周仲瑛辨治恶性淋巴瘤学术思想管窥

恶性淋巴瘤为淋巴系统恶性增殖的肿瘤性疾病，属中医学中“恶核”、“痰毒”、“痰核”等范畴，临床可表现为浅表淋巴结的肿大，也可仅表现为发热、脏器侵犯，而致诊断困难。目前本病发病呈上升趋势，西药治疗该病以联合化疗、靶向治疗、造血干细胞移植为主，并且形成了个体化分层治疗的模式，使该病的治疗水平得到很大提高。但仍有部分病人存在化疗耐药、化疗不耐受、疾病复发等问题。淋巴瘤为免疫系统的肿瘤，发病的机制与免疫监控、免疫逃逸等因素相关。

Primary intestinal non-Hodgkin's lymphoma:A clinicopathologic analysis of 81 patients

AIM:To analyze the clinicopathologic features and the prognosis of primary intestinal lymphoma.METHODS:Patients were included in the study based on standard diagnostic criteria for primary gastrointesti-nal lymphoma,and were treated at Sun Yat-sen Univer-sity Cancer Centre between 1993 and 2008.RESULTS:The study comprised 81 adults.The most common site was the ileocaecal region.Twenty-two point two percent patients had low-grade B-cell lym-phoma.Fifty-one point nine percent patients had high-grade B-cell lymphoma and 25.9% patients had T-cell lymphoma.Most patients had localized disease.There were more patients and more early stage diseases in the latter period,and the origin sites changed.The ma-jority of patients received the combined treatment,andabout 20% patients only received nonsurgical therapy.The wverall survival and event-free survival rates after 5 years were 71.6% and 60.9% respectively.The mul-tivariate analysis revealed that small intestine and ileo-caecal region localization,B-cell phenotype,and normal lactate dehydrogenase were independent prognostic factors for better patient survival.Surgery based treat-ment did not improve the survival rate.CONCLUSION:Refined stratification of the patients according to the prognostic variables may allow indi-vidualized treatment.Conservative treatment may be an optimal therapeutic modality for selected patients.

Pseudolymphoma of the liver associated with primary biliary cirrhosis:A case report and review of literature

We report a case of two pseudolymphomas of the liver in a 63-year-old Japanese woman with primary biliary cirrhosis.One of the lesions was found incidentally during a medical examination,presenting as a 10 mm hypodense nodule that revealed hyperdensity in the early phase and hypodensity in the late phase in computed tomography(CT)after injection of contrast medium.Retrospectively,the 10 mm nodule had first been discovered as a 4 mm nodule during CT 4 years previously.Superparamagnetic iron oxide-enhanced MRI revealed another 4 mm hyperintense nodule in segment 6 in addition to the 10 mm hyperintense nodule in segment 7.CT during arterial portography revealed two hypointense nodules.Findings with other imaging modalities such as ultrasonography,magnetic resonance imaging,and hepatic angiography were consistent with hepatocellular carcinoma.A right posterior segmentectomy was performed,and the lesions were microscopically diagnosed as pseudolymphoma.To the best of our knowledge,only 31 other cases of this disease have ever been reported,with a highly asymmetrical male:female ratio of 1:9.7.Although we could find only one case of transformation of hepaticpseudolymphoma into lymphoma in the liver,the exact nature of development from benign pseudolymphoma to malignant lymphoma is still not fully understood and cases of hepatic lymphoma need to be followed carefully.

EXPRESSION OF PTEN AND CASPASE-3 AND THEIR CLINICOPATHOLOGICAL SIGNIFICANCE IN PRIMARY GASTRIC MALIGNANT LYMPHOMA

Objective To investigate the expression of PTEN and Caspase-3 in malignant lymphoma of the stomach and explore their role in progression of primary gastric malignant lymphoma. Methods Formalin-fixed paraffin embedded tissues from 56 cases of primary gastric malignant lymphoma and their adjacent non-tumor mucosa were evaluated for PTEN and Caspase-3 protein ex-pression by streptavidin-biotin-complex (SABC) immunohistochemistry. Their expression was compared with clinical tumor parameters with the relationship between PTEN and Caspase-3 expression concerned as well. Results The positive rate of PTEN expression in primary gastric lymphomas(50.0%, 28/56) was significantly lower than that in adjacent non-tumor gastric mucosa(96.4%, 27/28)(P < 0.05). Meanwhile,43 of 56(76.8%)gastric lymphomas indicated Caspase-3 expression, less than that in adjacent non-tumor mucosa (93.5%, 29/31) (P < 0.05). The expression of PTEN was negatively correlated with invasion and lymph node metastasis of gastric lymphoma(P < 0.05), while the Caspase-3 expression was negatively associated with the latter one(P < 0.05). Additionally, the PTEN expression was posi-tively correlated with Caspase-3 expression in the primary gastric malignant lymphoma(P < 0.05). Conclusions The down-regulated expression of PTEN and Caspase-3 played an important role in progression of primary malignant gastric lymphoma. PTEN, as a molecular marker of pathobiological behaviors of tumor, contributes to tumor progression by increasing cell mobility and angiogenesis, as well as decreasing cell adhesion and apoptosis.

Value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas using automated biopsy gun

AIM: To evaluate the value of CT-guided core-needle biopsy in diagnosis and classification of malignant lymphomas.METHODS: From January 1999 to October 2004, CT-guided core-needle biopsies were performed in 80 patients with suspected malignant lymphoma. Biopsies were performed with an 18-20 G biopsy-cut (CR Bard, Inc., Covington, GA,USA) needle driven by a spring-loaded Bard biopsy gun.RESULTS: A definite diagnosis and accurate histological subtype were obtained in 61 patients with a success rate of 76.25% (61/80). Surgical sampling was performed in 19 patients (23.75%) with non-diagnostic core-needle biopsies. The success rate of CT-guided core-needle biopsy varied with the histopathologic subtypes in our group.The relatively high success rates of core-needle biopsy were noted in diffuse large B-cell non-Hodgkin's lymphoma (NHL, 88.89%) and peripheral T-cell NHL (90%). However,the success rates were relatively low in anaplastic large cell (T/null cell) lymphoma (ALCL, 44.44%) and Hodgkin's disease (HD, 28.57%) in our group.CONCLUSION: CT-guided core-needle biopsy is a reliable means of diagnosing and classifying malignant lymphomas,and can be widely applied in the management of patients with suspected malignant lymphoma.

Primary Breast Lymphoma （PBL）： A Literature Review

Primary breast lymphoma is a rare disease. It is mainly found in female patients, the right breast in more frequently involved. The majority of PBL are diagnosed by biopsy or post- operative pathological findings. The combined therapy regimen, the main part of which is CHOP chemotherapy, is the main stream. Radical surgery is to be avoided.

Clinical Analysis of 10 AIDS Patients with Malignant Lymphoma

Objective This work summarizes the clinical features and treatment of 10 AIDS patients with malignant lymphoma. Methods A total of 10 AIDS patients with malignant lymphoma seen in Beijing Ditan Hospital since 2009 were enrolled. Clinical manifestations, pathological examinations, immunity levels, Epstein-Barr virus antibody examinations, complications, treatments, and outcomes were retrospectively analyzed. Results The main clinical manifestations of these patients included intermittent fever in 2 cases, neck masses and fever in 3 cases, auxiliary lymph node enlargement in 2 cases, and abdominal pain and bloating with fever in 3 cases. Up to 7 patients were pathologically diagnosed with diffuse large B cell lymphoma （DLBCL）, and 3 patients were pathologically diagnosed with Burkitt＇s lymphoma. Up to 8 patients had CD4 cell counts below 200/μL, and 2 patients had a level of more than 200/μL. Up to 7 patients were negative for EBV-IgM antibodies and 3 patients were not examined. Six patients underwent different chemotherapy and their prognoses were different. One patient with Burkitt＇s lymphoma alternatively took CODOXM and IVAC for 3 turns after VP chemotherapy; 1 patient with liver metastasis took R-CHOP 5 times, then changed therapy regimen to R-MINE and MINE. One patient with adrenal DLBCL took CHOP 6 times. Three patients with DLBCL took CHOP 1 or 2 times. Four patients gave up treatment. Various infections and side effects occurred, including bone marrow suppression, gastrointestinal bleeding, and renal dysfunction during chemotherapy. Six patients took HAARI, and 4 did not. Six patients died, whereas 3 patients got improved; and 1 patient was discharged. Conclusions AIDS patients with malignant lymphoma had various clinical manifestations, were immunocompromised, and had multiple metastases when they were admitted; they were already in the interim or late stage of lymphoma. Chemotherapy was not effective, and additional complications occurred. HAART failed to improve patient prognosis, and the overall prognosis was poor.

Malignant lymphoma of spleen presenting as acute pancreatitis: A case report

This is a case report of a patient who presented with acute pancreatitis without the common causes. A pancreatic biopsy revealed large B cell lymphoma. Spleen lymphoma with pancreatic involvement inducing acute pancreatitis, which is a rare disorder, was diagnosed. Here we also review the few similar cases reported in the literature.

Value of whole body diffusion weighted imaging in diagnostic and therapeutic evaluation of malignant lymphoma

Objective:The aim was to evaluate the role of whole body diffusion weighted imaging(WB-DWI) of magnetic resonance in the diagnosis and efficacy evaluation of malignant lymphoma.Methods:The clinical manifestation of whole body diffusion weighted imaging of 47 patients with malignant lymphoma being pathologically proved were carried on by retrospective analysis and to compare with 10 healthy volunteers.There were 8 cases of Hodgkin's lymphoma(HD) patients,of which WB-DWI examination of 5 cases were carried out before and after treatment and 3 cases were done after treatment.There were 39 cases of non-Hodgkin's lymphoma(NHL) patients,of which WB-DWI examination in 19 cases were acted before treatment,11 cases were done before and after treatment and 9 cases done after treatment.In apparent diffusion coefficient(ADC) diagram the ADC values of lymph nodes in patients with malignant lymphoma and healthy volunteers were measured respectively,among 16 patients the ADC values of parts of lymph node being consistent with the initial inspection were determined again and compared the values before and after,and compared with healthy volunteers.Results:Whole body magnetic resonance diffusion weighted imaging(MR-DWI) showed more sensitive to lymphoma,and 372 lymph nodes greater than 1 cm were detected with MR-DWI.Before treatment,mean ADC value of 35 patients with malignant lymphoma was(0.86 ± 0.21) × 10-3 mm2/s,of which an average ADC values of 28 cases after treatment was(1.22 ± 0.31) × 10-3 mm2/s,before and after treatment difference of the average ADC values of patients was statistically significant(P < 0.05);the average ADC value of cervical lymph nodes of 10 healthy volunteers(1.29 ± 0.12) × 10-3 mm2/s and of 30 patients with malignant lymphoma before treatment was statistically significant(P < 0.05),and to compare with 28 patients after treatment difference of the ADC values was not statistically significant(P > 0.05).Conclusion:WB-DWI and ADC values being measured in the clinical diagnosis of malignant lymphoma,staging and evaluation of efficacy of monitoring is a fast and effective technology,with some clinical value.

Clinical Analysis of 29 Cases with Primary Malignant Lymphoma of the Prostate

OBJECTIVE To summarize the clinical characteristics, pathology, treatment and prognosis of malignant lymphoma of the prostate. METHODS Clinical data from 29 patients with primary malignant lymphoma of the prostate were reviewed retrospectively. The median age was 66 years. Clinical signs and symptoms were due to lower urinary tract obstruction resulting from a diffusely enlarged prostate. Prostate biopsies revealed diffuse large B-cell non-Hodgkin＇s lymphoma. The therapeutic modalities included prostatectomy, radiotherapy and chemotherapy. RESULTS Extraprostatic involvement at various sites became evident in 19 of the 29 patients after diagnosis. Ten patients died from lymphoma with a median survival of 23 months （range, 2-30 months）. Seven patients were alive up to 60 months. CONCLUSION Malignant lymphoma involving the prostate was rare and has a rather poor prognosis. Prognosis related to the patient age, histologic type, and treatment or clinical stage of the disease at presentation.

A case of malignant fibrous histiocytoma of the head after trauma and radiation therapy

Malignant fibrous histiocytoma(MFH) firstly described as"malignant fibrous xanthoma"by O' Brien and Stout in 1964, is the most common soft tissue sarcoma of late adult life.Uncertain histogenesis and numerous subtypes make MFH a rather controversial entity.MFH only rare arises from structures of the head and neck.When it does, it most often originates in facial structures, particularly the maxilla.This report details a case of a patient with malignant fibrous histiocytoma presenting clinically as a right-sided large indurated frontoparietal mass, three months after head trauma and eight years after radiation therapy for brain lymphoma located in the right frontal and parietal lobes.Radical excision was a surgical challenge because of the extensiveness of the lesion.

Dignosis and Treatment of Primary Malignant Lymphoma of the Thyroid Gland

Primary malignant lymphoma of the thyroid gland is a rare disease comprising about 1%–3% of the thyroid malignancies, and this uncommon lymphoma represent less than 1% of all non-Hodgkinlymphomas (NHL). According to the modified Ann-Arbor-Classification primary thyroid lymphoma by definition is a lymphoma that is restricted to the thyroid gland (stage I E ) or involves the thyroid gland and supradiaphragmatic predominantly adjacent thyroid lymph nodes (stage II E ). Primary thyroid lymphoma is a heterogenous disease encompassing a wide variety of lymphoma entities. The diagnosis and treatment of this lymphoma are emphasis of this article. Key words thyroid gland - lymphoma - diagnosis - treatment

Solitary gastric Peutz-Jeghers type stomach polyp mimicking a malignant gastric tumor

Most cases of Peutz-Jeghers type polyps of the stomach are associated with mucocutaneous pigmentation and multiple intestinal polyposis.A solitary PeutzJeghers type polyp of the stomach is rare.We here report a case of a 71-year-old woman with a solitary Peutz-Jeghers type polyp of the stomach who presented with intolerable epigastric pain and weight loss of 5 kg over the prior two months.During the hospital treatment course for this patient,endoscopic examination revealed a bulging lesion with a central hole,mucosal ulceration,an asymmetrical wall thickness and a narrowing of the gastric lumen.A gastric biopsy further revealed ulceration with moderate dysplasia.The patient received endoscopic ultrasonography which showed a second subepithelial lesion that measured 4 cm×3 cm.Computed tomography of the abdomen subsequently showed a thickened gastric wall with three visibly enlarged lymph nodes,all greater than 1 cm.The suspected diagnosis was malignant gastric cancer with lymph node metastases.The other lesion,which measured 2 cm×2 cm×1 cm was noted in the submucosa of the jejunum during surgery.The patient was treated using a subtotal gastrectomy and partial resection of the jejunal tumor.The final pathological report indicated a gastric Peutz-Jeghers type polyp with proliferation of smooth muscle bundles in the submucosal layer,and hyperplastic glands in the mucosal layer and ectopic pancreas of the jejunum.This is the first reported clinical case of a solitary Peutz-Jeghers type polyp of the stomach accompanying a lymph node enlargement and ectopic pancreas in the jejunum that simulates stomach cancer with lymph node metastases.

Reduced-intensity conditioning allogeneic stem cell transplantation in malignant lymphoma: current status

stem cell transplantation （allo-SCT） is a potential cure for patients with malignant lymphoma that is based on the graft-versus-lymphoma （GVL） effect. Myeloablative conditioning allo-SCT is associated with high mortality and morbidity, particularly in patients older than 45 years, heavily pretreated patients （prior hematopoietic stem cell transplantation or more than two lines of conventional chemotherapy） or patients affected by other comorbidities. Therefore, conventional allo-SCT is restricted to younger patients （〈50 to 55 years） in good physical condition. Over the last decade, allo-SCT with reduced-intensity conditioning （RIC-allo-SCT） has been increasingly used to treat patients with lymphoma. This treatment is associated with lower toxicity and substantial decrease in the incidence of transplant- related mortality, and has the potential to lead to long-term remissions. Therefore, patients who are not suitable to undergo conventional allo-SCT can benefit from the potentially curative GVL effects of allo-SCT. Although RIC-allo-SCT has improved the survival of lymphoma patients, high post-transplant relapse rates or disease progression mainly results in treatment failure. Thus, further improvement is clearly needed. The role and timing of RIC-allo-SCT in the treatment of lymphoma remains unclear. Therefore, more prospective studies should clarify the effectiveness of this method. In this article, we review the recent literature on RIC-alIo-SCT as a treatment for major lymphoma subtypes. Areas that require further investigation in the context of clinical trials are also highlighted.

MR imaging features of secondary breast lymphoma in a male patient:a case report and literature review

We reported the rare case of an elderly man with secondary breast lymphoma （SBL） associated with magnetic resonance imaging findings. MR images demonstrated multiple well-defined masses in the left breast, with heterogeneous enhancement on dynamic contrast-enhanced sequences. The time signal-intensity curve rapidly increased during the initial rise phase and washed out during the delayed phase. The apparent diffusion coefficient （ADC） value was 0.649 x 104 mm2/s. Maximum intensity projection （MIP） showed that the masses were distributed in the upper outer quadrant, in the axillary region and in the lower outer region of the left chest wall. The pathology confirmed the diagnosis of non-Flodgkin＇s lymphoma. The combination of morphological and kinetic features, as well as a significantly lower ADC value, are helpful in the diagnosis of breast lymphoma and its differentiation from breast cancer.

Primary Pleural Extranodal Non-Hodgkin＇s Lymphoma Presenting As Pleural Thickening-A Case Report

Primary pleural lymphoma is a rare entity that has been described in association with human immunodeficiency virus （HIV） infection or pyothorax. This paper reports on a 27 year old man with no history of HIV infection or pyothorax who presented with progressive dyspnea and heaviness of chest.Chest radiography revealed complete opacification of the left hemithorax, and contrast enhanced computed tomography showed large left pleural effusion and homogeneous, extensive thickening of the parietal pleura. CT guided biopsy of thickened pleura is suggestive of non-Hodgkin＇s lymphoma-T cell lymphoblastic variety. Physicians should be aware of this rare location of primary pleural lymphoma manifested by thickening of the pleura.

Imaging Analysis of Primary Malignant Intracranial Lymphoma

OBJECTIVE To investigate the images characteristics of primary malignant intracranial lymphoma. METHODS Retrospective study was conducted on CT/MRI imaging characteristics of 9 cases with primary malignant intracranial lymphoma. RESULTS The patients had lesions mostly in the supratentorial region, including the parts of deep white matter, para-ependymal regions, and corpus callosum. The shapes of the lesions were round or irregular. CT scan showed equal or slightly high density of the tumor images, compared with the normal tissue in the brain. The TIWI of MRI scan on the tumor showed low signal and the T2WI showed equal or slightly high signal. The MRI signals were homogenous. Cystic lesion, calcification, and hemorrhage were rarely seen in MRI. Edema around tumor and its occupational effect was lessened. Edema around tumor shown in MRI was not in accordance with the true volume of the tumor mass. Enhanced scan on the lesions showed homogenous enhancement, and the pia mater invaded and/or the spread along ependyma. CONCLUSION Images of primary malignant intracranial lymphoma have specific characteristics that are useful in its diagnosis and differential diagnosis.

Paraaortic lymph node metastasis in patients with intra-abdominal malignancies:CT vs PET

AIM： To compare the diagnostic accuracy of computed tomography （CT） and positron emission tomography （PET） for the preoperative detection of paraaortic lymph node （PAN） metastasis in patients with intra- abdominal malignancies. METHODS： Sixty-six patients with intra-abdominal malignancies who underwent both CT and PET before lymphadenectomy were included in this study. Histopathologicaliy, 13 patients had metastatic PAN, while 53 had non-metastatic PAN. The CT criteria for metastasis were： short diameter ：）f 〉 8 mm, Iobular or irregular shape, and/or combined ancillary findings, including necrosis, conglomeration, vessel encasement, and infiltration. The PET criterion was positive fluorodeoxyglucose （FDG） uptake. The sensitivity, specificity, positive predictive value （PPV）, negative predictive value （NPV）, and accuracy of both modalities were compared with the pathologic findings, and the false positive and false negative cases with both CT and PET were analyzed.RESULTS： The sensitivity, specificity, PPV, NPV, and accuracy of CT were 61.5%, 84.9%, 50%, 90% and 80.3%, respectively. For PET, the percentages were 46.2%, 100%, 100%, 88.3%, and 89.4%. Additionally, there were 8 false positive CT cases （8/53, 15.1%） and zero false positive PET cases. Of the 13 metastatic PANs, there were 5 false negative CT scans （38.5%） and 7 （53.9%） false negative PET scans.CONCLUSION： For detecting PAN metastasis, CT is more sensitive than PET, while PET is more specific.

Duodenal pseudolymphoma: A case report and review of literature

We report a rare case of duodenal pseudolymphoma without any symptoms. The lesion located in front of the head of the pancreas was found accidentally during a medical examination. The findings of computed tomography and positron emission tomography-computed tomography suggested a stromal tumor or malignant lymphoma. Surgical resection was performed. The lesions were patho- logically diagnosed as duodenal pseudolymphoma.

Pathology Verified Concomitant Papillary Thyroid Carcinoma in the Sonographically Suspected Thyroid Lymphoma:A Case Report

PAPILLARY thyroid carcinoma （PTC） is the most common thyroid cancer and consists of nearly 80% of all cases of thyroid cancer.1 It is asso- ciated with the lowest level of malignancy and an excellent prognosis. Primary thyroid lymphoma （PTL） is a lymphomatous process which develops in the thyroid without involvement of primary lymphoid organs or distant metastases at diagnosis.2 It is a rare malignancy that accounts for 1%-5% of all thyroid malignancies and less than 2% of all extranodal lymphomas. The incidence of PTL is one or two cases per million.2＇ 3 It occurs frequently in elder woman, with a peak incidence in the sixth decade of life.