Primary diffuse large B cell lymphoma of the base of tongue

Primary non-Hodgkin's lymphoma of tongue is very rare. We report a case of an elderly female who presented with a mass lesion and pain primarily involving the tongue and was diagnosed with diffuse large B cell lymphoma. Computed tomography revealed a 3-cm enhanced mass localized to the right tongue base. The patient was treated with three cycles of combination rituximab and CHOP chemotherapy, followed by external beam radiotherapy. The patient had a complete response after treatment, and three years following treatment, the patient has no signs of recurrence.     

Primary non-Hodgkin's lymphoma in the dorsolumbar muscles

We report a case of primary soft tissue lymphoma with pulmonary involvement in a 57-year-old man, successfully treated with surgery and chemotherapy. The patient presented with a giant mass (16 × 20 cm) in the left dorsolumbar region. Computed tomography (CT) demonstrated a right-sided pulmonary tumor, in addition to the giant tumor in the left dorsolumbar muscles. On an incisonal biopsy, the left dorsolumbar muscle tumor was suspected to be a sarcoma, and en-bloc resection was therefore performed. During surgery, four left pulmonary tumors that had not been observed on CT were found and surgically resected. The patient was finally diagnosed with soft tissue non-Hodgkin's B cell lymphoma with pulmonary involvement. After postoperative chemotherapy, the right pulmonary nodule disappeared. The patient was well and had no evidence of disease 22 months after surgery. To the best of our knowledge, primary soft tissue lymphoma is extremely rare. Received: August 14, 1997 / Accepted: May 8, 1998     

Primary adrenal lymphoma discovered as an incidentaloma: case report and review of the literature

Primary adrenal lymphoma (PAL) discovered at an early stage is extremely rare. We report a case of PAL incidentally discovered by abdominal computed tomography (CT) scan as a 4.5-cm solid mass in the left adrenal gland. The patient was an 80-year-old man, and, from imaging studies, the left adrenal mass was considered to be a non-functioning adrenal cortical cancer. Left adrenalectomy was performed, and the resected tumor proved to be non-Hodgkin's lymphoma of diffuse large B-cell type. Adjuvant chemotherapy was administered, and the patient has been well with no evidence of the disease for 20 months postoperatively. Received: September 3, 1998 / Accepted: November 30, 1998     

Primary renal angiosarcoma: case report and review of world literature

This article focuses on a rare case of primary renal angiosarcoma in a 56-year-old man with a previous clinical history of stage III Hodgkin's lymphoma treated with supra- and subdiaphragmatic radiotherapy, splenectomy in association with vincristine-based chemotherapy and thermochemotherapy, and subsequent thymectomy. The patient was referred to the department of urology from the department of cardiology, where he had been seen for right coronary stenosis after the incidental finding on an abdominal scan of a large left renal mass. There was no family history of renal cancer. Diagnosis was high-grade angiosarcoma, extensively necrotic and hemorrhagic, involving the renal parenchyma and perirenal soft tissue. Taking into account tumor histology, grade, size and site as well as patient's age and general condition, a therapeutic program was planned comprising surgery followed by chemotherapy (epirubicin 60 mg/m2 and ifosfamide 3000 mg/m2). Adjuvant radiotherapy, normally delivered to the site of surgery, was not considered necessary. Unfortunately the patient died 4 months after surgery, before chemotherapy was started. Our paper highlights the extreme rarity and aggressiveness of renal sarcoma, its poor prognosis, and the fact that there is no one, accepted approach to its treatment.     

Lymphome non hodgkinien primitif du foie : à propos d''un cas et revue de la littérature

Purpose was to describe the clinical, radiological and therapeutic features in primary liver lymphoma. We report the case of a 54-year-old patient, who is followed since the age of 20 years for neutropenia associated with mediastinal adenopathy. Systematical ultrasound find a mass of the left liver confirmed by Computed tomography (CT). Histological examination of laparoscopic liver biopsy specimens confirmed diffuse large-cell non-Hodgkin's lymphoma. The disease was confined to the liver without any evidence of extrahepatic involvement. The serology of Epstein Barr virus was highly positive. PET-scan show increased FDG uptake at the site of hepatic lesion and the mediastin. The patient received chemotherapy followed by radiation therapy of the left liver at the dose of 31 Gy. The patient was alive and free of disease 20 months after the diagnosis of primary liver lymphoma. The primary hepatic lymphoma is a rare malignancy, which classically affects 50-year-old patients with a male preponderance. The incidence is increased in immunosuppressed patients and some authors have suggested an association with hepatitis B or C infection, and with the Epstein Barr virus. The imaging studies including ultrasound, CT, magnetic resonance imaging (MRI) and now PET-scan help to establish the diagnosis and to the following. Treatment options are surgery, radiation, chemotherapy, or a combination.     

Obstructive solitary bronchial non-Hodgkin's lymphoma--a rare presentation of primary extranodal disease.

Endobronchial involvement by non-Hodgkin's lymphoma (NHL) is uncommon and usually occurs in the presence of more generalised disease. Solitary endobronchial lymphoma in the absence of disease elsewhere is extremely rare. In this report we describe a patient with an obstructing endobronchial mass which was the initial manifestation of NHL. The patient was treated initially with radiotherapy followed by cyclic combination chemotherapy with initial complete resolution of the endobronchial disease. However, he subsequently developed widespread lymphoma. This unusual presentation of NHL is discussed and the relevant literature is reviewed.     

Primary non-Hodgkin's lymphoma of the female genital tract

Genital tract lymphoma is a rare disease; information on diagnosis, treatment and outcome are limited. We report on eight patients affected by non-Hodgkin's lymphoma of the genital tract, five from the cervix, two from the vagina and one from the vulva collected between 1987 and 1998. Age at presentation ranged from 36 to 82 (median 67) years. The commonest initial symptom was vaginal bleeding, post coital in 1 patient. Three patients complained of vescical symptoms. Ann Arbor classification was stage IAE for 6 patients. Histology, according to the IWF, was either intermediate grade (4 patients), or high grade (3 patients), not evaluable in one case. Seven patients were treated with chemotherapy (anthracycline based in four) followed by pelvic radiotherapy in five; one patient received irradiation alone. Five patients are currently alive and free of disease with follow-up ranging from 8 to 126 months. Based on our experience in this series, we support a management scheme of combination chemotherapy and radiotherapy for patients with non-Hodgkin's lymphoma of the genital tract.     

原发性结直肠恶性淋巴瘤20例临床分析

目的掌握原发性结直肠恶性淋巴瘤的诊断和治疗。方法回顾性分析２０例原发性结直肠恶性淋巴瘤的临床病理特点。结果病变主要发生在右半结肠，以腹块（８５％）、腹痛（７５％）、体重下降（４５％）以及血便（４０％）、腹胀（３０％）等为主要特点。１例为霍奇金淋巴瘤；１９例为非霍奇金淋巴瘤，其中１８例为弥散型Ｂ细胞型。治疗宜采用手术、化疗、放疗等的综合治疗方法。结论临床、影像学和内窥镜检查结合可提高诊断率；根治切除者预后较好；规范性化疗可以提高远期疗效。     

Primary non-hodgkin’s lymphoma of the breast: a report of two cases

Background: Primary non-Hodgkin’s lymphoma of the breast (PBNHL) is a rare neoplasm and PBNHL occuring in a man is extremely rare. Method: We report herein two cases of PBNHL and discuss methods of diagnosis and treatment. Results: The first patient was a 35-year-old woman who presented with an elastic-hard mass in her left breast and adenopathy in her left axillary fossa. Mammography and ultrasonography suggested left breast cancer. Frozen sections demonstrated PBNHL histologically. Quadrantectomy of the breast was performed followed by chemotherapy. The second patient was a 65-year-old man with an elastic-hard mass in his left breast and left axillary lymphadenopathy. Mammography and ultrasonography suggested breast cancer or a soft tissue tumor. Intraoperative histological examination revealed a diagnosis of non-Hodgkin’s lymphoma (NHL). A simple mastectomy and postoperative chemotherapy were performed and the patient had a good prognosis. Conclusion: A multidisciplinary approach including surgery, chemotherapy, and radiotherapy is indispensable in treating PBNHL, after diagnosis by excisional biopsy or aspiration cytology.     

原发于上颌窦非霍奇金淋巴瘤15例临床分析

目的对原发于上颌窦非霍奇金淋巴瘤的临床、病理、治疗及预后结合文献进行分析。方法经手术后病理确诊为原发于上颌窦非霍奇金淋巴瘤15例在本院行放疗和化疗的综合治疗。放疗采用60Co-γ线或6MV~8MV高能X线,原发灶放疗中位剂量为56Gy,颈部放疗剂量为50Gy,颈部预防放疗剂量为44Gy。放射治疗前后行CHOP、COPP、COMP、BACOP等方案化疗2个~6个周期。结果5年生存率为53.4%。死亡8例,均死于远处转移。结论上颌窦非霍奇金淋巴瘤需行放射治疗和全身化疗,有条件时给予鞘内预防化疗。     

Non-Hodgkin's lymphoma of the testis: a retrospective study of 84 patients treated in the French anticancer centres.

Primary non-Hodgkin's lymphoma of the testicle is rare. We analysed cases treated in French anticancer centres from 1969 to 1995. All cases were reviewed and classified according to the R.E.A.L. Classification. Eighty-four cases were included in this study. The median age was 67 years (17-85). Disease was classified as stages I in 42 cases, stages II in 19 and stages III-IV in 23. Diffuse large B-cell lymphoma was diagnosed in 75% of cases. Treatment included orchidectomy and radiotherapy and/or chemotherapy. A complete response was obtained in 72.6% of the patient population and in 100%, 68% and 33% of stage I, II and III-IV disease respectively. Recurrence occurred in 32 cases and the most frequent site was the central nervous system: six of these patients presented stage I disease. Median overall survival was 32 months for the entire population, 52 months for stage I, 32 months for stage II, and 12 months for stage III-IV cases (P < 0.0001). Among patients presenting stage I disease, no difference was found between those treated with combined surgery and chemotherapy or surgery followed or not followed by radiotherapy. This study confirms that non-Hodgkin's lymphoma of the testicle carries a poor prognosis. Systemic adjuvant chemotherapy should be discussed because of the high recurrence rate. Inclusion of these cases in large co-operative prospective studies is recommended.     

Time course of urinary neopterin in a non-Hodgkin's lymphoma patient during chemotherapy and radiotherapy

The objective of this study was to follow urinary neopterin in a patient affected by non-Hodgkin's lymphoma during the three months treatment from the onset of the disease. In the study a patient affected by non-Hodgkin's lymphoma in Stage IV (centrocyto-centroblastic type) was enrolled. He was treated with combined chemotherapy and local radiotherapy. Neopterin was measured by high performance liquid chromatography in the first morning urine specimens. The time course of urinary neopterin levels ranged from 110 to 524 micromol x mol(-1) creatinine (mean 261, SD 67.5 micromol x mol(-1) creatinine). Over 70 % of the received values were higher than the upper limit of normal excretion of healthy subjects. Longitudinal analysis showed a relatively big variance of urinary neopterin with a tendency of decrease during the treatment. The significant decrease of urinary neopterin was observed till after the radiotherapy period which followed the chemotherapy period. In conclusions, the response to the therapy was accompanied by a reversal tendency of neopterin excretion to physiological values. This study confirms neopterin as a suitable additional parameter for the control of non-Hodgkin's lymphoma therapy.     

Diffuse large B-cell non-Hodgkin's lymphoma presenting as a vaginal mass in a patient with a history of intestinal mucosa-associated lymphoid tissue (MALT) lymphoma

Vaginal involvement in non-Hodgkin's lymphoma is uncommon and is often secondary to disseminated disease. Primary disease at this site is quite rare. We present here an unusual case of a patient who developed a diffuse large B-cell lymphoma presenting as a vaginal mass after having been treated for primary intestinal mucosa-associated lymphoid tissue (MALT) lymphoma 4 years earlier. Combined chemotherapy and radiation therapy for the intestinal MALT lymphoma produced complete remission that lasted for 2 years. Chemotherapy given for the diffuse large B-cell lymphoma with secondary vaginal involvement produced a second complete remission. The second remission was consolidated with high-dose chemotherapy and autologous bone marrow transplantation. Although the patient died from complications related to the transplant procedure, the disease was in complete remission at the time of her death. Given the rarity of primary intestinal MALT lymphoma and primary vaginal lymphoma, no standard treatment has been established. Treatment options have included chemotherapy, radiation therapy, or surgery, given alone or in combination.     

Debulking surgery for patients with diffuse large B-cell non-Hodgkin's lymphoma

Chemotherapy and radiotherapy have been the principal modalities of treatment for diffuse large B-cell non-Hodgkin's lymphoma (B-NHL) for over 30 years. Various treatment regimens have been designed over the years to try to increase response and cure rates. The role of surgery has been generally restricted to defined and limited situations including diagnostic tissue biopsies and treating abdominal emergencies such as organ rupture or perforation. We present two cases of refractory B-NHL, where surgery was used as a part of stepwise and multi-modal treatment with curative intent. In both cases, the treatment approach included standard dose chemotherapy, eradication of residual mass by surgery, high dose chemotherapy (HDC) with stem cell support and posttransplantant immunotherapy. Currently, 2 years after completing the therapy, both patients are well with no evidence of active disease. Based on our experience with 2 patients we believe that in specific cases of residual chemo-resistant lymphomatous mass, surgery should be considered as a part of a multimodal approach.     

Primary rectal lymphoma as a cause of bowel obstruction. Report of a case

BACKGROUND: Malignant lymphoma involving the rectum either as a localized process or as a manifestation of disseminated disease is rare. Several treatments have been proposed and reported, including surgical resection alone or associated with adjuvant chemoradiation, chemotherapy alone, and radiotherapy alone. METHODS: A case of bowel obstruction caused by a primary rectal MALT lymphoma is reported. Following emergency loop sigmoid colostomy the patient was started on multiple specific cycles of chemotherapy according to the MACOP-B protocol. RESULTS: At the end of chemotherapy a remarkable reduction in the size of the tumor was noted. Subsequently the patient underwent an ultralow anterior resection followed by a straight coloanal anastomosis. At 36 months of follow-up the patient is alive with no tumor recurrence. CONCLUSIONS: The present report describes the unique case of a patient with primary obstructing rectal lymphoma treated with neoadjuvant chemotherapy and sphincter-saving curative surgery.     

Primary hepatic lymphoma in an adolescent treated with hepatic lobectomy and chemotherapy

A case of B-cell non-Hodgkin's lymphoma, confined to the liver, in a 17-year-old boy is reported. The patient was treated with an extended left hepatectomy and combination chemotherapy: Cytoxan (cyclophosphamide), vincristine, prednisone, and methotrexate (COMP). The patient remains disease free at 1 year.     

Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type of the liver in a patient with hepatitis C virus infection

We report a case of primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue (MALT)-type of the liver presenting as a solitary mass in a patient with hepatitis C virus infection. A 73-year-old male was referred to our hospital because of a solitary mass in the liver, which was identified by ultrasonography during a routine follow-up study for his hepatitis C virus carrier status. A fine-needle biopsy was performed and the mass was diagnosed as non-Hodgkin's lymphoma. A detailed investigation showed no evidence of lymphoma in other sites. Left lateral segmentectomy was performed. Histologic examination showed diffuse, monotonous infiltration of centrocyte-like cells that are CD 19(+), CD 20(+), sIgM-lambda(+), CD 3(-), CD 5(-), CD 10(-). The patient received no adjuvant chemotherapy and is alive and disease free 34 months after surgery.     

Successfully-treated mesenteric non-Hodgkin's lymphoma involving hepatic mass--a case report

A mesenteric diffuse large B-cell lymphoma which also involves the liver is very rare. We describe herein a mesenteric diffuse large B-cell lymphoma with hepatic involvement successfully treated by the combination of surgical resection and multiagent chemotherapy. A 77-year-old man was referred to our hospital because of a right lower abdominal tumor. Abdominal computed tomography showed a mass in the mesenterium at the ileocoecal region and multiple mass in the liver. Gallium scintigram showed focal hot uptake at the ileocoecal region and multiple areas of increased Gallium uptake in the liver. With the diagnosis of a mesenteric tumor with liver metastases, a laparotomy was performed. By an intraoperative pathological examination, non-Hodgkin's lymphoma was suggested. The mesenteric mass was completely resected, but additional operative procedures were not done to the liver. After the operation, the patient was determined to have Stage IVB diffuse large B-cell lymphoma, and chemotherapy based on the CHOP-like regimen was given. After the 8th course of such chemotherapy, he was confirmed to have achieved a complete remission by abdominal computed tomography and Gallium scintigram.The Stage IV mesenteric diffuse large B-cell lymphoma involving the liver seems to be an indication for combination therapy of surgical resection and multiagent chemotherapy.     

原发性胃肠道非霍奇金淋巴瘤的临床特征及疗效分析

背景与目的:原发性胃肠道淋巴瘤是来源于结外淋巴组织的非霍奇金淋巴瘤(non-Hodgkinslymphoma,NHL),具有独特的临床病理特征。本文报告原发性胃肠道淋巴瘤的临床病理特征及其治疗效果。方法:回顾性分析我院1994年1月至2000年6月收治的经病理检查证实的22例原发性胃肠道淋巴瘤患者的病例资料。结果:本研究所有病例均随访3年以上,随访5年以上13例,3、5年生存率分别为45.5%(10/22)、38.5%(5/13);随着临床分期增高,3、5年生存率降低;低度恶性边缘带粘膜相关淋巴组织淋巴瘤较其它病理类型预后为佳;16例治疗后达到完全缓解者,3、5年生存率分别为62.5%(10/16)、45.5%(5/11),而6例原发灶未控者3年生存率为0,有显著性差异(P<0.05);12例单纯手术治疗者3、5年生存率分别为33.3%(4/12)、10%(1/10),6例手术联合化、放疗者(5例手术后辅助化疗,1例手术后行全腹照射)的3、5年生存率分别为83.3%(5/6)、66.7%(2/3)。结论:原发性胃肠道淋巴瘤应以综合治疗为主,原发灶未控可影响预后。