Psychosis as an indicator of recurrent non-Hodgkin's lymphoma:a rare presentation

Psychotic manifestations of brain tumours are rare but described in the literature mostly along with other neurological defcits. Memory loss, diffculty in attention and concentration, depression, anxiety, and mood symptoms are commonly described in brain tumours. A schizophrenia-like picture without a defcit in motor or sensory function may land the clinician into a diagnostic dilemma. Primary central nervous system lymphoma （PCNSL） is a highly malignant disease with high mortality and needs immediate attention. Our case which had a unique recurrence in the postoperative period with psychotic symptoms can be an eye-opener to be more vigilant about underlying clinical extension.

Non-Hodgkin's lymphoma involving chronic difficult-to-heal wounds:A case report

BACKGROUND Non-Hodgkin's lymphoma(NHL)is a malignant tumor that originates from the lymphoid tissues and can potentially affect numerous organs within the body.Among these,the skin stands out as one of the primary sites affected by NHL,often presenting with multiple extra-nodal manifestations.In this report,we present an unusual case of NHL involving chronic wounds in the lower extremities that were difficult to heal.The scars were successfully treated using radiotherapy in combination with extended excision debridement and peroneal artery perforator flap grafting,resulting in satisfactory outcomes.CASE SUMMARY A 19-year-old male patient presented with ulceration of the skin on the left calf near the ankle accompanied by purulent discharge.Subsequent pathologic biopsy confirmed a diagnosis of NHL(extranodal NK/T-cell lymphoma,nasal type).Initial treatment comprised local radiotherapy and wound care;however,the wound exhibited prolonged non-healing.Consequently,the patient underwent a series of interventions including radiotherapy,wound enlargement excision debridement,and peroneal artery perforator flap grafting.Ultimately,successful healing was achieved with favorable postoperative outcomes characterized by good texture of the flap without any signs of rupture or infection.CONCLUSION The combination of radiotherapy,wound enlargement excision debridement,and peroneal artery perforator flap grafting may present a favorable treatment modality for chronic non-healing lower leg wounds resulting from NHL.

Autologous peripheral blood stem cell mobilization following dose-adjusted cyclophosphamide, doxorubicin, vincristine and prednisolone chemotherapy alone or in combination with rituximab in treating high-risk non-Hodgkin's lymphoma

Background: The regimen of cyclophosphamide, doxorubicin, vincristine, and prednisolone(CHOP) is an eicient treatment of non-Hodgkin's lymphoma(NHL). This study aimed to assess the eicacy and toxicity of dose-adjusted CHOP alone or in combination with rituximab(R-CHOP) by examining the stem cell mobilization in NHL patients. Factors afecting the collection of CD34+ cells were also explored.Methods: Our retrospective study included 39 patients eligible for autologous stem cell transplantation: 14 patients who expressed CD20 and were inancially eligible received R-CHOP for autologous peripheral blood stem cell(APBSC) mobilization; the remaining 25 patients received CHOP.Results: The median CD34+ cell yield was 7.01 × 106 cells/kg body weight(range 1.49–28.39 × 106 cells/kg body weight), with only two patients failing to meet the target CD34+ cell harvest of ber of apheresis procedures per patient was 1(range 1–3). The≥2.0 APBS× 106 cells/kg body weight. The median numC mobilization yield of the CHOP group appeared to be higher than that of the R-CHOP group(P response(CR) rate in = 0.005), whereas the success rate was similar between groups. R-CHOP elevated the completeB cell lymphoma patients as compared with CHOP(P = 0.01). No signiicant diferences in toxicity or engraftment were observed between the two groups.Conclusion: The present study demonstrated that dose-adjusted CHOP chemotherapy efectively mobilized APBSCs in NHL patients and that the addition of rituximab to dose-adjusted CHOP chemotherapy elevated the CR rate for patients with B-cell lymphoma.

Hepatitis C virus and non-Hodgkin's lymphomas:Metaanalysisof epidemiology data and therapy options

Hepatitis C virus(HCV) is a global health problem affecting a large fraction of the world's population: This virus is able to determine both hepatic and extrahepatic diseases. Mixed cryoglobulinemia, a B-cell "benign" lymphoproliferative disorders, represents the most closely related as well as the most investigated HCVrelated extrahepatic disorder. Since this virus is able to determine extrahepatic [non-Hodgkin's lymphoma(NHL)] as well as hepatic malignancies(hepatocellular carcinoma), HCV has been included among human cancer viruses. The most common histological types of HCV-associated NHL are the marginal zone, the lymphoplasmacytic and diffuse large cell lymphomas. The role of the HCV in the pathogenesis of the B-cell lymphoproliferative disorders is confirmed also by the responsiveness of the NHL to antiviral therapy. The purpose of this review is to provide an overview of the recent literature and a meta analysis of the epidemiology data, to explain the role of HCV in the development of NHL's lymphoma. Furthermore, the possibility to treat these HCV-related NHL with the antiviral therapy or with other therapeutic options, like chemotherapy, is also discussed.

Detection of BCL2-IGHrearrangement on paraffin-embedded tissue sections obtained from a small submucosal tumor of the rectum in a patient with recurrent follicular lymphoma

A 59-year-old woman was admitted to our hospital because of recurrent follicular lymphoma(FL).Colonoscopic examination revealed a rectal submucosal tumor(SMT)without any erosions and ulcers.In this patient,it was difficult to distinguish non-Hodgkin's lymphoma(NHL)invasion from other disorders of the colon including carcinoid tumor merely based on endoscopic findings.Histopathologic and immunohistochemical studies on biopsy specimens showed an infiltration of atypical lymphocytes that were positive for CD20 and BCL2 but negative for UCHL-1.Fluorescence in situ hybridization on paraffin-embedded tissue sections (T-FISH)identified a translocation of BCL2 with IGHgene. Based on these findings,the tumor was defined as an invasion of FL.T-FISH method is useful for the detection of a monoclonality of atypical lymphocytes in an SMT of the gastrointestinal tract,and particularly for the detection of chromosomal translocations specific to lymphoma subtypes.

Temozolomide plus rituximab in the treatment of recurrent central nervous system lymphoma:Case report and literature review

Objective： The aim of our study was to investigate the treatment of recurrent central nervous system lymphoma. Methods： A case of recurrent central nervous system lymphoma in a 46-year-old male was treated with temozolomide 150 mg/m2 per day for 5 days; rituximab 750 mg/m2 on dl and d8, injected from Ommaya capsule to lateral ventricle, cycles were repeated every 28 days. Results： The patient achieved complete remission and the side effects was light after the treatment. Conclusion： Using this therapy method had certain curative effect on recurrent central nervous system lymphoma. Further studies should be needed on its indication.

STUDIES OF THE CHARACTERISTIC FEATURES OF KI-1 POSITIVE NON-HODGKIN'S LYMPHOMA

The clinical histopathological and immuno-phenotypic features in 5 patients with Ki-1 positive non-Hodgkin's lymphoma (NHL) were studied. When firstseen, 4 patients presented enlargement of superficiallymph nodes, with skin lesions in 2 patients. Two patientsin stage Ⅳ with fever, hepato-splenomegaly and bonemarrow invasion, died. Histologically, the tumor cellsshowed diffused or patchy hyperplasia. The cells wererelatively large in size, rich in basophilic or slightlyeosinophilic cytoplasm with irregular-shaped nuclei,prominent nucleoli, and distinct anaplasia andpleomorphism. Some of the cells looked very much likethe Reed-Sternberg cells. Multinucleated giant cells wereseen. Immunophenotypically, all the cells were CD30 (Ki-1) and CD25 (IL-2 receptor) positive but CD15 (Leu M1)negative. Thus, the 5 patients with Ki-1 positive NHLwere all of T cell type.

Extranodal Imaging Manifestations of Non-Hodgkin's Lymphoma

A series of imaging features of extranodal, multi-systemic involvements in Non-Hodgkin's lymphoma (NHL) were investigated The clinical data and imaging findings of 16 patients with pathologically proved NHL were retrospectively analyzed The related literatures were reviewed Of the 16 cases of NHL, skeletal involvement was found in 4, nasal cavity and nasal sinuses were involved in 4, too Lesion in the thorax was seen in 3 patients, hepatic involvement occurred in one case, cerebral ventricle was affected in 3 cases, mesentery was involved in one case Even though extranodal involvement of NHL exhibited extremely variable patterns, there were some relatively typical imaging findings Emphasized in this report were the relatively specific imaging manifestations of different systems, which may mimic infectious or other neoplasms of different sites The importance of imaging studies lies in the availability for diagnosis, staging and follow-up of NHL Combined with the clinical and other related information, the diagnostic accuracy can be further improved, thus, providing reliable evidence in guiding clinical management

Successful Treatment of Elderly Diffuse Large B-Cell Lymphoma with Central Nervous System Recurrence by Rituximab, Ranimusutine, Ifosfamide, Procarbazine, Dexamethasone, and Etoposide Therapy

The prognosis of CD20-positive (CD20+) diffuse large B-cell lymphoma (DLBCL) with central nervous system (CNS) recurrence is still poor. A standard treatment for CD20+ DLBCL with CNS recurrence in elderly patients has not been established mainly due to adverse effects. We previously reported the efficacy and safety of MIND-E (ranimustine, ifosfamide, procarbazine, dexamethasone, and etoposide) therapy for elderly CD20+ DLBCL patients with CNS recurrence. Here, we report the use of R-MIND-E therapy (rituximab, ranimustine, ifosfamide, procarbazine, dexamethasone and etoposide) in an elderly CD20+ DLBCL patient with CNS recurrence. The patient achieved a complete response according to Revised Response Criteria for Malignant Lymphoma, and treatment-related toxicity was tolerable. R-MIND-E therapy may be a feasible and useful treatment option for elderly CD20+ DLBCL patients with CNS recurrence.

非霍奇金淋巴瘤幸存患者癌症复发恐惧状况调查及影响因素分析

目的 探讨非霍奇金淋巴瘤幸存患者的癌症复发恐惧(FCR)情况及其影响因素。方法 选择2022年1月至2023年3月就诊于江苏省人民医院的100例非霍奇金淋巴瘤幸存患者,评估患者FCR状况,根据患者病历资料采集其一般资料,评估其焦虑、抑郁状态,比较不同一般资料、焦虑、抑郁状态患者FCR情况,分析非霍奇金淋巴瘤幸存患者FCR的影响因素。结果 100例患者FCR评分为(89.36±4.02)分。不同年龄、疾病分期、家庭人均月收入、焦虑状态患者的FCR评分比较,差异有统计学意义(P<0.05)。多元线性回归分析显示,年龄(X_(1))、疾病分期(X_(2))、家庭人均月收入(X_(3))、焦虑(X_(4))是恶性淋巴瘤幸存患者FCR的独立危险因素(P<0.05)。回归方程如下:Y=26.116-2.274×X_(1)+3.152×X_(2)-0.070×X3+0.234×X4(R~2=0.521,△R~2=0.497,F=22.071,P<0.05)。结论 目前非霍奇金淋巴瘤幸存患者FCR情况值得引起重视,特别是要注重对年龄偏低、疾病分期高、家庭人均月收入偏低患者的管理和干预,并强化心理干预等,以缓解患者焦虑,进一步控制患者FCR。

不同HDAC水平的外周T细胞淋巴瘤患者预后复发的影响因素分析

目的:基于潜在类别分析不同组蛋白去乙酰化酶(HDAC)水平的外周T细胞淋巴瘤(PTCL)患者预后复发的影响因素分布特征。方法:选取2012年9月至2019年9月在本院就诊的PTCL患者112例,将患者分为复发组和未复发组,比较两组患者的临床资料。通过多因素Logistic回归分析影响患者预后复发的危险因素。采用潜在类别分析法比较复发高风险组与复发低风险组间预后复发影响因素的分布特征差异。结果:复发组患者87例(77.68%),未复发组患者25例(22.32%)。多因素Logistic回归分析结果显示,ECOG评分≥2分、Ann Arbor分期为III-IV期、IPI评分>2分、骨髓受累、血清β2-微球蛋白(β2-MG)水平升高、近期疗效未达到完全缓解(CR)和部分缓解(PR)、HDAC高表达为患者复发的独立危险因素(P<0.05)。HDAC高水平患者的复发率明显高于HDAC低水平患者(P<0.05)。聚类分析结果显示,预后复发风险呈明显聚集性,可将患者分为预后复发高风险组(HDAC>5分)和低风险组(HDAC≤5分)。潜在类别分析结果显示,与预后复发低风险组相比,预后复发高风险组中“危险因素分布较多型”占比较高(P<0.05)。结论:不同HDAC水平的PTCL患者的预后复发情况以及预后复发高风险与低风险人群中危险因素分布特征均有差异。

基于多随机经验核的弥漫大B细胞淋巴瘤复发预测

目的基于多随机经验核分类器构建弥漫大B细胞淋巴瘤完全缓解后两年内复发情况的预测模型,为患者的治疗提供决策依据。方法利用山西省某三甲医院2010-2020年电子病历库中符合本研究要求的445名患者信息,基于五种常见类别不平衡处理方法以及多随机经验核分类器构建复发预测模型,并与五种分类器进行比较。结果基于SMOTE Tomek Links+多随机经验核分类器的复发预测模型取得了最优的分类性能(accuracy=0.89,precision=0.87,recall=0.92,f1-Score=0.89,brier score=0.11)。结论对DLBCL实际数据集,本文使用SMOTE Tomek links处理不平衡数据并构建多随机经验核模型,模型性能达到最优的同时计算复杂度也不高,可为DLBCL复发预测提供有力参考。

深度神经网络在不规则弥漫大B细胞淋巴瘤时间序列数据分类预测中的应用

目的探讨深度神经网络在不规则时间序列数据中的分类效果,并对山西某医院2014-2020年362例弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)患者进行复发预测。方法回顾性地收集了确诊且治疗后达到完全缓解的362例DLBCL患者的病例资料,并预测其两年内的复发。先利用LASSO回归进行变量的筛选,再构建基于GRU-ODE-Bayes(gated recurrent unirt-ordinary differential equation-Bayes)的不规则时间序列深度神经网络模型,并与传统模型及其他深度神经网络模型进行比较。结果在本文的所有模型中,传统模型的分类性能不及深度神经网络模型。其中GRU-ODE-Bayes模型最优,其AUC为0.85,灵敏度为0.84,特异度为0.71,G-means为0.77。结论关于不规则DLBCL时间序列数据,与本文其他模型相比,GRU-ODE-Bayes模型可以更精准地预测DLBCL患者的复发情况,可为患者个性化治疗和医生决策提供参考。

Primary Lymphoma of Respiratory System (A Report of 11 Cases)

Objective: To analyze the clinical and pathologic features and the treatmentoutcomes of primary lymphoma of respiratory system (PLRS). Methods: The clinical manifestation,imaging changes, pathologic subtypes, treatment and overall survival of 11 patients with PLRS wereanalyzed retrospectively. Results: Of the 11 patients diagnosed with PLRS by histopathology, thetumor of 2 patients occurred in trachea and the other 9 in lung. Cough, dyspnea and fever were themost frequent symptoms. Mass or infiltrative changes could be found on the chest X-ray and/or CTscan. Two patients were diagnosed as having Hodgkin's Lymphoma (HL) and 9 having non-Hodgkin'sLymphoma (NHL), including 7 patients with low degree NHL [5 of them (55.6%) were mucosa-associatedlymphoid tissue (MALT) lymphoma] and 2 with intermediate degree NHL. Of 10 patients undergoingexploratory thoracotomy and surgical treatment, 8 received adjuvant chemotherapy and 2 adjuvant ofradiotherapy. The remaining patient was subjected to combined chemotherapy. Both of HL patientssurvived more than 5 years without clinical disease. The median survival of MALT lymphoma and othertype of NHL was 39 months and 34 months respectively. Conclusion: Both the clinical manifestationand imaging changes are non-specific. The diagnosis was made through exploratory thoracotomy (10cases) and fiber-optical bronchoscopy (1 case). MALT lymphoma is the most frequent pathologicsubtype. Majority of patients are diagnosed and treated by surgical resection. The prognosis isacceptable.

结外自然杀伤/T细胞淋巴瘤的治疗研究进展

结外自然杀伤/T细胞淋巴瘤(ENKTCL)是一种少见的与EB病毒感染相关的恶性肿瘤,具有较强的侵袭性。目前,对于晚期或复发/难治性ENKTCL,常规推荐使用含左旋门冬酰胺酶的非蒽环类药物联合其他药物进行化学治疗,但长期生存率仍较低。近年来,造血干细胞移植、免疫治疗和靶向治疗受到了广泛关注,为ENKTCL的治疗提供了新的选择。本文就造血干细胞移植、免疫治疗和靶向治疗在ENKTCL治疗中的应用进展进行综述。

Pancreatic T/histiocyte-rich large B-cell lymphoma: A case report and review of literature

Primary pancreatic lymphoma(PPL)is an extremely rare form of extranodal malignant lymphoma.The most common histological subtype of PPL is diffuse large B cell lymphoma(DLBCL).In rare cases,PPL can also present as follicular lymphoma,small lymphocytic lymphoma,and T cell lymphoma either of non-Hodgkin’s lymphoma or of Hodgkin’s lymphoma.T-cell/histiocyterich large B-cell lymphoma(T/HRBCL)is an uncommon morphologic variant of DLBCL with aggressive clinical course,it is predominantly a nodal disease,but extranodal sites such as bone marrow,liver,and spleen can be involved.Pancreatic involvement of T/HRBCL was not presented before.Herein,we report a 48-year-old male who was hospitalized with complaints of jaundice,dark brown urine,pale stools,and nausea.The radiological evaluation revealed a pancreatic head mass and,following operative biopsy,the tumor was diagnosed as T/HRBCL.The patient achieved remission after six cycles of CHOP chemotherapy.Therefore,T/HRBCL can be treated similarly to the stage-matched DLBCL and both of them get equivalent outcomes after chemotherapy.

Therapeutic Efficacy of L-asparaginase in the Treatment of Refractory Midfacial Peripheral T-Cell Non-Hodgkin’s Lymphoma

Objective: To improve the efficacy of refractory midfacial peripheral T-cell non-Hodgkin’s lymphoma (MPTC-NHL) with L-asparaginase (L-ASP) based salvage chemotherapy. Methods: 21 patients with refractory MPTC-NHL were analyzed. 11patients (L-ASP group) received L-asparaginase based salvage chemotherapy consisting of L-asparaginase, vincristine and dexame-thosone. 10 patients (control group) received salvage combination chemotherapy without L-asparaginase. Results: Complete remission rates were 45.6% for L-ASP group and 0.0% for control group (p<0.05). Overall response rates (CR+PR) were 63.6% for L-ASP group and 10.0% for control group, respectively (p<0.05). 2-year survival rates were 45.5% for L-ASP group and 0.0% for control group (p<0.05). The major adverse effects of L-ASP were leukopenia, elevation of serum bilirubin and hyperglycemia. Conclusion: The preliminary clinical study shows that the L-ASP based salvage chemotherapy may improve the response rate and 2-year survival rate of the patients with refractory MPTC-NHL. It is necessary to continue the study further.

Loss of CD20 expression in relapsed diffuse large B cell lymphoma after rituximab therapy:a case report and review of the literature

Nowadays, resistance to rituximab has become a major issue in clinical practice. And loss of CD20 may contribute to it. Here we presented a case of loss of CD20 expression in relapsed diffuse large B cell lymphoma treated with rituximab and discuss the incidence, mechanism, influence factors, specific markers, prognosis and treatment of this disease. These results suggested that a post-relapse biopsy after rituximab treatment shguld be performed. CD79a and Pax-5 should be used as the first-line B lineage-specific markers for these patients. Though mechanisms of CD20 decrement are not fully elucidated, the down-regulation of CD20 mRNA is the most probable hypothesis. Recently various new agents are developed, but the prognosis is still poor. Further studies for new treatments are needed.

癌症复发恐惧在中青年淋巴瘤患者家庭功能与创伤后成长间的中介效应研究

目的:探讨癌症复发恐惧在中青年淋巴瘤患者家庭功能与创伤后成长间的中介作用。方法:采用自行设计一般资料调查表、创伤后成长量表、癌症患者恐惧疾病进展简化量表、家庭功能评定量表对280例淋巴瘤患者进行调查。结果:淋巴瘤患者创伤后成长总分为(69.69±17.75)分,与既往调查结果一致,个人力量条目均分最高;淋巴瘤患者恐惧疾病进展量表总分为(40.01±9.08)分,高于大肠癌、乳腺癌患者得分;淋巴瘤患者家庭功能总分为(134.61±22.11)分,家庭功能处于一般水平。创伤后成长、癌症复发恐惧、家庭功能三者两两之间存在相关性。癌症复发恐惧在创伤后成长与家庭功能间发挥中介作用,中介效应占总效应比为32.69%。结论:临床护理工作中,要重视家庭访视和居家护理的作用,提高家属对患者治疗康复护理的积极性和投入度,改善患者家庭功能,加强健康教育,分享成功抗癌经验,降低患者的癌症复发恐惧,提高患者创伤后成长水平。

非霍奇金淋巴瘤患者癌症复发恐惧现状及影响因素研究

目的调查非霍奇金淋巴瘤(NHL)患者癌症复发恐惧(FCR)现状,分析其影响因素。方法采用一般资料调查表、恐惧疾病进展简化量表、社会支持量表、焦虑自评量表、抑郁自评量表、创伤后应激障碍检查表、简体中文版创伤后成长评定量表、疾病认知问卷、简易应对方式问卷及医患关系问卷对2021年5—12月上海交通大学医学院附属瑞金医院住院的264例NHL患者进行调查。结果NHL患者FCR得分为(30.69±9.13)分,有33.33%的患者(n=88)FCR≥34分;女性、居住在农村、在职、病程、疾病认知、应激水平、焦虑水平是FCR的影响因素(P<0.01)。结论约1/3的非霍奇金淋巴瘤患者存在病理水平的FCR,需要引起临床工作人员的高度重视;对于居住在农村、在职、病程在1年以内的女性,需要格外关注;可以通过认知行为疗法等干预措施,改变患者认知,降低患者的应激水平和焦虑水平,从而降低非霍奇金淋巴瘤患者FCR水平。