cancer: A population based cohort study

BackgroundWith the introduction of investigational human epidermal growth factor receptor 2 (HER2) targeting treatments, thorough understanding of breast cancer with different HER2 expression levels is critical. The aim of this study was to compare clinicopathologic characteristics and survival of patients with metastatic breast cancer according to the level of HER2 expression.MethodsWomen with distant metastatic breast cancer during 2008–2016 were selected from PALGA, the Dutch Pathology Registry, and linked to the PHARMO Database Network. Breast cancer samples were categorised as HER2 immunohistochemistry score 0 (IHC0), HER2-low or HER2+.ResultsAmong women with hormone receptor (HR) positive metastatic breast cancer (n = 989), 373 (38%) cancers were HER2 IHC0, 472 (48%) were HER2-low and 144 (15%) were HER2+. Among HR negative patients (n = 272), the proportion of HER2 IHC0, HER2-low and HER2+ was 110 (40%), 104 (38%) and 58 (21%) respectively.Within the HR + cohort, patients with HER2 IHC0 or HER2-low cancer were significantly older compared to HER2+ patients. This age difference was not seen in the HR-cohort. The localisation of distant metastases differed significantly between HER2 IHC0 or HER2-low versus HER2+ cases. Survival rates did not differ markedly by subtypes.ConclusionSubstantial proportion of patients had a HER2-low breast cancer. No clear differences in survival were found when comparing HER2 and HR status. Getting more granular insights in the level of HER2 expression and addressing HER2-low as a separate category could help to assess the impact of emerging treatment strategies. Therefore, more detailed information on HER2 expression should be routinely reported.     

Coeliac disease and risk of tuberculosis: a population based cohort study

BACKGROUND: Coeliac disease (CD) is an autoimmune disease often characterised by malnutrition and linked to a number of complications such as an increased risk of lymphoma, adverse pregnancy outcome, and other autoimmune diseases. Tuberculosis (TB) affects a large proportion of the world population and is more common in individuals with malnutrition. We investigated the risk of TB in 14 335 individuals with CD and 69 888 matched reference individuals in a general population based cohort study. METHODS: Cox proportional hazards method was used to calculate the risk of subsequent TB in individuals with CD. In a separate analysis, the risk of CD in individuals with prior TB was calculated using conditional logistic regression. RESULTS: CD was associated with an increased risk of subsequent TB (hazard ratio (HR) 3.74, 95% CI 2.14 to 6.53; p < 0.001). Similar risk estimates were seen when the population was stratified for sex and age at CD diagnosis. Individuals with CD were also at increased risk of TB diagnosed in departments of pulmonary medicine, infectious diseases, paediatrics, or thoracic medicine (HR 4.76, 95% CI 2.23 to 10.16; p < 0.001). The odds ratio for CD in individuals with prior TB was 2.50 (95% CI 1.75 to 3.55; p < 0.001). CONCLUSIONS: CD is associated with TB. This may be due to malabsorption and lack of vitamin D in persons with CD. Individuals with TB and gastrointestinal symptoms should be investigated for CD.     

Injury severity and increased socioeconomic differences: A population-based cohort study

BackgroundSeveral studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort.MethodsWe conducted a registry-based cohort study of all individuals aged 25–64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation.ResultsWe identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07).DiscussionWe observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.     

原发性睾丸淋巴瘤17例的诊治体会

目的 总结原发性睾丸淋巴瘤的诊疗要点及预后,以提高对该病的临床认识.方法 1995 -2010年,首都医科大学附属北京友谊医院泌尿外科共收治原发性睾丸淋巴瘤17例,回顾性分析其临床特点、诊疗经过及预后.结果 17例患者平均年龄68岁,以睾丸实性肿物为首发症状,肿物平均直径4.7 cm,均接受患侧睾丸高位切除术,病理均为非霍奇金淋巴瘤,弥漫大B性15例,间变大细胞性2例,临床分期均为IE期.长期随访14例,失访3例,平均随访时间37.8月,术后所有患者均接受CHOP化疗,部分患者合并行利妥昔单抗及预防性低剂量盆腔放疗.共5例患者死于其他内科慢性合并症,对侧睾丸转移1例再次行手术治疗,目前9例患者均无瘤生存.结论 原发性睾丸淋巴瘤较为少见,多见于老年男性,术后病理诊断为金标准,治疗以综合性全身治疗为主,需根据患者具体情况制定个体化治疗方案.     

原发睾丸淋巴瘤的临床特点及预后因素分析

目的 探讨原发睾丸淋巴瘤(PTL)的临床特点及其与预后的相关性. 方法回顾性分析1977年6月至2009年5月收治的33例PTL患者的临床资料,以Kaplan-Meier法绘制生存曲线,Log-rank检验进行单因素分析,采用COX回归模型多因素分析评估独立的预后因素. 结果 33例患者中位发病年龄为62(33～81)岁,24例就诊时处于早期,首发症状主要表现为睾丸无痛性肿大,最常见的病理类型是B细胞淋巴瘤,占76%(25/33),其中弥漫大B细胞淋巴瘤占48%(16/33).经术后化疗和(或)放疗,23例完全缓解,7例部分缓解.中位随访时间23(4～231)个月.5、10年总生存率分别为39.1%和19.5%.化疗≥4个周期及B细胞淋巴瘤加利妥昔单抗患者疗效好.多因素分析显示:Ann Arbor分期、B症状、年龄和结外受侵数是PTL的独立预后因素. 结论 PTL应采取综合治疗,术后给予蒽环类药物为主的全身化疗,B细胞淋巴瘤首选利妥昔单抗联合化疗,预防性鞘内注射和对侧睾丸预防性放疗有助于减少复发.Ann Arbor分期、B症状、年龄和结外受侵数为PTL预后的独立影响因素.     

Thoracoscopic esophagomyotomy for achalasia in the pediatric population: A retrospective cohort study

Background/Purpose

Achalasia is an extremely rare disease in children (0.1 per 100,000 individuals). Standard treatments for this include pneumatic dilation and esophagomyotomy. Minimally invasive esophagomyotomies have increasingly been used owing to improved postoperative pain and length of stay. We describe our experience with thoracoscopic esophagomyotomy in this population.

Gastrocnemius tightness: A population based observational study

BackgroundGastrocnemius tightness is believed to be associated with multiple musculoskeletal pathologies such as back pain, plantar fasciitis and metatarsalgia. Although surgical treatment of gastrocnemius tightness is gaining popularity the objective definition of a gastrocnemius contracture has not been determined. The aim of our study was therefore to quantify gastrocnemius tightness in a normal population.MethodsAdult participants with no obvious foot and ankle pathology were recruited. Gastrocnemius tightness was quantified using a weightbearing lunge test. Maximal ankle-foot dorsiflexion was measured on participants with the knee in full extension and flexed to 20° using a digital inclinometer. The ankle-foot dorsiflexion index or ADI (difference in ankle dorsiflexion with the knee extended and flexed) was calculated. The ADI values were plotted on a histogram to identify the distribution of values and were compared according to participant demographics.Results800 limbs from 400 participants were examined. There was a wide distribution of absolute values of maximal ankle-foot dorsiflexion ranging from 8 to 52°. The ADI ranged from 0 to19° and approximated to a normal distribution. The mean ADI was 6.04 ± 3.49° and was positively correlated with age (r = 0.132, P < 0.001) and negatively correlated with physical activity (r = ?0.88, P = 0.015).Conclusion(s)Our study is the first to quantify gastrocnemius tightness in a large healthy adult population with differences observed by age and physical activity. We have defined an easy and reproducible weightbearing test that can be used in both research and clinical settings. The majority of the population have some degree of gastrocnemius tightness and values of ADI greater than 13° (>2 SD of the mean), as measured by the lunge test, may be considered abnormal.     

Malignant lymphoma of the testis presenting as primary testicular tumor.

A case of malignant lymphoma of the testis is presented. A 49-year-old male presented with swelling and dull pain of his left scrotal content. The initial clinical diagnosis was left testicular tumor. Left high orchiectomy was performed immediately after admission and histopathology showed malignant lymphoma, large cell type, B-cell type according to the Lymphoma Study Group (LSG) classification. Extensive investigations revealed clinical stage lE, with no evidence of metastasis. Chemotherapy was initiated with vincristine, prednisolone, adriamycin and methotrexate (VEPA-M). After therapy, the patient is doing well without any evidence of metastasis.     

Hysteroscopy in the evaluation of patients with recurrent pregnancy loss: a cohort study in a primary care population

Background The purpose of this study was to determine the prevalence of structural uterine defects (SUD) in patients with recurrent pregnancy loss (RPL) attending a large family medicine practice and to determine the effectiveness of the therapeutic intervention.Methods This prospective cohort study from October 1995 to October 1998 included 23 patients aged 23 to 35 years (mean, 28.1) with an otherwise unexplained history of three or more 1st- or 2nd-trimester miscarriages and no live births. None of the couples were tobacco or alcohol users, all of them and had normal cytogenetic examinations and testing. Their jobs were unrelated to chemical handling. All patients had a complete history taken and underwent physical examination and hysteroscopy with directed biopsy. They had normal values for complete blood count, sedimentation rate, urinalysis and culture (gonorrhea, Chlamydia, syphilis, hepatitis B, HIV), lupus anticoagulant, anticardiolipin antibodies, spermiogram, progesterone, and pelvic ultrasound.Results Fourteen patients (60.9%) had a normal hysteroscopy (with biopsies). Nine patients (39.1 %) had SUD, as follows: Five patients (21.8%) had intrauterine adhesions, two patients (8.7%) had a septated uterus, one patient (4.3%) had submucosal myoma, and one patient (4.3%) had multiple factors. After appropriate therapy of the SUD, seven patients (77.8%) achieved successful pregnancy and two patients (22.2%) had recurrent miscarriage. In the normal hysteroscopy group, eight patients (57.1%) had recurrent miscarriages, two patients (14.3%) had infertility, and four patients (28.6%) achieved successful pregnancy with no further therapy.Conclusions The prevalence of SUD in our studied population was 39.1 %. After appropriate treatment, the rate of live-birth pregnancies in these patients was 77.8%. Because SUD are the most treatable cause of RPL, these patients should be identified early after other potential causes of RPL are eliminated.     

Age related flow rate nomograms in a normal pediatric population

Uroflow studies in a normal pediatric population were analysed statistically. Single studies for 511 subjects (272 boys and 239 girls) were reviewed. Nomograms relating peak flow to volume voided and age were established. An acceptable lower limit for peak flow was obtained from the data and a volume voided range was calculated so that both criteria could be used with 90% probability to define the normal voiding situation. The mean values of peak flow rate increased with volume voided in both sexes and also with age in the male population. Different sets of nomograms, which are necessary for daily clinical evaluation, are given. They define the normal values in the normal population.     

睾丸原发性弥漫性大B细胞淋巴瘤临床病理学分析

目的:探讨睾丸原发性弥漫性大B细胞淋巴瘤(DLBCL)的临床病理特征、免疫表型及治疗方法。方法:回顾性分析23例睾丸DLBCL的病理形态学及免疫组化标记,结合文献对其临床病理学特点进行分析。23例患者年龄48～76岁,平均61.4岁,82.6%患者超过50岁。病变部位左侧睾丸9例,右侧14例,均为单侧发病。临床主要表现为睾丸无痛性进行性肿大。结果:组织学主要表现为肿瘤细胞弥漫浸润于睾丸实质,细胞体积较大,异型性明显,核分裂易见。免疫表型均表达B细胞标志物。5例获得随访资料,4例截止随访时均存活,随访时间2～32个月,1例随访9个月后死亡。结论:睾丸DLBCL少见,多发于老年男性患者,具有侵袭性生物学行为。诊断时极易误诊或漏诊,其确诊依赖组织病理学,免疫组化标记对明确诊断及鉴别诊断有一定价值。     

A study of primary central nervous system lymphoma in northern India

BACKGROUND: Primary central nervous system lymphoma (PCNSL) is rare and accounts for 1 to 2% of all lymphomas. There are conflicting reports about the rise in incidence of PCNSL cases in the last two decades; this has largely been attributed to an increase in incidence of AIDS and other immunosuppressive states in some studies. This study was undertaken to view the trend of PCNSL at the Postgraduate Institute of Medical Education and Research, Chandigarh, which is a referral hospital in northern India. METHODS: The PCNSL cases from our surgical material of 15 years (1985-1999) were reviewed. Slides were examined independently by three histopathologists. Immunophenotyping was done on paraffin-embedded tissue using indirect immunoperoxidase technique. RESULTS: Out of a total of 3,325 intracranial tumors diagnosed during this period (1985-1999), there were 40 cases (1.2%) of PCNSL; gliomas accounted for 1,531 cases (46.04%). The age ranged from 24-75 years with the sex ratio (M:F) being 2:1. HIV serology, available in 14 cases, was negative in all. The parietal lobe was the most common site of involvement. Diffuse large cell lymphoma was the most common morphological type. Immunohistochemistry could be done in 31 cases; 28 cases were found to be B-cell type whereas 3 cases were T-cell type. No statistically significant increase was seen on comparing the number of cases at 5-year intervals. CONCLUSION: This study revealed that there has been no significant increase in PCNSL cases over the last 15 years.