Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most variant of Non-Hodgkin’s Lymphoma (NHL) and also the most common variant with secondary intracardiac masses. Case summary: 7 years old child presented to ...Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most variant of Non-Hodgkin’s Lymphoma (NHL) and also the most common variant with secondary intracardiac masses. Case summary: 7 years old child presented to emergency with acute decompensated cardiac failure, ascites and tender hepatomegaly. 2D echo evaluation was suggestive of large intracardiac mass in the right atrium almost completely obstructing Tricuspid valve orifice, gross pericardial effusion and dilated Inferior Vena Cava (IVC). Emergency tumor excision surgery was performed which revealed 4 × 4 cm pinkish firm mass arising from anterior Tricuspid annulus which was completely excised. Child was extubated on postoperative day (POD) 0 and was on minimal inotropic support. Ascites reduced significantly on POD1 allowing abdominal palpation which revealed a mass in the epigastric region. This prompted evaluation by pediatrician and oncology workup suggestive of increased 18-Flouro Deoxy Glucose (18-FDG) uptake in the mediastinum, abdomen, bilateral proximal thighs, all mediastinal lymph nodal stations, bilateral lung hilar stations 10R, 10L involving all encasing the heart and great vessels with pleural deposits, Celiac trunk, superior Mesenteric Artery (SMA), Portal vein, IVC and abdominal aorta. Histo pathology Examination (HPE) and Immuno Histo Chemistry (IHC) of intracardiac mass revealed DLBCL which is metastatic in nature. Chemotherapy was started as per (French American British Lymphomes Malins B) FAB LMB-96 protocol with the child currently in the Induction phase having poor prognosis and less survival interval. Conclusion: Surgery can be considered a treatment option for metastatic intracardiac masses during emergency scenarios like cardiogenic shock to relieve obstruction along the pathway of blood flow in the heart even though we may not be able to completely excise the tumor surgically.展开更多
In Senegal, few studies have been devoted to non-Hodgkin’s lymphoma. We conducted a retrospective descriptive study of 73 cases treated at the Institut J. Curie Hospital Aristide Le Dantec for non-Hodgkin’s lymphoma...In Senegal, few studies have been devoted to non-Hodgkin’s lymphoma. We conducted a retrospective descriptive study of 73 cases treated at the Institut J. Curie Hospital Aristide Le Dantec for non-Hodgkin’s lymphomas from 2001 to 2007. The main objective was to determine the clinical and therapeutic aspects. Our population consisted of 39 men and 34 women (sex ratio: 1.14). The average age was 36 years with extremes of 5 and 76 years. The most common locations were cervical (30.6%) and oropharynx (8.21%). Multiple locations were found in 30.6% of cases. Only 54.4% have histological exam. Patients were managed on cytology basis 42.6% of cases. Histology was performed in 39 patients (54.4%). Among these patients, 69% had aggressive lymphoma, of which 12.82% had a large B-cell lymphoma among indolent lymphomas (59%). The small cleaved cell lymphoma was most often found with 78.26% of cases. The patients were staged with insufficient tools. The protocol most often used was CHOP (64.3%). The most common complications reported were gastrointestinal (11%) followed by skin complications (8.2%). Radiotherapy was performed for 6 patients or 8.2% of cases. Therapeutic strategy was most often used as chemotherapy alone (69.9%). The median duration of follow-up is 18 months.展开更多
Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides ...Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.展开更多
Introduction: Immunohistochemistry (IHC) enables the examination of a greater number of trephine biopsy levels and is helpful in determining additional scattered malignant cells. The aim of this study is to detect ext...Introduction: Immunohistochemistry (IHC) enables the examination of a greater number of trephine biopsy levels and is helpful in determining additional scattered malignant cells. The aim of this study is to detect extra-pattern and subtle lymphomatous infiltration in bone marrow biopsies using CD20 and CD3 immunostaining. Patients and Methods: This study was conducted on 100 newly diagnosed Non Hodgkin Lymphoma (NHL) patients. Their bone marrow trephine biopsies were assessed on routine histology [Hematoxylin and Eosin (H & E)], and were further subjected to IHC using CD20 and CD3. Results: Pattern of involvement by H & E was highlighted by IHC. It showed additional interstitial pattern in 9 cases, parasinusoidal streaks in one case and highlighted a patchy pattern in another case with interstitial involvement on H & E. IHC also detected subtle infiltrations on additional 5.5% cases compared with histology alone. It helped in differentiating reactive (12 cases) and malignant lymphoid infiltration (33 cases). Conclusion: CD20 and CD3 immunostaining performed routinely on bone marrow trephine biopsies has the ability to reveal extra-pattern of infiltration and improve detection of subtle lymphoid involvement. A combined procedure identifying several distinctive features, in particular histotopography and IHC, provides a promising way of discriminating reactive from neoplastic lymphoid infiltrates in bone marrow trephine biopsies.展开更多
Human immunodeficiency virus (HIV) infection is endemic in South Africa. Non-Hodgkin lymphoma (NHL) occurs with increased frequency in HIV seropositive individuals. The increase in NHL has been more marked in the last...Human immunodeficiency virus (HIV) infection is endemic in South Africa. Non-Hodgkin lymphoma (NHL) occurs with increased frequency in HIV seropositive individuals. The increase in NHL has been more marked in the last decade, with HIV being the major contributor to this increase. More than 70% of the adult NHL patients at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg, are HIV seropositive. In addition, HIV has impacted on the clinical presentation—being more aggressive and atypical. Histologically, HIV-NHL typically manifests as B-cell, high grade lymphomas, including diffuse large B-cell lymphoma (DLBCL);Burkitt lymphoma (BL);B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL and plasmablastic lymphoma. The latter two entities, which were previously rare or unknown, have gained prominence in the last decade, occurring primarily in HIV seropositive individuals. HIV-NHL, being associated with all these adverse prognostic factors results in a poorer overall survival.展开更多
目的:研究非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)中微小染色体维持蛋白2(Minichromosome maintenance protein 2,MCM2)与细胞间隙连接蛋白43(Connexin 43,Cx43)以及S期激酶相关蛋白2(S phase kinase-associated protein 2,Sk...目的:研究非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)中微小染色体维持蛋白2(Minichromosome maintenance protein 2,MCM2)与细胞间隙连接蛋白43(Connexin 43,Cx43)以及S期激酶相关蛋白2(S phase kinase-associated protein 2,Skp2)在非霍奇金淋巴瘤中的表达及临床意义,以期为临床诊治非霍奇金淋巴瘤提供一定的参考。方法:选取2013年1月至2015年1月间入院诊治的非霍奇金淋巴瘤36例作为实验组,并选取同期入院诊治的淋巴结反应性增生18例作为对照组,应用免疫组化法检测MCM2、Cx43、Skp2的表达情况,同时分析MCM2、Cx43、Skp2的表达与非霍奇金淋巴瘤恶性程度、临床分期等的相关性。结果:实验组NHL患者MCM2阳性表达率为83.33%、Skp2阳性表达率为86.11%,显著高于对照组22.22%与27.78%的阳性表达率(P<0.01);NHL患者Cx43阳性表达率为22.22%,显著低于对照组61.11%阳性表达率(P<0.01)。NHL患者MCM2阳性表达与肿瘤恶性程度、临床分期及Ki67水平密切相关(P<0.05);NHL患者Cx43阳性表达与肿瘤恶性程度呈负相关(P<0.01);NHL患者Skp2阳性表达与肿瘤恶性程度及临床分期密切相关(P<0.05)。结论:MCM2、Cx43、Skp2的异常表达与非霍奇金淋巴瘤的恶性程度密切相关,联合检测MCM2、Cx43、Skp2可为非霍奇金淋巴瘤的诊治提供一定的参考。展开更多
文摘Background: Diffuse Large B-Cell Lymphoma (DLBCL) is the most variant of Non-Hodgkin’s Lymphoma (NHL) and also the most common variant with secondary intracardiac masses. Case summary: 7 years old child presented to emergency with acute decompensated cardiac failure, ascites and tender hepatomegaly. 2D echo evaluation was suggestive of large intracardiac mass in the right atrium almost completely obstructing Tricuspid valve orifice, gross pericardial effusion and dilated Inferior Vena Cava (IVC). Emergency tumor excision surgery was performed which revealed 4 × 4 cm pinkish firm mass arising from anterior Tricuspid annulus which was completely excised. Child was extubated on postoperative day (POD) 0 and was on minimal inotropic support. Ascites reduced significantly on POD1 allowing abdominal palpation which revealed a mass in the epigastric region. This prompted evaluation by pediatrician and oncology workup suggestive of increased 18-Flouro Deoxy Glucose (18-FDG) uptake in the mediastinum, abdomen, bilateral proximal thighs, all mediastinal lymph nodal stations, bilateral lung hilar stations 10R, 10L involving all encasing the heart and great vessels with pleural deposits, Celiac trunk, superior Mesenteric Artery (SMA), Portal vein, IVC and abdominal aorta. Histo pathology Examination (HPE) and Immuno Histo Chemistry (IHC) of intracardiac mass revealed DLBCL which is metastatic in nature. Chemotherapy was started as per (French American British Lymphomes Malins B) FAB LMB-96 protocol with the child currently in the Induction phase having poor prognosis and less survival interval. Conclusion: Surgery can be considered a treatment option for metastatic intracardiac masses during emergency scenarios like cardiogenic shock to relieve obstruction along the pathway of blood flow in the heart even though we may not be able to completely excise the tumor surgically.
文摘In Senegal, few studies have been devoted to non-Hodgkin’s lymphoma. We conducted a retrospective descriptive study of 73 cases treated at the Institut J. Curie Hospital Aristide Le Dantec for non-Hodgkin’s lymphomas from 2001 to 2007. The main objective was to determine the clinical and therapeutic aspects. Our population consisted of 39 men and 34 women (sex ratio: 1.14). The average age was 36 years with extremes of 5 and 76 years. The most common locations were cervical (30.6%) and oropharynx (8.21%). Multiple locations were found in 30.6% of cases. Only 54.4% have histological exam. Patients were managed on cytology basis 42.6% of cases. Histology was performed in 39 patients (54.4%). Among these patients, 69% had aggressive lymphoma, of which 12.82% had a large B-cell lymphoma among indolent lymphomas (59%). The small cleaved cell lymphoma was most often found with 78.26% of cases. The patients were staged with insufficient tools. The protocol most often used was CHOP (64.3%). The most common complications reported were gastrointestinal (11%) followed by skin complications (8.2%). Radiotherapy was performed for 6 patients or 8.2% of cases. Therapeutic strategy was most often used as chemotherapy alone (69.9%). The median duration of follow-up is 18 months.
文摘Background and Purpose: The relapsed low grade non-Hodgkin’s lymphoma (LG-NHL) is currently?incurable disease and the optimal treatment regimen has not determined yet. Low dose total body irradiation (LTBI) provides an alternative mechanism of action against cancer cells rather than direct cell kill. The mode of action of LTBI is immune-modulatory effect, induction of apoptosis and?hypersensitivity to low radiation doses. The aim of our study is to evaluate the effect of LTBI on relapsed?LG-NHL and reporting our experience at National Cancer Institute, Cairo (NCI, Cairo). Material and Methods: Fifty eight patients with relapsed LG-NHL and received LTBI studied retrospectively.?LTBI dose was 1.6 Gy/8 fractions divided on 2 courses;each course 4 fractions treated over 4 days with 2 weeks rest between the 2 courses. Results: The median age is 54 years;65% of the patients are men. Forty (69%) patients had performance status of 2 or more. Twenty seven patients were stage II/III and 31 patients (53%) had stage IV disease. Twenty six (45%) patients had bulky disease more than 10 cm and 22 (38%) patients had B symptoms at the time of relapse. The?extranodal disease was present in 17 patients (29%) and 78% of the patients received?>3 regimens of chemotherapy before referral to LTBI. Twenty three patients received IFRT (mean dose 32 ± 4 Gy) to initially bulky sites after LTBI. Fourteen patients (24%) achieved complete remission (CR) while 45%, 21% and 10% had partial remission (PR), stable disease (SD) and progressive disease (PD) respectively. The median PFS duration was 14 months and the median OS duration?was 39 months. Stage VI,?>3 regimen of chemotherapy and bad response to LTBI (SD) affected?progression duration adversely (0.03, 0.05 and 0.01 respectively). The response to LTBI is the only factor affected the OS duration significantly. The 3-year PFS was 19% ± 9%, and 3-year OS was 45% ± 8%. Stage IV was the only factor affected the 3-year PFS significantly with p value 0.03. The hematological toxicity was the main side effect of LTBI. Eleven patients developed G3/4 anemia while 8 patients only developed G3/4 thrombocytopenia and 13 patients developed G3/4 leucopenia. Conclusion: The use of LTBI in patients with relapsed low grade NHL is a feasible, effective and tolerable treatment that is worthy of testing in a future with chemotherapy and Rituximab maintenance.
文摘Introduction: Immunohistochemistry (IHC) enables the examination of a greater number of trephine biopsy levels and is helpful in determining additional scattered malignant cells. The aim of this study is to detect extra-pattern and subtle lymphomatous infiltration in bone marrow biopsies using CD20 and CD3 immunostaining. Patients and Methods: This study was conducted on 100 newly diagnosed Non Hodgkin Lymphoma (NHL) patients. Their bone marrow trephine biopsies were assessed on routine histology [Hematoxylin and Eosin (H & E)], and were further subjected to IHC using CD20 and CD3. Results: Pattern of involvement by H & E was highlighted by IHC. It showed additional interstitial pattern in 9 cases, parasinusoidal streaks in one case and highlighted a patchy pattern in another case with interstitial involvement on H & E. IHC also detected subtle infiltrations on additional 5.5% cases compared with histology alone. It helped in differentiating reactive (12 cases) and malignant lymphoid infiltration (33 cases). Conclusion: CD20 and CD3 immunostaining performed routinely on bone marrow trephine biopsies has the ability to reveal extra-pattern of infiltration and improve detection of subtle lymphoid involvement. A combined procedure identifying several distinctive features, in particular histotopography and IHC, provides a promising way of discriminating reactive from neoplastic lymphoid infiltrates in bone marrow trephine biopsies.
文摘Human immunodeficiency virus (HIV) infection is endemic in South Africa. Non-Hodgkin lymphoma (NHL) occurs with increased frequency in HIV seropositive individuals. The increase in NHL has been more marked in the last decade, with HIV being the major contributor to this increase. More than 70% of the adult NHL patients at Chris Hani Baragwanath Academic Hospital (CHBAH), Soweto, Johannesburg, are HIV seropositive. In addition, HIV has impacted on the clinical presentation—being more aggressive and atypical. Histologically, HIV-NHL typically manifests as B-cell, high grade lymphomas, including diffuse large B-cell lymphoma (DLBCL);Burkitt lymphoma (BL);B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL and plasmablastic lymphoma. The latter two entities, which were previously rare or unknown, have gained prominence in the last decade, occurring primarily in HIV seropositive individuals. HIV-NHL, being associated with all these adverse prognostic factors results in a poorer overall survival.
文摘目的:研究非霍奇金淋巴瘤(non-hodgkin's lymphoma,NHL)中微小染色体维持蛋白2(Minichromosome maintenance protein 2,MCM2)与细胞间隙连接蛋白43(Connexin 43,Cx43)以及S期激酶相关蛋白2(S phase kinase-associated protein 2,Skp2)在非霍奇金淋巴瘤中的表达及临床意义,以期为临床诊治非霍奇金淋巴瘤提供一定的参考。方法:选取2013年1月至2015年1月间入院诊治的非霍奇金淋巴瘤36例作为实验组,并选取同期入院诊治的淋巴结反应性增生18例作为对照组,应用免疫组化法检测MCM2、Cx43、Skp2的表达情况,同时分析MCM2、Cx43、Skp2的表达与非霍奇金淋巴瘤恶性程度、临床分期等的相关性。结果:实验组NHL患者MCM2阳性表达率为83.33%、Skp2阳性表达率为86.11%,显著高于对照组22.22%与27.78%的阳性表达率(P<0.01);NHL患者Cx43阳性表达率为22.22%,显著低于对照组61.11%阳性表达率(P<0.01)。NHL患者MCM2阳性表达与肿瘤恶性程度、临床分期及Ki67水平密切相关(P<0.05);NHL患者Cx43阳性表达与肿瘤恶性程度呈负相关(P<0.01);NHL患者Skp2阳性表达与肿瘤恶性程度及临床分期密切相关(P<0.05)。结论:MCM2、Cx43、Skp2的异常表达与非霍奇金淋巴瘤的恶性程度密切相关,联合检测MCM2、Cx43、Skp2可为非霍奇金淋巴瘤的诊治提供一定的参考。
