Comparison of clinical features of patients with or without severe gastrointestinal complications in aggressive gastrointestinal lymphomas

BACKGROUND Aggressive primary gastrointestinal non-Hodgkin lymphoma(PGINHL)is an uncommon and heterogeneous group of lymphoid malignancies,that differs from indolent lymphoma and has a high incidence of severe gastrointestinal complications(GICs).AIM To investigate and compare the clinicopathological characteristics,treatments and outcomes in the GICs and No-GICs group with aggressive PGINHL.METHODS This retrospective analysis was performed on aggressive PGINHL patients between January 2013 and December 2021 at our hospital.The independent influence factors of GICs were obtained by univariate and multivariate Logistic regression analysis,the selected variables significantly related to GICs were selected as the final predictors to construct nomogram.Kaplan-Meier curves further analyzed the survival of patients in GICs and No-GICs groups.Survival analysis of GICs group was performed using Cox regression.RESULTS We focused on 124 aggressive PGINHL cases,which had a relatively high incidence 48.4%(60/124 cases)of GICs,the most common histological type in GICs group was diffuse large B-cell lymphoma(DLBCL)(n=49,81.7%).In the GICs group,small intestine was the most common anatomic site of lesion(43.3%),followed by large intestine(31.7%),and then stomach and esophagus(25.0%).Multivariate Logistic regression analysis showed that the independent risk factors for GICs were the small intestine[odd ratio(OR)=3.33;95%confidence interval(CI):1.47-9.41;P=0.009),aggressive B-cell(OR=0.09;95%CI:0.01-0.83;P=0.033),maximum tumor diameter(OR=1.25;95%CI:1.07-1.47;P=0.005),invaded deep serous layer(OR=3.38;95%CI:1.24-9.19;P=0.017).We developed a nomogram to predict risk of GICs in aggressive PGINHL patients based on independent risk factors.The value of area under curve calculated by receiver operating characteristic curve was 0.815,and calibration curve and decision curve analysis further indicated that the prediction effect was superior.The majority of patients with GICs were given combination therapy(chemotherapy combined with surgery or radiation).Event-free survival and overall survival in GICs group were no worse than those in the No-GICs group.CONCLUSION The complication rate of GICs in patients with aggressive PGINHL was relatively high,particularly in PGI-DLBCL.The independent risk factors for GICs were the small intestine,PGI-TNKL,bulky tumor,and depth of invasion.A combination treatment,involving surgery,improved survival in the GICs group.

Endoscopic features and prognoses of mantle cell lymphoma with gastrointestinal involvement

AIM: To evaluate the endoscopic manifestations and prognoses of gastrointestinal (GI) mantle cell lymphoma (MCL). METHODS: A database search at the Department of Pathology of Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences revealed 57 MCL patients with GI involvement. Clinical records were available for 35 of the 57 patients from 21 institutions, and those 35 patients were enrolled in this study. We summarized the gross types of endoscopic features, event-free survival (EFS), and overall survival (OS) of those patients.RESULTS: Of the 35 patients, GI involvement in the esophagus, stomach, and duodenum was found in 2 (5.7%), 26 (74.3%), and 12 (34.3%) patients, respectively. Twenty-one of the 35 patients underwent colonoscopy; among them, GI involvement in the ileum, cecum, colon, and rectum was found in 10 (47.6%), 3 (14.3%), 12 (57.1%), and 10 (47.6%), respectively. Various lesions, such as superficial, protruded, fold thickening, or ulcerative, were found in the stomach, whereas multiple lymphomatous polyposis (MLP) was dominant from the duodenum to the rectum. Twelve patients were treated with a hyper-CVAD/MA regimen, and they had better OS (3-year rate, 88.3% vs 46.4%, P < 0.01) and better EFS (3-year rate, 66.7% vs 33.8%, P < 0.05) than the remaining 23 patients who were not treated with this regimen. CONCLUSION: MLP was a representative form of intestinal involvement, whereas a variety of lesions were found in the stomach. The hyper-CVAD/MA regimen may improve survival in these patients.

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.

Lymphomatous involvement of gastrointestinal tract: Evaluation by positron emission tomography with ^(18)F-fluorodeoxyglucose

AIM： To demonstrate the ^18F-fluorodeoxyglucose positron emission tomography （18F-FDG PET） findings in patients with non-Hodgkin＇s lymphoma （NHL） involving the gastrointestinal （GI） tract and the clinical utility of modality despite of the known normal uptake of FDG in the GI tract. METHODS： Thirty-three patients with biopsy-proven gastrointestinal NHL who had undergone FDG-PET scan were induded. All the patients were injected with 10-15 mCJ FDG and scanned approximately 60 min later with a CTI/ Siemens HR （＋） PET scanner. PET scans were reviewed and the maximum standard uptake value （SUVmax） of the lesions was measured before and after the treatment, if data were available and compared with histologic diagnoses. RESULTS： Twenty-five patients had a high-grade lymphoma and eight had a low-grade lymphoma. The stomach was the most common site of the involvement （20 patients）. In high-grade lymphoma, PET showed focal nodular or diffuse hypermetabolic activity. The average SUVmax＋SD was 11.58±5.83. After the therapy, the patients whose biopsies showed no evidence of lymphoma had a lower uptake without focal lesions. The SUVmax＋SD decreased from 11.58±5.83 to 2.21± 0.78. in patients whose post-treatment biopsies showed lymphoma, the SUVmax＋SD was 9.42±6.27. Low-grade follicular lymphomas of the colon and stomach showed diffuse hypermetabolic activity in the bowel wall （SUVmax= 8.2 and 10.3, respectively）. The SUVmax was 2.02-3.8 （mean 3.02） in the stomach lesions of patients with MALT lymphoma. CONCLUSION： ^18F-FDG PET contributes to the diagnosis of high-grade gastrointestinal non-Hodgldn＇s lymphoma, even when there is the normal background FDG activity. Furthermore, the SUV plays a role in evaluating treatment response. Low-grade NHL demonstrates FDG uptake but at a lesser intensity than seen in high-grade NHL.

Ultrasound features of primary non-Hodgkin’s lymphoma of the palatine tonsil:A case report

BACKGROUND Lymphomas are the second most common malignancy of the head and neck.In this region,the vast majority of extranodal lymphomas are located in the palatine tonsil,accounting for about 51%.Tonsillar lymphomas are aggressive tumors with intermediate-or high-grade histology.We here report a case of primary non-Hodgkin’s lymphoma of the palatine tonsil and analyze its ultrasound features.CASE SUMMARY A 40-year-old man presented with right palatine tonsil swelling for 2 mo after a cold,accompanied by dysphagia,snoring,and suffocation.He had no sore throat,fever,or history of upper respiratory tract infection or tuberculosis.The patient was generally in good health and denied other diseases.He was diagnosed with acute tonsillitis initially and treated with antibiotics for 7 d.However,there was no improvement with the treatment.Tonsil biopsy and ultrasound-guided biopsy of the biggest lymph node of the right neck showed the typical pathology of non-Hodgkin lymphoma.CONCLUSION Primary lymphoma of the tonsils is rare,and its diagnosis is challenging.Ul-trasound is a useful modality in diagnosing oropharyngeal diseases,and can clearly show the features of this tumor,but the final diagnosis should be estab-lished by histology.

Primary Ovarian Non-Hodgkin’s Lymphoma: Retrospective Study of 16 Patients

Background: Primary non-Hodgkin’s lymphoma (PONHL) of the ovary is rare disease. Ovarian involvement by NHL is usually secondary, as a part of systemic disease. It is frequently diagnosed as ovarian carcinoma which causes a significant delay in diagnosis and management. Objective: To analyze, to report and to better understand the clinico-pathologic features and results of treatment, and prognostic factors of these tumors. Material & methods: This was a retrospective single institutional work that included 16 cases of primary ovarian non-Hodgkin lymphoma (PONHL) treated in National Cancer Institute-Cairo University from January 2010 till January 2015. All available medical data including the clinical and pathological characteristics, treatment, and outcomes of patients with PONHL are analyzed. Results: Data from 16 patients are obtained. The patient’s age ranges from 14 to 55 years (mean 28 years). Ascites is the most common manifestation (75%). Tumor size ranges from 5 to 24 cm (mean 13.1). LDH is elevated in all cases (mean 644 U/L) and CA-125 is elevated in only 4 cases (25%) especially when there is an extensive peritoneal irritation. Ten cases (62.5%) are bilateral with stage IV-E according to the Ann Arbor staging system. The remaining six cases (37.5%) are unilateral with Ann Arbor stage I-E. There are no stage II-E or III-E in the current study. Tumors are classified according to the World Health Organization as follows: diffuse large B-cell lymphoma (10 cases) (62.5%), Burkitt’s lymphoma (5 cases) (31%) and only one case of B-lymphoblastic lymphoma/leukemia. All the tumors are of B-cell lineage and are all CD20 positive. All Burkitt’s lymphoma cases show higher Ki67 index (4 cases are 100% and one is 88%). The case of B-lymphoblastic lymphoma/leukemia is positive for TDT & CD 10. Surgery is the main treatment modality for primary diagnosis and for staging, although chemotherapy should have been the primary treatment because it is one of the most chemosensitive tumors. Follow-up period ranges from 3 months to 5 years (mean 33 months). Ten patients are alive without disease. Two cases experienced relapse and one case died during chemotherapy treatment. The remaining three cases died from other causes than disease. The median overall survival time was not reached yet;however, the mean overall survival was 46.8 monthes;median progression free survival was 36 months. Conclusion: Most patients with PONHL present with symptoms attributable to an ovarian mass which necessitates extensive surgical staging that is not mandatory for lymphomas. More studies will be needed to better define and treat this rare entity.

Primary non-Hodgkin' s lymphoma of the pancreas:report of six cases

Objective To evaluate the diagnosis and treatment of primary non-hodgkin’ s lymphoma (PNHL) of the pancreas. Methods The therapeutic result of 6 cases admitted from January 1980 to March 2000 was reviewed retrospectively. Results The lesion was located in the head of the pancreas in 2 cases and the body and/or tail in 4, respectively. Clinical manifestations included epigastric discomfort, loss of weight, abdominal mass and jaundice. Two cases underwent Whipple’ s procedure and distal pancreatectomy respectively, the other 4 underwent laparotomy and biopsy. B cell non-Hodgkin’ s lymphoma of 5 cases and T cell non-Hodgkin’s lymphoma of one were verified by pathology. One patient lost follow-up, the other 5 patients survived 58, 49, 22, 13 and 4 months respectively. Conclusion The clinical manifestation and radiological features of PNHL of the pancreas are not specific. Comprehensive therapy including surgery is beneficial to the long-term survival of patients with PNHL of the pancreas. 4 refs.

Primary cardiac lymphoma:a case report and review of the literature

Primary cardiac lymphoma (PCL) is an extremely rare neoplasm and usually defined as a non-Hodgkin's lymphoma being exclusively located in the heart and/or the pericardium. It is particularly difficult to diagnose this rare disease due to its nonspecific clinical manifestations. The prognosis of this disease is poor. In this diffuse large B-cell lymphoma, the patient finally died of heart failure after 2 courses of chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).

Primary hepatic peripheral T-cell lymphoma associated with Epstein-Barr viral infection

Primary hepatic peripheral T-cell lymphoma(H-PTCL) is one of the rarest forms of non-Hodgkin lymphoma. We report a patient who presented with worsening jaundice, abdominal pain, and vomiting. Laboratory values were significant for elevated total bilirubin, alkaline phosphatase, and liver aminotransferases. Following a liver biopsy, histopathology revealed several large dense clusters of atypical T-lymphocytes which were CD2+, CD3+, CD5+, CD7-, CD4+, CD8-, CD56-, CD57-, CD30+ by immunohistochemistry. The proliferation index was approximately 70% by labeling for ki67/mib1. The above histological profile was consistent with peripheral T-cell lymphoma of the liver. Epstein-Barr viral serology indicated a remote infection, a likely risk factor for PTCL. Bone marrow biopsy was negative for malignancy, further supporting hepatic origin.

Primary spinal epidural non-Hodgkin’s lymphoma presentedwith spinal cord compression syndrome

The spinal epidural space is an uncommon presenting site in primary non-Hodgkin’s lymphomas,especially for children.A boy suffered spinal cord compression syndrome caused by primary spinal epidural non-Hodgkin’s lymphoma.Thoracolumbar magnetic reso-nance imaging(MRI)demonstrated an intraspinal mass.An operation was performed with gross total tumor removal.Histological examination revealed a non-Hodgkin’s B-cell lymphoma.Bone marrow aspiration was negative for lymphoma involvement.No other therapies(chemotherapy and/or radiotherapy)were per-formed according to the parents’opinion.The patient died approximately one year after the operation due to brain metastases.The clinical course and imaging features were discussed with a review of literatures.

原发性胃肠道非霍奇金淋巴瘤25例分析

目的对原发性胃肠道非霍奇金淋巴瘤(PG IL)的临床特征、诊治及预后进行探讨。方法回顾性分析25例PG IL的临床资料、病理类型;按上述变量分组,分别统计其3年及5年生存率,探讨各变量与生存率之间的关系。结果本组病例均随访5年以上,3年和5年总生存率分别为56%(14/25),36%(9/25)。3年和5年生存率:Ⅰ、Ⅱ期患者为76.9%(10/13)、61.5%(8/13),Ⅲ、Ⅳ期患者为33.3%(4/12)、8.3%(1/12)(P<0.05)。血清乳酸脱氢酶(LDH)<245 u/L为75%(12/16)、56%(9/16),LDH>245u/L者为22.2%(2/9)、0(0/9)(P<0.05)。低度恶性为73.3%(11/15)、53.3%(8/15),中高度恶性为30%(3/10)、10%(1/10)(P<0.05)。B细胞型PG IL为72.2%(13/18)、50%(9/18),而T细胞型PG IL为14.3%(1/7)、0(0/7)(P<0.05)。结论临床分期、血清乳酸脱氢酶高低、病理及免疫表型为影响PG IL预后的重要因素。

原发性胃肠道恶性淋巴瘤诊治体会(附35例报道)

目的总结和探讨原发性胃肠道恶性淋巴瘤(PGML)的诊断和治疗经验。方法回顾分析1995-2006年收治的35例原发性胃肠道恶性淋巴瘤的临床资料。结果内镜及活检确诊率为31%(11/35),28例接受手术治疗,所有病人均接受CHOP方案化疗。总5年生存率为60%(21/35),ⅠE期86%(6/7),ⅡE期73%(8/11),ⅢE期和Ⅳ期41%(7/17)。结论内镜活检病理联合CT是诊断胃肠恶性淋巴瘤的重要手段,手术联合化疗治疗效果好。

原发性消化道非霍奇金淋巴瘤31例临床分析

目的探讨原发性消化道非霍奇金淋巴瘤(primary gastrointestinal non-Hodgkin’s lymphoma,PGI-NHL)的临床特征和预后。方法回顾性分析新疆石河子大学医学院第一附属医院2006年1月-2012年12月收治的31例经病理确诊的PGI-NHL患者的临床资料。结果临床表现包括纳差、腹痛、腹胀、呕吐、黑便、发热、乏力、消瘦等,其中最主要临床表现为纳差、腹胀。病理分型均为B细胞性淋巴瘤。Kaplan-Meler分析,Log Rank比较显示,性别、年龄、是否行手术、是否有B组症状与生存无显著相关性(P>0.05),分期与生存有显著相关性(P<0.05)。结论 PGI-NHL分期发现越早预后越好,因此,PGI-NHL的早期诊断有重要的临床意义。

原发性胃肠道非霍奇金淋巴瘤的临床特征及预后因素效果观察

目的研究原发性胃肠道非霍奇金淋巴瘤的临床特征及预后因素效果。方法选择2008年1月至2013年6月在苏州大学附属第一医院接受治疗的30例原发性胃肠道非霍奇金淋巴瘤患者作为本研究对象,对其临床特征及预后因素进行分析。结果原发性胃肠道非霍奇金淋巴瘤患者的临床表现以非特异性为主,本组30例患者中,主要临床表现为贫血、缺乏食欲、腹痛,占比分别为53.33%、46.67%、73.33%。并发症包括1例消化道穿孔、2例消化道出血、4例消化道梗阻。所有患者均进行胶囊内镜检查或胃肠镜检查,在初次胃镜检查中,有9例患者诊断为原发性胃肠道非霍奇金淋巴瘤,其中13例误诊为低分化或中等分化胃癌、误诊5例为良性胃溃疡、有3例被误诊为胃间质瘤。随访平均时间(45.34±1.09)个月,5年生存率为46.67%。经多因素Cox分析显示,影响患者生存时间的不良指标包括临床分期和肿瘤大小,而肿瘤类型、治疗方式、肿瘤部位与患者生存时间无明显相关性。结论影响原发性胃肠道非霍奇金淋巴瘤预后的因素较多,比如临床分期、肿瘤大小等,临床应以化疗或化疗联合放疗方式进行治疗,从而改善患者预后。