Beta‐2 microglobulin as a significant prognostic factor and a new risk model for patients with diffuse large B‐cell lymphoma

Previous reports have evaluated the prognostic value of serum beta‐2 microglobulin (B2MG) level in patients with non‐Hodgkin lymphoma. However, its role in predicting clinical outcome of patients with diffuse large B‐cell lymphoma (DLBCL) in the rituximab era has not been extensively investigated. Here, we evaluated the prognostic value of B2MG and proposed a new prognostic model including B2MG for patients with DLBCL. A total of 274 patients with newly diagnosed de novo DLBCL were retrospectively analyzed. We defined the best cutoff value as 3.2 mg/L by using a receiver operating characteristic curve. Patients with a B2MG level ≥3.2 mg/L had significantly lower overall survival (OS) and progression‐free survival than those with a B2MG level <3.2 mg/L (3‐year OS, 50.9% vs. 89.4%, p < 0.001; 3‐year progression‐free survival, 45.3% vs. 79.7%, p < 0.001). Multivariate analysis showed that B2MG, age, performance status, and Ann Arbor stage were independent prognostic factors for OS. We developed a new prognostic model consisting of these four significant factors. We stratified patients into four‐risk groups: low (L, 0 factor), low‐intermediate (LI, 1–2 factors), high‐intermediate (HI, 3 factors), high (H, 4 factors). This new prognostic model showed better risk discrimination compared with the National Comprehensive Cancer Network‐International Prognostic Index (5‐year OS: 100% and 23.4% vs. 100% and 27.1%, in L and H risk groups, respectively). Our study suggested that B2MG level is a significant prognostic factor in patients with DLBCL. A new prognostic index composed of age, performance status, stage, and B2MG could stratify the outcomes of patients with DLBCL effectively and appears to be a valuable risk model for these patients. Copyright © 2016 John Wiley & Sons, Ltd.     

The diagnosis and treatment of the thymic carcinoma

Thymic carcinoma was indistinct for criteria of clinicopathological diagnosis. Recently it gets easier to diagnose thymic carcinoma, because of progression of WHO classification and immunohistochemical technique. Commonly, patients are men and in sixties. Common symptoms are chest pain and dyspnea. Most cases are advanced, over Stage III of the Masaoka's classification. Combined therapies e.g. operation, chemotherapy and radiation were done, but complete resection is difficult. Prognosis is poor, the 3- and 5-year survival is 48.7% and 40.6%.     

A novel case with germline p53 gene mutation having concurrent multiple primary colon tumours

During a search for causative genes in patients with concurrent multiple primary colon tumours, we found a novel case with a germline mutation of the p53 gene, from GCC (Ala) to GTC (Val) at codon 189. Of the six primary colon tumours that this patient had, one large advanced carcinoma exhibited a somatic p53 mutation and a somatic APC mutation, in addition to the germline p53 mutation. Two early carcinomas and three adenomas had somatic APC mutations but no somatic p53 mutation or loss of the p53 allele. K-ras-2 mutations were detected in an advanced carcinoma and an early carcinoma. The present results suggest that a patient with a certain type of germline p53 mutation is predisposed to concurrent multiple colon tumours. It is also suggested that in such a patient, a somatic APC mutation is involved in tumour formation and that an additional somatic p53 mutation contributes to tumour progression.     

Unusual type of left paraduodenal hernia caused by a separated peritoneal membrane

Internal hernias are an uncommon cause of intestinal obstruction, with left paraduodenal hernia being the most frequent of these. Computed tomography (CT) with contrast media is advantageous for the clinical workup of suspected paraduodenal hernias. Here, we report a case of an unusual paraduodenal sac formed by a peritoneal membrane between the transverse and the descending colon, which entrapped the proximal jejunum, causing intestinal obstruction. Preoperative CT demonstrated a cluster of jejunal loops between the stomach and pancreas, and showed that the inferior mesenteric vein was laterally displaced. Received: January 15, 2001 / Accepted: May 11, 2001 Reprint requests to: T. Nishida