Comparative analysis of conventional ultrasound and shear wave elastography features in primary breast diffuse large B-cell lymphoma

BACKGROUND Primary breast diffuse large B-cell lymphoma(PB-DLBCL)is a rare subtype of non-Hodgkin lymphoma that accounts for<3%of extranodal lymphomas and 1%of breast tumors.Its diagnosis and management are challenging because of its rarity,heterogeneity,and aggressive behavior.Conventional ultrasound(US)is the first-line imaging modality for breast lesions;however,it has limited specificity and accuracy for PB-DLBCL.Shear wave elastography(SWE)is a novel US technique that measures tissue stiffness and may reflect the histological characteristics and biological behavior of breast lesions.AIM To compare the conventional US and SWE features of PB-DLBCL and evaluate their diagnostic performance and prognostic value.METHODS We retrospectively reviewed the clinical data and US images of 32 patients with pathologically confirmed PB-DLBCL who underwent conventional US and SWE before treatment.We analyzed conventional US features(shape,margin,orientation,echo,posterior acoustic features,calcification,and vascularity)and SWE features(mean elasticity value,standard deviation,minimum elasticity value,maximum elasticity value,and lesion-to-fat ratio)of the PB-DLBCL lesions.Using receiver operating characteristic curve analysis,we determined the optimal cutoff values and diagnostic performance of conventional US and SWE features.We also performed a survival analysis to assess the prognostic value of conventional US and SWE features.RESULTS The results showed that the PB-DLBCL lesions were mostly irregular in shape(84.4%),microlobulated or spiculated in margins(75%),parallel in orientation(65.6%),hypoechoic in echo(87.5%),and had posterior acoustic enhancement(65.6%).Calcification was rare(6.3%)and vascularity was variable(31.3%avascular,37.5%hypovascular,and 31.3%hypervascular).The mean elasticity value of PB-DLBCL lesions was significantly higher than that of benign breast lesions(113.4±46.9 kPa vs 27.8±16.4 kPa,P<0.001).The optimal cutoff value of the mean elasticity for distinguishing PB-DLBCL from benign breast lesions was 54.5 kPa,with a sensitivity of 93.8%,specificity of 92.9%,positive predictive value of 93.8%,negative predictive value of 92.9%,and accuracy of 93.3%.The mean elasticity value was also significantly correlated with Ki-67 expression level(r=0.612,P<0.001),which is a marker of tumor proliferation and aggressiveness.Survival analysis showed that patients with higher mean elasticity values(>54.5 kPa)had worse overall survival(OS)and progression-free survival(PFS)than those with lower mean elasticity values(<54.5 kPa)(P=0.038 for OS and P=0.027 for PFS).CONCLUSION Conventional US and SWE provide useful information for diagnosing and forecasting PB-DLBCL.SWE excels in distinguishing PB-DLBCL from benign breast lesions,reflects tumor proliferation and aggressiveness,and improves disease management.

Helicobacter pylori eradication treatment for primary gastric diffuse large B-cell lymphoma:A single-center analysis

BACKGROUND Unlike the already established effect of Helicobacter pylori(H.pylori)eradication on gastric mucosa-associated lymphoid tissue(MALT)lymphoma,its therapeutic effect on primary gastric diffuse large B-cell lymphoma(DLBCL)is still unclear.AIM To clarify the efficacy of H.pylori eradication treatment for primary gastric DLBCL.METHODS We reported on 3 new cases,and added them to 3 previously reported cases.We analyzed the usefulness of H.pylori eradication treatment for gastric DLBCL for a total of 6 cases at our center.RESULTS Of the 6 patients(27-90 years old,3 males and 3 females),all 3 patients with single lesions(one transformed from MALT lymphoma)achieved complete remission(CR)after H.pylori eradication.Regarding the 2 newly reported cases,CR was maintained for more than 6 years with eradication treatment alone.In contrast,none of the 3 patients with 2 lesions achieved CR.In 1 newly reported case,endoscopic CR was achieved in one lesion,while stable disease was obtained in the other lesion.Two patients with progressive disease responded to standard chemo therapy±radiation and remained in CR for more than 6 years.CONCLUSION We believe it is worthwhile to attempt H.pylori eradication for elderly patients with primary gastric DLBCL in a single lesion with a small tumor burden.

Comprehensive treatment for primary right renal diffuse large B-cell lymphoma with a renal vein tumor thrombus:A case report

BACKGROUND Renal involvement in lymphoma is commonly associated with widespread nodal or extranodal lymphoma.Primary renal diffuse large B-cell lymphoma is an extremely rare extranodal lymphoma,accounting for fewer than 1%of all renal masses.Interestingly,the patient in this study had a renal vein tumor thrombus that was observed after laparoscopic radical nephrectomy.CASE SUMMARY We report the case of a 56-year-old female patient with primary renal lymphoma and a renal vein tumor thrombus whose first symptom was right pain in the back and gross hematuria.Histopathology revealed primary renal diffuse large B-cell lymphoma.The patient received 8 standard cycles of rituximab with cyclophosphamide,doxorubicin,vincristine,and prednisone chemotherapy after surgery,and no obvious signs of recurrence were observed during the one-year follow-up.CONCLUSION We evaluated comprehensive treatment of primary renal diffuse large B-cell lymphoma and multidisciplinary management of this malignancy.

Individualized Treatment and Palliative Care for A90-Year-Old Patient with Primary Gastric Diffuse Large-B Cell Lymphoma:4 Year Follow-up and Inspiration

A 90-year-old man was diagnosed with primary gastric diffuse large B-cell lymphoma(PGDLBL)by PET/CT examination,gastroscopy,biopsy and histopathological analysis at a regular physical check in April,2016.The patient received R-CO chemotherapy(rituximab,cyclophosphamide,and vincristine)and radiotherapy subsequently,with enteral nutritional treatment through 3-cavity nasogastric tube due to development of pyloric obstruction.To satisfy patient's strong desire of eating by himself,we performed surgery of exploratory laparotomy and Roux-en-Y gastric bypass(RGB)to relieve pylorus obstruction.Postoperatively,the patient resumed oral feeding,supplemented by nasogastric tube feeding at 1350-1550 Kcal daily.He is now 94 years old with fairly well nutrition and normal communication.The outcome of 4 year follow-up suggests that nutritional treatment and palliative medicine are important for improving prognosis and life-quality of very elderly patients with end-stage tumors apart from the effective chemotherapy,radiotherapy,and surgery.

Disseminated soft tissue diffuse large B-cell lymphoma involving multiple abdominal wall muscles:A case report

BACKGROUND Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non�Hodgkin lymphoma,and patients with DLBCL typically present rapidly growing masses.Lymphoma involving muscle is rare and accounts for only 5%;furthermore,multiple muscles and soft tissue involvement of DLBCL is unusual.Due to unusual clinical manifestation,accurate diagnosis could be delayed.CASE SUMMARY A 61-year-old man complained of swelling,pain and erythematous changes in the lower abdomen.Initially,soft tissue infection was suspected,however,skin lesion did not respond to antibiotics.18Fluoro-2-deoxy-D-glucose(18F-FDG)positron emission tomography-computed tomography demonstrated FDG uptake not only in the skin and subcutaneous tissue of the abdomen but also in the abdominal wall muscles,peritoneum,perineum,penis and testis.DLBCL was confirmed by biopsy of the abdominal wall muscle and subcutaneous tissue.After intensive treatment including chemotherapy with rituximab,cyclophosphamide,doxorubicin,vincristine and prednisolone,central nervous system prophylaxis(intrathecal injection of methotrexate,cytarabine and hydrocortisone)and orchiectomy,he underwent peripheral blood stem cell mobilization for an autologous hematopoietic stem cell transplantation.Despite intensive treatment,the disease progressed rapidly and the patient showed poor outcome(overall survival,9 mo;disease free survival,3 mo).CONCLUSION The first clinical manifestation of soft tissue DLBCL involving multiple muscles was similar to the infection of the soft tissue.

Heterochronous multiple primary prostate cancer and lymphoma:A case report

BACKGROUND Multiple primary malignant tumors(MPMTs)are rare type of cancer,especially when solid tumors are the first and lymphoma is the second primary malignancy.We report a patient with heterochronous MPMTs consisting of prostate cancer and rectal diffuse large B-cell lymphoma(DLBCL).CASE SUMMARY We report a 77-year-old male patient diagnosed with prostate cancer who was treated with radiation therapy and one year of endocrine therapy with bicalutamide(50 mg per day)and an extended-release implant of goserelin(1/28 d).Seven years later,rectal DLBCL with lung metastases was found.CONCLUSION Although rare,the possibility of prostate cancer combined with a double primary cancer of DLBCL can provide a deeper understanding.

Primary gastric non-Hodgkin lymphomas:Recent advances regarding disease pathogenesis and treatment

Primary gastric lymphomas(PGLs)are distinct lymphoproliferative neoplasms described as heterogeneous entities clinically and molecularly.Their main histological types are diffuse large B-cell lymphoma(DLBCL)or mucosaassociated lymphoma tissue.PGL has been one of the main fields of clinical research of our group in recent years.Although gastric DLBCLs are frequent,sufficient data to guide optimal care are scarce.Until today,a multidisciplinary approach has been applied,including chemotherapy,surgery,radiotherapy or a combination of these treatments.In this minireview article,we provide an overview of the clinical manifestations,diagnosis and staging of these diseases,along with their molecular pathogenesis and the most important related clinical published series.We then discuss the scientific gaps,perils and pitfalls that exist regarding the aforementioned studies,in parallel with the unmet need for future research and comment on the proper methodology for such retrospective studies.Aiming to fill this gap,we retrospectively evaluated the trends in clinical presentation,management and outcome among 165 patients with DLBCL PGL who were seen in our institutions in 1980-2014.The study cohort was divided into two subgroups,comparing the main 2 therapeutic options[cyclophosphamide doxorubicin vincristine prednisone(CHOP)vs rituximab-CHOP(R-CHOP)].A better outcome with immunochemotherapy(R-CHOP)was observed.In the next 2 mo,we will present the update of our study with the same basic conclusion.

Primary colonic lymphoma:An incidental finding in a patient with a gallstone attack

We report a case of primary colonic lymphoma incidentally diagnosed in a patient presenting a gallbladder attack making particular attention on the diagnostic findings at ultrasound(US) and total body computed tomography(CT) exams that allowed us to make the correct final diagnosis.A 85-year-old Caucasian male patient was referred to our department due to acute pain at the upper right quadrant,spreaded to the right shoulder blade.Patient had nausea and mild fever and Murphy's maneuver was positive.At physical examination a large bulky mass was found in the right flank.Patient underwent to US exam that detected a big stone in the lumen of the gallbladder and in correspon-dence of the palpable mass,an extended concentric thickening of the colic wall.CT scan was performed and confirmed a widespread and concentric thickening of the wall of the ascending colon and cecum.In addition,revealed signs of microperforation of the colic wall.Numerous large lymphadenopathies were found in the abdominal,pelvic and thoracic cavity and there was a condition of splenomegaly,with some ischemic outcomes in the context of the spleen.No metastasis in the parenchimatous organs were found.These imaging findings suggest us the diagnosis of lymphoma.Patient underwent to surgery,and right hemicolectomy and cholecystectomy was performed.Histological examination confirmed our diagnosis,revealing a diffuse large B-cell lymphoma.The patient underwent to Cyclophosphamide,Hydroxydaunorubicin,Oncovin,Prednisone chemotherapy showing only a partial regression of the lymphadenopathies,being in advanced stage at the time of diagnosis.

Primary central nervous system lymphoma presenting as a single choroidal lesion mimicking metastasis:A case report

BACKGROUND Primary choroidal lymphoma is usually an indolent B-cell lymphoma and rarely progresses to extraocular sites.Herein,we report a case of primary choroidal lymphoma diagnosed as diffuse large B-cell lymphoma(DLBL),which progressed to the brain parenchyma after 4 mo.CASE SUMMARY A 78-year-old man presented with diminution of vision in his right eye.A choroidal lesion suspected of metastatic lesion was observed in the right eye by ophthalmologic examination.To discover the primary tumor,imaging investigations were performed but no malignant lesion was detected.After 4 mo,the patient returned to the clinic presenting with neurological symptoms.Brain magnetic resonance imaging revealed an abnormal contrast-enhancing mass in the left cerebellum.A stereotactic biopsy was performed,and DLBL was confirmed.The patient received the high dose methotrexate-based chemotherapy and he achieved complete remission.CONCLUSION Primary choroidal lymphoma is usually known to have a benign clinical course without systemic involvement.We present a rare case of primary choroidal lymphoma diagnosed as DLBL that progressed to the brain parenchyma within months.

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.

双侧原发性乳腺弥漫大B细胞淋巴瘤1例

原发性乳腺淋巴瘤(PBL)是一种原发于乳腺的罕见结外型淋巴瘤,临床常表现为进行性增大的无痛性肿块,易与乳腺纤维腺瘤、乳腺癌等其他疾病相混淆。PBL患者病情进展较快且预后差,目前尚无明确的治疗指南。本文报道双侧原发性乳腺弥漫大B细胞淋巴瘤1例,旨在为这类患者的诊疗提供临床经验。

9例原发性乳腺弥漫大B细胞淋巴瘤的临床病理分析

目的:探讨原发性乳腺弥漫大B细胞淋巴瘤(PBDLBCL)的临床特征、诊断及治疗方法。方法:回顾性分析皖南医学院附属弋矶山医院2001年08月-2014年01月收治的9例原发性乳腺弥漫大B细胞淋巴瘤患者的临床特征、诊断及治疗方法。结果:所有患者均为女性,年龄28-75岁,中位年龄为48岁;8例单侧乳腺受累,1例累及双侧乳腺;Ann arbor分期为I E期2例,II E期7例;所有患者均无B组症状;国际预后指数0分6例,1分3例;生发中心(GCB)型2例,非生发中心(non-GCB)型7例;伴双重打击(Double-Hit)3例。所有患者均行手术确诊,其中3例行空芯针活检,5例行包块切除术,1例行改良根治术明确诊断。1例行单纯乳腺癌根治切除术;1例行单侧乳腺切除术联合化疗;1例活检后放弃治疗;1例行包块切除联合化放疗;5例行包块切除联合化疗;9例中1例进行中枢预防PBDLBCL,其中一线化疗后6例获得CR,中位随访时间为18个月。3例复发,5例死亡。结论:PBDLBCL多发于女性,病理类型以non-GCB伴Double-Hit型为主;空芯针取组织活检有助于明确PBL的诊断。治疗以R-CHOP或CHOP类方案化疗和(或)联合放疗为主,辅以鞘内注射化疗药物可能有助于预防PBL中枢复发。

原发乳腺淋巴瘤的研究进展

原发性乳腺恶性淋巴瘤是一种少见的、异质性结外非霍奇金淋巴瘤类型,具有特殊的临床表现。最常见的病理类型是弥漫大B细胞淋巴瘤,但也存在其他不常见的亚型。我们将描述原发性乳腺恶性淋巴瘤的特点,重点在发病机理、分期、风险分层、预后及最新治疗进展。

原发性乳腺弥漫性大B细胞淋巴瘤MRI表现及与病理对照

目的:探讨原发性乳腺弥漫性大B细胞淋巴瘤的MRI表现及其临床病理特征。方法:回顾性分析18例经组织病理学证实的原发性乳腺弥漫性大B细胞淋巴瘤的临床、MRI及病理学特征。结果:18例患者均为女性,平均年龄51岁。临床触及肿块18例,6例在短期内迅速增大。MRI检查共发现病灶25处,其中单发病灶13例,单侧多发病灶2例,双侧多发病灶3例。病灶在T1WI上呈等或略低信号,T2WI呈高或稍高信号。增强后呈肿块样强化19处(76.0%),其中形态呈椭圆形或不规则形16处(84.2%),内部均匀强化14处(73.7%);非肿块样强化6处,其中内部不均匀强化3处(50.0%);10处病灶内可见"血管造影征"。伴有皮肤增厚7例,同侧腋窝淋巴结肿大10例。病理学镜下表现为肿瘤性淋巴样细胞较大或中等大小,弥漫性分布,部分呈单行索条状排列。结论:原发性乳腺弥漫性大B细胞淋巴瘤的病理学基础决定了其MRI表现有一定特征性,MRI检查有助于本病的诊断及鉴别诊断。

原发性乳腺淋巴瘤的诊治进展

原发性乳腺淋巴瘤(Primary breast lymphoma,PBL)是一种少见而独特的结外淋巴瘤类型。女性占绝大多数,其病因尚不明确,可能与雌激素有关,隆胸女性的患病率增加,以乳腺无痛性包块为最常见临床表现,大多以乳腺癌收治,手术切除包块及空芯针活检有助于疾病诊断。弥漫大B细胞型是PBL最常见病理类型,以非GCB型多见,易出现结外复发,中枢神经系统复发多见,预后不良。在治疗方面采取手术、化疗、放疗联合治疗手段,而利妥昔单克隆抗体的应用未能改善患者的生存期。小分子靶向药物可能有益于PBL。本文就PBL发病机制、临床特点、诊断和治疗作一简要的综述。

原发性乳腺弥散性大B细胞淋巴瘤临床病理分析

目的探讨原发性乳腺弥散性大B细胞淋巴瘤的病理学形态、免疫表型特征与预后的关系。方法本组收录了5例原发性乳腺弥散性大B细胞淋巴瘤患者的资料,分析其临床病理及免疫表型特征,并随访其预后。结果5例乳腺原发性弥散性大B细胞淋巴瘤,4例为手术切除标本,1例为粗针活检标本,其组织学特征表现为瘤细胞呈弥散浸润性生长,瘤细胞体积大,核圆形或卵圆形,大而深染,部分瘤细胞内见小核仁;瘤细胞增殖活跃,核分裂象易见;其免疫组化表型均为非生发中心亚型。明确病理诊断,患者均进行化疗,目前1例死亡。结论乳腺原发性弥散性大B细胞淋巴瘤少见,空心针穿刺并辅以免疫组化可明确诊断。R-CHOP仍是最为有效的化疗方案。

A Case of Primary Central Nervous System Lymphoma with Ciliary Body Involvement

INTRODUCTION Primary central nervous system lymphoma （PCNSL） is defined as lymphoma confined to the brain, eye, spinal cord, or leptomeninges. It constitutes approximately 3% of all brain tumors, and 2-3% of all cases of non-Hodgkin lymphoma. Ocular involvement can be detected during clinical staging in about 20% of patients with PCNSL, with primary vitreous retinal lymphoma being the most common subtype. Uveal involvement of PCNSL is uncommon, and PCNSL with ciliary body involvement （CBL）, to the best of our knowledge, has not been reported.

原发性乳腺弥漫大B细胞淋巴瘤1例报道及文献复习

目的通过观察原发性乳腺弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)的临床资料、病理学特征和免疫组化检测结果,探讨其诊断、鉴别诊断和治疗方法。方法通过分析彩超、HE形态学改变和免疫组化结果,对右江民族医学院附属医院(以下简称我院)收治的1例原发性乳腺DLBCL进行确诊,并温习相关文献进行讨论。结果彩超示左乳探及一大小40mm×35mm×25mm低回声团块,边界尚清。光镜下见乳腺组织被弥漫浸润的异型淋巴样细胞所取代,肿瘤细胞大部分区域排列成单列。免疫组化标记物:CD20、CD79a、Mum-1、Bcl-2、CD45、Ki67均阳性表达,ER、PR、HerbB-2、E-cadherin均阴性表达。综合彩超、组织形态学及免疫组化结果证实为原发性乳腺DLBCL。结论原发性乳腺DLBCL相对少见,与乳腺癌难以辨别,诊断主要依靠组织形态学与免疫组化进行确诊,治疗主要以全身化疗及局部放疗为主。

原发性乳腺淋巴瘤六例临床病理分析

目的探讨原发性乳腺淋巴瘤(PBL)的临床病理特征、鉴别诊断及预后。方法回顾分析广州市番禺区中心医院2009年1月1日至2020年12月30日收治的6例PBL患者的临床病理特点、免疫表型及随访信息,并复习相关文献。结果6例均为女性,发病年龄34~84岁,平均55.8岁;左乳4例,右乳2例,均为单侧乳腺肿块无痛性进行性增大,或伴同侧淋巴结肿大。镜下均见异型淋巴细胞浸润乳腺组织生长,表达B细胞标记,其中乳腺原发弥漫性大B细胞淋巴瘤(PB-DLBCL)5例,2例非GCB型,3例GCB型;1例为黏膜相关淋巴组织结外边缘区(MALT)淋巴瘤。6例患者均未见骨髓累及,均不伴B症状。治疗以手术联合CHOP/R-CHOP方案化疗6个疗程伴放疗为主。截止2020年12月,6例患者在随访9~86个月后均未复发,病例3因上消化道出血死亡,其余存活。结论PBL罕见,大多数发生于女性,表现为单侧乳腺包块无痛性进行性增大,临床易误诊,其诊断和鉴别主要依靠病理组织学和免疫组化、分子病理。组织学类型大多数是PB-DLBCL,少数是MALT淋巴瘤。治疗以术后CHOP/R-CHOP足疗程化疗联合放疗等综合治疗为主,及时充分治疗预后好。

原发性乳腺弥漫性大B细胞淋巴瘤4例临床病理分析

目的:探究原发性乳腺弥漫性大B细胞淋巴瘤(Primary breast diffuse large B-cell lymphoma,PB-DLBCL)的临床病理特征、鉴别诊断及治疗预后。方法:收集右江民族医学院附属医院病理科2017年1月至2020年12月就诊的4例PB-DLBCL患者的相关临床资料、病理组织切片及免疫组化表型并结合相关文献进行分析。结果:4例均为中青年女性,年龄38~56岁,均因乳腺无痛性增大包块就诊,左乳2例,右乳2例。3例为非生发中心型,1例为生发中心型。根据Ann Arbor分期标准:Ⅰ期3例,Ⅱ期1例。镜检:乳腺正常结构被破坏,中等大小的圆形或卵圆形肿瘤细胞弥漫分布,胞质少至丰富,嗜碱性,核仁可见,核分裂像易见。免疫组化:CD19、CD20、CD79a、PAX5(+),部分病例CD10、BCL-6及BCL-2(+),Ki-67增殖指数85%~90%。随访至2021年7月,1例失访,1例死亡,2例健在。结论:PB-DLBCL发病率低,临床症状及影像学表现无特殊,预后差,确诊需结合病理组织形态学及免疫表型。