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.

Effect of taurine on immune function in mice with T-cell lymphoma during chemotherapy

Objective: To observe the effect of taurine on immune function in mice with T-cell lymphoma during chemotherapy.Methods: A total of 40 C57 BL/6 mice were selected and randomly divided into 4 groups,namely model group, chemotherapy group, taurine group and chemotherapy + taurine group, each containing 10 mice. Hypodermic injection was adopted to inoculate EL-4 cells in order to establish model of T-cell lymphoma. When the tumor achieved the size of1 cm3, intervention treatments were given to the groups respectively. Mice in model group received 0.2 m L of normal saline which was intraperitoneally injected on Days 1, 8 and 15 with 3 weeks as a cycle; mice in chemotherapy group were administered with 80 mg/kg body weight of gemcitabine which was also intraperitoneally injected on Days 1, 8 and 15 with 3 weeks as a cycle; mice in taurine group were administered with 80 mg/kg body weight of taurine intraperitoneally injected daily for consecutive 8 d; mice in chemotherapy + taurine group were treated in the same manner as the mice in taurine group and chemotherapy group. Five mice were sacrificed at 2 and 3 weeks after intervention respectively, and the tumor tissues were collected and weighted after removal of auxiliary tissue, then the tumor inhibition rate was calculated. The thymus and spleen of mice sacrificed at 3 weeks after intervention were collected and weighted, and thymus and spleen indexes were calculated. Enzyme linked immunosorbent assay was used to detect the serum levels of IL-4, IL-10, IL-12 and IFN-g in mice of each group.Results: The tumor weights in chemotherapy group, taurine group and chemotherapy + taurine group after 2 and 3 weeks of treatment were significantly lower than that in model group(P < 0.05); the tumor weight in chemotherapy + taurine group after 2 and 3 weeks of treatment was significantly lower than that in chemotherapy group(P < 0.05); the tumor inhibition rate in chemotherapy + taurine group was significantly higher than that in chemotherapy group and taurine group(P < 0.05); the thymus and spleen indexes in taurine group and chemotherapy + taurine group were significantly higher than those in chemotherapy group and model group(P < 0.05); the thymus and spleen indexes in chemotherapy group were significantly lower than those in model group(P < 0.05); after 3 weeks of treatment, the serum levels of IL-4, IL-12 and IFN-g in chemotherapy group, taurine group and chemotherapy + taurine group were significantly lower than those in model group(P < 0.05); the IL-4 level in taurine group and chemotherapy + taurine group was significantly lower than that in chemotherapy group(P < 0.05); the serum level of IL-10 in chemotherapy group and chemotherapy + taurine group was significantly higher than that in model group and taurine group(P < 0.05); the serum level of IFN-g in taurine group and chemotherapy + taurine group was significantly lower than that in model group and chemotherapy group(P < 0.05); after treatment of 3 weeks, the serum levels of IL-4 and IL-10 in chemotherapy group, taurine group and chemotherapy + taurine group were significantly lower than those in model group(P < 0.05), and IL-12 level was significantly higher than that in model group(P < 0.05);the level of IFN-g in taurine group and chemotherapy + taurine group was significantly higher than that in model group(P < 0.05), while the level of IFN-g in chemotherapy group was significantly lower than that in the other 3 groups(P < 0.05).Conclusions: Taurine can effectively enhance the immune function of mice with T-cell lymphoma during chemotherapy, reduce the toxicity of chemotherapy.

Unusual case of B cell lymphoma after immunosuppressive treatment for psoriasis

Lymphomas may be induced by the systemic immunosuppressive therapies used to treat psoriasis,such as ciclosporin,methotrexate and tumour necrosis factor(TNF)-α blockers.The biologic agents currently used in psoriasis include alefacept,efalizumab,and the TNF-α antagonists etanercept,infliximab,and adalimumab.Infections and cancer are the main possible consequences of intended or unexpected immunosuppression.We report a 59-year-old man with a history of severe psoriasis vulgaris treated with traditional immunosuppressant drugs followed by anti-TNF-α therapy;the patient was firstly hospitalized for an acute cholestatic toxic hepatitis,which we supposed to be related to adalimumab.The first liver biopsy showed active disease with severe hepatocellular damage caused by heavy lymphocytes infiltrate in portal tracts at in the interface with a not conclusive diagnosis of lymphoproliferative disease.The correct diagnosis of T cell/histiocyte-rich large B cell lymphoma(T/HRBCL) was only reached through a gastric biopsy and a second liver biopsy.T/HRBCL is an uncommon morphologic variant of diffuse large B-cell lymphoma not described until now in psoriatic patients receiving immunosuppressive biologic agents.In psoriatic patients,treated with biologic immunosuppressive agents,the suspect of abdominal lymphoma should always be included as differential diagnosis.Abdominal ultrasound evaluation need therefore to be included in the pretreatment screening as in the follow-up surveillance.

Hepatosplenic T-cell lymphoma in a 47-year-old Crohn's disease patient on thiopurine monotherapy

Hepatosplenic T-cell lymphoma(HSTCL) is a rare nonHodgkin lymphoma with a high mortality rate. Higher incidence is reported in patients with inflammatory bowel disease, specifically in male patients that are younger than 35 years, and have been treated with thiopurine and tumor necrosis factor(TNF)-α inhibitor combination therapy for over 2 years. In this case report we describe a 47-year-old patient with Crohn's disease(CD) who developed HSTCL after having been treated with thiopurine monotherapy for 14 years. To our best knowledge, only eleven cases exist of patients with CD who developed HSTCL while on thiopurine monotherapy. We report the first patient with CD, older than 35 years, who developed HSTCL while on thiopurine monotherapy. This emphasizes that HSTCL risk is not limited to young men receiving both thiopurines and TNF-α inhibitors.

All ileo-cecal ulcers are not Crohn's:Changing perspectives of symptomatic ileocecal ulcers

AIM To investigated clinical,endoscopic and histopathological parameters of the patients presenting with ileocecal ulcers on colonoscopy.METHODS Consecutive symptomatic patients undergoing colonoscopy,and diagnosed to have ulcerations in the ileocecal(I/C) region,were enrolled.Biopsy was obtained and theirclinical presentation and outcome were recorded.RESULTS Out of 1632 colonoscopies,104 patients had ulcerations in the I/C region and were included in the study.Their median age was 44.5 years and 59% were males.The predominant presentation was lower GI bleed(55,53%),pain abdomen ± diarrhea(36,35%),fever(32,31%),and diarrhea alone(9,9%).On colonoscopy,terminal ileum was entered in 96(92%) cases.The distribution of ulcers was as follows:Ileum alone 40%(38/96),cecum alone 33%(32/96),and both ileum plus cecum 27%(26/96).The ulcers were multiple in 98% and in 34% there were additional ulcers elsewhere in colon.Based on clinical presentation and investigations,the etiology of ulcers was classified into infective causes(43%) and noninfective causes(57%).Fourteen patients(13%) were diagnosed to have Crohn's disease(CD).CONCLUSION Non-specific ileocecal ulcers are most common ulcers seen in ileo-cecal region.And if all infections are clubbed together then infection is the most common(> 40%) cause of ulcerations of the I/C region.Cecal involvement and fever are important clues to infective cause.On the contrary CD account for only 13% cases as a cause of ileo-cecalulcers.So all symptomatic patients with I/C ulcers on colonoscopy are not Crohn's.