Primary Non-Hodgkin’s Malignant Lymphoma of the Uterus at the Reference Hospital of Maradi/Niger: A Case Report

Malignant non-Hodgkins lymphoma (MHNL) of the uterus is uncommon. We report a case diagnosed on the basis of histologic and immunohistochemical studies of a hysterectomy specimen induced by a very painful pelvic mass in a 50-year-old patient with no previous history of the disease. It was classified as Ann Arbor IV Bb after imaging, given the medullary infiltration and signs of clinical and biological evolutivity: the patient had received two courses of chemotherapy, CHOP protocol. She died 23 days after the second treatment due to a hypertensive crisis.

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.

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 in the ileum diagnosed by double-balloon enteroscopy

A 73-year old man presented with abdominal pain. A tumor with central ulceration was observed in the ileum using double-balloon enteroscopy. Histological findings of the biopsy specimens were consistent with malignant lymphoma. Double-balloon enteroscopy confirmed the diagnosis of a malignant lymphoma tumor which was surgically resected. The patient is still in complete remission now.

Establishment of a Human Malignant T Lymphoma Cell Line Carrying a Retrovirus-like Particles with RT Activity

We have established an IL-2 independent malignant lymphoma line (CM-1) from peripheral T lymphocytes donated by a femalc patient with nervous systcm disease, the binlogical characteristics of CM-1 cells was studied in this paper. Another T lymphocytes,such as peripheral T lymphocytes donated by a maIe patient with multiple sclerosis, could be transformed into a malignant lymphoma line by using filtered supernatant of the CM-1 cultured medium, thus the CM-2 cell line u'as estabIished. The CM-1 and CM-2 cells were transplanted by subcutaneous inoculation into nude mice, and could cause the occurrenceof typical maIignant lymphoma. The observation of eIectron micrographs suggested the existence of virions in the CM-1 and CM-2 cells, and these virions were similar toretrovirus in the ultra-structure characteristics. lt was found that this virus possesses reverse transcriptase activity. ResuIts obtained from serological assay, molecular hybridization and PCR excluded the existence of other human viruses, which were commonly usedin our laboratory. The unknown virus possesses strong transformation activity, and probably is a new retro virus. Meanwhile, the work on the clone and sequence analysis ofthis virus are being carried out.

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 Patient with Malignant Spinal Epidural Lymphoma with Initial Rapidly Aggravating Paraplegia

We report the case of a 51-year-old female with rapid neurological deterioration as an initial presentation of non-Hodgkin’s lymphoma. Paraplegia occurred suddenly after a 4-day history of weakness and numbness of the lower extremity. MRI revealed a dorsal epidural mass from T10 to T11 that compressed the spinal cord. There was neither bone destruction nor a paravertebral mass. Emergency decompressive laminectomy and tumor resection were performed. Histological analysis of the surgical specimen indicated diffuse large B cell lymphoma. The clinical stage was IV on CT and complete remission was achieved by subsequent chemotherapy. Spinal cord compression occurs in the course of non-Hodgkin’s lymphoma in 0.1% - 6.5% of cases, but this situation usually develops in the late phase with bone destruction and/or a paravertebral mass. Cord compression and especially the severe symptoms such as paraplegia are rare as the initial presentation of lymphoma.

Rikkunshi-to Partially Reverses Cancer Chemotherapy-Induced Decrease in Plasma Valproic Acid Concentration in a Patient with Malignant Lymphoma

A fifty-five-year-old male patient with malignant lymphoma who took oral valproic acid (VPA) tablets and itraconazole (ITZ) capsles received 3 courses of cancer chemotherapy, including 2 courses of a combination of rituximab/methotrexate/ifosphamide/etoposide/ carboplatin/ methylpredonisolon (R-IMVP16/CBDCA regimen) and subsequent one course of a combination of rituximab/ranimustine/citara bine/etoposide/merphalan (R-MEAM regimen). Plasma concentration of VPA dramatically decreased below the therapeutic concentration after the first and second chemotherapy and seizures appeared in both cases. Plasma concentration of ITZ was also lowered after the second chemotherapy course. At the third chemotherapy, Rikkunshi-to, a Japanese herbal medicine, was prescribed for 14 days. Plasma VPA concentration decreased, though to a lesser extent, after chemotherapy, in which the level was near the border of therapeutic concentration. No convulsion was observed. Therefore, care should be taken to monitor plasma drug concentration during cancer chemotherapy. Rikkunshi-to may be useful to alleviate the chemotherapy-induced decrease in plasma concentrations of orally administered drugs.

COMBINATION CHEMOTHERAPY WITH COBDP IN MALIGNANT LYMPHOMA: AN ANALYSIS OF 64 CASES

From February 1986 to February 1989, 64 patients with malignant lymphoma were treated with COBDP regimen. Of these patients, there were 7 cases with Hodgkin's disease and 57 cases with non Hodgkin's lymphoma. Clinical staging showed 7 stage Ⅰ , 5 stage Ⅱ, 22 stage Ⅲ and 30 stage Ⅳ . The COBDP regimen was carried out as : Cyclophosphamide 600 mg iv on days 1,8; vincristine 2 mg iv on days 1,8; Pingyanymycin long im on days 1, 4, 8, 11; cis-dichlorodiamineplatinum 20 mg iv drip on day 1 - 5 and prednisone 10 mg po tid on day 1 -14. Treatment results showed 39% (25 cases) achieving complete remission (CR) , 52% (33 cases) partial remission (PR) , giving an over-all response rate of 91 % (CR+PR). There was a significant difference in the CR of the untreated patients (56%) and that of the treated ones (28%) (P< 0.05) .However, between two groups of patients, no statistical significance was observed in the median CR duration (> 12 months, vs >9 months) and the median surrivals of the CR patients (> 16. 5 months, vs > 15 months) (P< 0.05). The median survival after CR was significantly longer than that after PR (P<0. 05). The side effects were: anorexia, nausea; vomiting, alopecia and leucopenia without montality or pulmonary complication. The authors believe that COBDP regimen mayserve as the first line attack against walignant lymphomas.

Successful endoscopic hemostasis for gastric arterial bleeding due to invasion of malignant lymphoma

A 75-year-old male with malignant lymphoma (ML) accompanied with gastric lesion was treated with combination chemotherapy. The patient produced tarry stool on the 4th d, and emergency gastroscopy showed arterial bleeding from the lesion. Hemostasis was achieved by injecting pure ethanol and using hemostatic clips. There is only one previous report on endoscopic hemostasis being effective for bleeding due to lymphoma. Since gastric bleeding causes significant mortality, endoscopic hemostasis should be considered as first-line treatment for ML patients who were treated with chemotherapy.

Relevance on the diagnosis of malignant lymphoma of the salivary gland

Malignant lymphoma originates from the lymphohematopoietic system.It can occur in any lymphoid tissue.Malignant lymphoma of the salivary gland is rare,but its incidence has increased in recent years.Its clinical-presentations are nonspecific,and it is often manifested as a painless mass in a salivary gland,which can be accompanied by multiple swollen cervical lymph nodes.Confirmation of the diagnosis before an invasive procedure is difficult.Clinically,malignant lymphoma of the salivary gland tends to be misdiagnosed,leading to an inappropriate treatment plan and the ultimate delay in the optimal treatment of the disease.This article reviews the pathogenesis,clinical features,imaging findings,diagnosis,treatment and prognosis of malignant lymphoma of the salivary gland.

OKT_（10） POSITIVE CELLS IN PERIPHERAL BLOOD OF MULTIPLE MYELOMA AND MALIGNANT LYMPHOMA

patients with maligant lywioma and 18 patients with multiple myeloma were investigated for expression of OKT10 in Peripheral blood. A significant increasing of OKT10 positive cells was found in most of patients(26/3espectively) with Non_Hodgekin's lymphoma(NHL)and multiple myeloma(MM). The increasing of OKT10 positive cells is related to the degree of malignancy of patients with NHL from low_grade to high_grade.It is useful to judge prognosis of NHL.The presence of OKT10 positive cells was unrelated with treatment status and clinic phases. some of OKT10 positive cells belong to neoplastic precursors.

CLONAL PROLIFERATION AND LONG-TERM CULTURE OF MALIGNANT LYMPHOMA CELLS UNDER SERUM-FREE CULTURE CONDITIONS

We developed a serum-free culture system that promoted the growth of B cell colonies in peripheral blood, bone marrow, lymph nodes and cerebrospinal fluid (CSF) from 7 out of 8 patients with non-Hodgkin's lymphomas of B cell type. The culture cells were pretreated with or without galactose oxi-dase (GO) prior to plating. Colony growth was best supported with BCGF. A moderate increment was observed with rIL-3, as well as rIL-1β and even to a lesser degree, by rlL-2, while B cell stimulating factor-2 (rBCSF-2) and rlL-1β did not show significant activity. rGM-CSF and rG-CSF had little effect, while rM-CSF enhanced the formation of lymphoma colonies. The cells from different patients had different requirements for Staphylococcus aureus protein A and GO pretreatment. It reflected the differences in activation and differentiation status and surface properties of lymphoma cells from different patients. The cells from CSF of one patient were successfully maintained in serum-free culture medium supplemented with 10% BCGF or 5% PHA-LCM for more than 4 months. The long-term culture cells were EBV negative, phenotypically consistent with B cells and gene rearrangements for JH, Kappa and myc. This serum-free culture system allowed extensive analysis of the growth requirements for clonogenic precursors.

PRIMARY MALIGNANT LYMPHOMA OF THE LUNG: REPORT OF A CASE AND REFERENCE TO DIAGNOSTIC CRITERIA

Although pulmonary involvement ofmalignant lymphoma is quite common, primarymalignant lymphoma of the lung is rare. Two caseswere reported by Chinese literature in 1985. Thispaper describes a case of primary pulmonarymalignant lymphoma which has been remitted by

CLINICAL STUDY ON SERUM COPPER AND ZINC LEVELS AND COPPER/ZINC RATIO IN MALIGNANT LYMPHOMA

173 simultaneous determinations of serum copper levels (SCL), serum zinc levels (SZL) and copper/zinc ratio (CZR) were made by atomic absorption spectrophotometry in 51 previously untreated lymphoma patients. SCL and CZR were significantly higher in patients before treatment (mean value 22.97 μmol/L, 1.55, respectively) and in those who did not reach complete remission (mean 21.21 μmol/L, 1.36) as compared with the patients in complete remission (mean 16.36 μmol/L, 1.06) or normal controls (mean 15.67 μmol/L, 0.98). The mean value of SCL and CZR of patients in complete remission did not differ significantly from those of normal controls. Patients in stages HI and IV had higher SCL and CZR (mean 25.15 μmol/L, 1.79) than those in stage Ⅰ and Ⅱ (mean 19.30 μmol/L, 1.16). No significant difference in SZL was observed between the patient groups and normal controls. Thus, SCL and CZR may be used as prognostic indicators for monitoring disease activity and response to therapy in malignant lymphoma.

Clinical Presentation and Outcome in Patients of over 75 Years Old with Malignant Lymphoma—Clinical Presentation and Outcome in Elderly Lymphoma Patients

We analyzed the relationship between the clinical characteristics, comorbidity, average relative dose intensity (aRDI) and outcome in patients of over 75 years old with malignant lymphoma. Of the 98 patients studied, the mean age was 79.9 years, and 68 patients (69.4%) had B-cell lymphomas, corresponding to mainly diffuse large B-cell lymphoma. The 5-year overall survival rate was 32.2% in 97 malignant lymphoma patients. T/NK subtype, poor performance status (PS) and high-intermediate/high international prognostic index (IPI) were found to be predictive of significantly poorer overall survival, as is the case in young patients. Correlation between comorbidity index and survival rate was not observed. We also analyzed the aRDI of cyclophosphamide and pirarubicin for 64/97 patients. The proportion of patients receiving ≤84% of the planned DI during five cycles gradually increased. Most patients could not maintain aRDI ≥85%. However, overall survival was not significantly different between patients with aRDI ≥0.85 and those with aRDI ≤0.84. In conclusion, the prognoses of very elderly patients with malignant lymphoma were not so poor when they were appropriately treated with modification of the applied dose and the duration of chemotherapy according to their status.

Pediatric Primary Malignant Lymphoma of the Spine: A Case Report

Background: Cases of primary malignant lymphomas of the bone are rare and account for about <1% of all lymphomas and 5% of extranodal non-Hodgkin’s lymphomas. Furthermore, most reports have described the occurrence of this disease in the middle-aged population, pediatric malignant lymphomas originating in the bone, particularly in the spine is rare. Methods: A 10-year-old boy presented with low back pain caused by T12 vertebral compression fracture due to sustaining a fall. A month later, he still presented with prolonged low back pain that intensified after exercise. A neoplastic lesion in T12 vertebral body was identified after spine computed tomography (CT) and magnetic resonance imaging. Results: We performed CT-guided biopsy, and he was diagnosed with primary malignant lymphoma of the vertebral body. He was treated with multiagent chemotherapy without irradiation, and complete remission was maintained at the 5-year follow-up. Moreover, the height of the deformed vertebral body improved as he grew. Conclusions: Herein, we report a rare case of pediatric primary malignant lymphoma of the spine with successful clinical and radiological outcome.

Primary Malignant Lymphoma of Prostate with Silent <i>MYD</i>88 Mutation

We present a case of primary malignant lymphoma of the prostate in a 77-year-old Japanese man. Immunohistochemical examinations revealed the presence of a non-GCB subtype of DLBCL (CD10 (-), Bcl-6 (-), MUM1 (+)), and genetic analysis disclosed a lack of typical codon 206 or 265 missense mutation in MYD88, suggesting that the case was of type3 (non-GCB andnon-ABC), a subtype of DLBCL. Three courses of chemotherapy (rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)) were effective, and the patient has been free of the disease with no local or systemic recurrence for three years. Although the significance of silent mutation at hot spot of the highly oncogenic MYD88 gene in this case is unclear, a minute increase in translational efficiency by silent mutation may have contributed to the activation of MYD88.

Fatal septic shock caused by candida myocarditis associated with malignant lymphoma and Epstein-Barr virus mediated disorder

A 60-year-old man with known epilepsy was admitted to our hospital due to hypotension, fever and arrhythmia. He was treated medically and myocardial infarction was ruled out. Treatment of septic shock was established according to the guidelines of the early goal-guided therapy including vasopressors, inotropic agents, mechanical ventilation, and hemofiltration in combination with empirical treatment with antimicrobial drugs and hydrocortisone. The patient’s condition deteriorated rapidly into multiorgan failure resulting in a fatal outcome. Antemortem blood cultures were sterile. Autopsy findings were compatible with Epstein-Barr virus mediated lymphoproliferative disorder, malignant lymphoma, disseminated candidiasis and candida myocarditis. Post-mortem blood and tissue cultures were positive for growth of candida glabrata and candida albicans, respectively. The post-mortem examination documented Epstein-Barr virus mediated lymphoproliferative disorder and malignant small cell lymphoma associated with candida myocarditis. Prior to death, the patient did not receive antiviral or antifungal treatment. Fatal candida myocarditis associated with septic shock secondary to disseminated candidiasis in a 60-years old male patient with prior unknown immune compromised state caused by Epstein-Barr virus mediated lymphoproliferative disorder and malignant lymphoma is described.