Review of lymphoma in the duodenum: An update of diagnosis and management

The presentation,subtype,and macroscopic images of lymphoma vary depending on the site of the tumor within the gastrointestinal tract.We searched PubMed for publications between January 1,2012 and October 10,2022,and retrieved 130 articles relating to duodenal lymphoma.A further 22 articles were added based on the manual screening of relevant articles,yielding 152 articles for full-text review.The most predominant primary duodenal lymphoma was follicular lymphoma.In this review,we provide an update of the diagnosis and management of representative lymphoma subtypes occurring in the duodenum:Follicular lymphoma,diffuse large B-cell lymphoma,extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue,mantle cell lymphoma,and Tcell lymphomas.

SENEX-mediated CDK4/6 inhibition promotes senescence and confers apoptosis resistance in B-cell non-Hodgkin lymphoma

Background:The primary cause of treatment failure in patients with refractory or relapsed B-cell non-Hodgkin lymphoma(r/r B-NHL)is resistance to current therapies,and therapy-induced senescence(TIS)stands out as a crucial mechanism contributing to tumor drug resistance.Here,we analyzed SENEX/Rho GTPase Activating Protein 18(ARHGAP18)expression and prognostic significance in doxorubicin-induced B-NHL-TIS model and r/r B-NHL patients,investigating its target in B-NHL cell senescence and the effect of combining specific inhibitors on apoptosis resistance in B-NHL-TIS cells.Methods:Raji cells were transfected with the human SENEX shRNA recombinant lentiviral vector(Sh-SENEX)and the empty vector negative(NC)to construct a stable transfection cell line with knockdown of SENEX.Effect of SENEX-silencing on B-NHL-TIS formation,cell function and cell cycle-related pathways was analyzed.Using doxorubicin(DOX)-inducible senescent B-NHL cells combined with the specific cyclin dependent kinase 4/6(CDK4/6)inhibitor Palbociclib to observe that blocking CDK4/6 effects on TIS formation.SENEX expression of 21 B-NHL patients and 8 healthy controls were analyzed by qRT-PCR,and the correlation between its expression and clinical indicators were evaluated.Results:The downregulation of SENEX expression promotes G1-S phase transition and apoptosis while inhibiting cell proliferation,collectively suppressing the formation of TIS in B-NHL.Blockade of CDK4/6 promotes the DOX-induced G1 phase arrest to enhance TIS formation in B-NHL cells which can reverse the regulatory effect of silencing SENEX on B-NHL cell cycle regulation and senescence.The expression levels of SENEX were notably elevated in B-NHL patients compared to healthy controls,and Elevated expression levels of SENEX were associated with poor prognosis of B-NHL patients.Conclusions:SENEX enhances apoptosis resistance in B-NHL by inhibiting CDK4/6,thereby preventing G1-S phase transition and promoting TIS formation.

Absence of enhancement in a lesion does not preclude primary central nervous system T-cell lymphoma:A case report

BACKGROUND Primary central nervous system lymphoma(PCNSL)is a non-Hodgkin lymphoma that originates in the central nervous system(CNS)and is exclusively limited to the CNS.Although most PCNSLs are diffuse large B-cell lymphomas,primary CNS T-cell lymphomas(PCNSTLs)are rare.PCNSTLs typically demonstrate some degree of enhancement on contrast-enhanced magnetic resonance imaging(MRI).To the best of our knowledge,non-enhancing PCNSTL has not been reported previously.CASE SUMMARY A 69-year-old male presented to the neurology department with complaints of mild cognitive impairment and gradual onset of left lower leg weakness over a span of two weeks.Initial MRI showed asymmetric T2-hyperintense lesions within the brain.No enhancement was observed on the contrast-enhanced T1 image.The initial diagnosis was neuro-Behçet’s disease.Despite high-dose steroid therapy,no alterations in the lesions were identified on initial MRI.The patient’s symptoms deteriorated further.An MRI performed one month after the initial scan revealed an increased lesion extent.Subsequently,brain biopsy confirmed the diagnosis of PCNSTL.The patient underwent definitive combined chemoradiotherapy.However,the patient developed bacteremia and died of septic shock approximately three months after diagnosis.CONCLUSION The absence of enhancement in the lesion did not rule out PCNSTL.A biopsy approach is advisable for pathological confirmation.

A comparative study of ^(67)Ga planar and SPECT images in diagnosis of non-Hodgkin's lymphoma

To comparatively study the sensitivity and specificity of 67Ga planar and SPECT images in diagnosis of non-Hodgkin’s lymphoma. Methods Simultaneous 67Ga planar and SPECT were conducted by using Sopha DS7 SPECF for 48 intermediate lesions in 30 patients that had been pathologically confirmed, with their healthy counterparts as controls. Results Thesensitivity of planar images in head-neck, chest and abdomen was 60.0%, 72.7% and 72.7% respectively, and that of SPECTwas 93.3%, 90.9% and 81.8% respectively. The planar imaging had a general false-neck rate of 31.3%, 2.5 times higherthan SPECF imaging (12.5%) had. Both of them had the same false-positive rate (6.3%). Conclusion SPECT imaging is superior in sensitivity to planar imaging for head-neck, chest and abdomen in detection of intermediate NHL.

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.

Massive bleeding in small intestinal mucosa-associated lymphoid tissue lymphoma associated with COVID-19 infection:a case report

The increased risk of mucosa-associated lymphoid tissue(MALT)lymphoma is closely associated with chronic antigenic stimulation,with infection being the most common cause of recurrence.Lesions are usually associated with the gastrointestinal tract,and the involvement of small intestinal is rare.Recent studies have established a close relationship between novel coronavirus 2019(COVID-19)and the occurrence and progression of various diseases.This article presents a rare case of a small intestinal MALT lymphoma.The patient was initially admitted with COVID-19 pneumonia and subsequently developed gastrointestinal bleeding during hospitalization.Medical and endoscopic treatments were ineffective,and an emergency exploratory laparotomy was performed.The affected segment of the small intestine was excised,and a pathological biopsy confirmed the diagnosis of MALT lymphoma.This case underscores the significance of raising clinical awareness of this condition among health care professionals.

Primary cutaneous B cell lymphoma: Clinical features, diagnosis and treatment

Primary cutaneous B cell lymphoma(PCBCL) is defined as B cell lymphomas that presents in the skin without any evidence of extra-cutaneous involvement at diagnosis. They are the second most common type of primary cutaneous lymphomas accounting for 25%-30%. Since the prognosis and treatment differ from systemic lymphomas involving the skin, differential diagnosis is very important. PCBCL is a heterogeneous group of disease comprising different B cell lymphomas with distinct treatment and prognosis. PCBCL is divided into 5 subclasses according to World Health Organization and European Organization of Research and Treatment of Cancer classification. Primary cutaneous marginal zone lymphoma and primary cutaneous follicle centerlymphoma are indolent forms and often confined to skin at presentation and during the course of the disease. But primary cutaneous diffuse large B cell lymphoma, leg type and intravascular large B cell lymphoma are more aggressive forms that may disseminate to extra-cutaneous tissues. There is not a treatment consensus since they are rare entities. Local therapies like radiotherapy, surgery or intralesional steroids are options for localized disease in indolent forms. More disseminated disease may be treated with a systemic therapy like single agent rituximab. However combination chemotherapies which are used in systemic lymphomas are also required for aggressive PCBCL. Although indolent forms have relatively better prognosis, early relapses and disseminated diseases are mostly observed in aggressive form with a consequent poor prognosis.

2022 Chinese expert consensus and guidelines on clinical management of toxicity in anti-CD19 chimeric antigen receptor T-cell therapy for B-cell non-Hodgkin lymphoma

Adoptive cellular immunotherapy with chimeric antigen receptor(CAR)T cells has emerged as a novel modality for treating relapsed and/or refractory B-cell non-Hodgkin lymphoma(B-NHL).With increasing approval of CAR T-cell products and advances in CAR T cell therapy,CAR T cells are expected to be used in a growing number of cases.However,CAR T-cell-associated toxicities can be severe or even fatal,thus compromising the survival benefit from this therapy.Standardizing and studying the clinical management of these toxicities are imperative.In contrast to other hematological malignancies,such as acute lymphoblastic leukemia and multiple myeloma,anti-CD19 CAR T-cell-associated toxicities in B-NHL have several distinctive features,most notably local cytokine-release syndrome(CRS).However,previously published guidelines have provided few specific recommendations for the grading and management of toxicities associated with CAR T-cell treatment for B-NHL.Consequently,we developed this consensus for the prevention,recognition,and management of these toxicities,on the basis of published literature regarding the management of anti-CD19 CAR T-cell-associated toxicities and the clinical experience of multiple Chinese institutions.This consensus refines a grading system and classification of CRS in B-NHL and corresponding measures for CRS management,and delineates comprehensive principles and exploratory recommendations for managing anti-CD19 CAR T-cell-associated toxicities in addition to CRS.

Diagnosis and surgical treatment of primary hepatic lymphoma

AIM: To assess the benefi ts and limits of surgery for primary hepatic lymphoma (PHL), and probability of survival after postoperative chemotherapy. METHODS: A retrospective analysis was undertaken to determine the results of surgical treatment of PHL over the past 8 years. Only nine patients underwent such treatment. The detailed data of diagnosis, treatment, and prognosis were carefully studied. RESULTS: All patients were mistaken as having α-fetoprotein-negative hepatic cancer before pathological diagnosis. The mean delay time between initial symptoms and final diagnosis was 26.8 d (range:14-47 d). Hepatitis B virus infection was noted in 33.3% of these patients. Most of the lesions were found to be restricted to a solitary hepatic mass. The surgical procedure performed was left hepatectomy in five cases, including left lateral segmentectomy in three. Right hepatectomy was performed in three cases and combined procedures in one. One patient died on the eighth day after surgery,secondary to hepatic insufficiency. The cumulative 6-mo, 1-year, and 2-year survival rates after hepatic surgery were, respectively, 85.7%,71.4%, and 47.6%. One patient survived for>5 years after surgery without any signs of recurrence until latest follow-up, who received routine postoperative chemotherapy every month for 2 years and then regular follow-up. By univariate analysis, postoperative chemotherapy was a significant prognostic factor that influenced survival (P=0.006). CONCLUSION: PHL is a rare entity that is often misdiagnosed, and has a potential association with chronic hepatitis B infection. The prognosis is variable, with good response to early surgery combined with postoperative chemotherapy in strictly selected patients.

Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up

Many progresses have been done in the management of gastrointestinal(GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosaassociated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.

Chinese Society of Clinical Oncology(CSCO) diagnosis and treatment guidelines for malignant lymphoma 2021(English version)

1. General guidelines2. Diagnosis3. Staging4. Treatment4.1 Diffuse large B-cell lymphoma(DLBCL)4.2 Follicular lymphoma(FL)4.3 Mantle cell lymphoma(MCL)4.4 Marginal zone lymphoma(MZL)4.5 Burkitt lymphoma(BL)4.6 CLL/Small lymphocytic lymphoma(SLL)4.7 Extra-nodal natural killer/T-cell lymphoma(ENKTCL), nasal type4.8 Peripheral T-cell lymphoma(PTCL)4.9 HL4.10 Primary central nervous system lymphoma5. Prognosis Lymphomas are a group of heterogeneous diseases.

National guidelines for diagnosis and treatment of malignant lymphoma 2022 in China(English version)

Contents 1.Overview 2.Diagnosis of lymphoma 2.1 Clinical manifestations 2.2 Physical examination 2.3 Laboratory examination 2.4 Imaging examination 2.4.1 CT 2.4.2 MRI 2.4.3 PET-CT 2.4.4 Ultrasound 2.4.5 Isotope bone scan 2.4.6 Endoscopy 2.5 Pathological examination 2.5.1 Morphology 2.5.2 IHC 2.5.3 Fluorescence in situ hybridization(FISH)2.5.4 Antigen receptor gene rearrangement of lymphocytes 2.5.5 Others。

Diagnosis of the jejunoileal lymphoma by double-balloon endoscopy

AIM:To investigate the feasibility of double-balloon endoscopy(DBE) to detect jejunoileal lymphoma,compared with fluorodeoxyglucose positron emission tomography(FDG-PET).METHODS:Between March 2004 and January 2011,we histologically confirmed involvement of malignant lymphoma of the jejunoileum in 31 patients by DBE and biopsy.In 20 patients of them,we performed with FDGPET.We retrospectively reviewed the records of these 20 patients.Their median age was 64 years(range 50-81).In the 20 patients,the pathological diagnosis of underlying non-Hodgkin's lymphoma(NHL) comprised follicular lymphoma(FL,n = 12),diffuse large B cell lymphoma(DLBCL,n = 4),mantle cell lymphoma(MCL,n = 2),enteropathy associated T cell lymphoma(ETL,n = 1) and anaplastic large cell lymphoma(ALCL,n = 1).RESULTS:Ten cases showed accumulation by FDGPET(50%).FDG-PET was positive in 3 of 12 FL cases(25%) while in 7 of 8 non-FL cases(88%,P < 0.05).Intestinal FL showed a significantly lower rate of positive FDG-PET,in comparison with other types of lymphoma.Cases with endoscopically elevated lesions(n = 10) showed positive FDG-PET in 2(20%),but those with other type NHL did in 8 of 10(80%,P < 0.05).When the cases having elevated type was compared with those not having elevated type lesion,the number of cases that showed accumulation of FDG was significantly smaller in the former than in the latter.CONCLUSION:In a significant proportion,small intestinal involvement cannot be pointed out by FDG-PET.Especially,FL is difficult to evaluate by FDG-PET but essentially requires DBE.

Chinese guidelines for diagnosis and treatment of malignant lymphoma 2018(English version)

1. Overview2. Diagnosis of lymphoma2.1 Clinical manifestations2.2 Physical examination2.3 Laboratory examination2.4 Imaging examination2.4.1 CT2.4.2 MRI2.4.3 PET-CT2.4.4 Ultrasound2.4.5 Isotope bone scan2.5 Other specific examinations2.6 Pathological examinations2.6.1 Morphology2.6.2 IHC2.6.3 Fluorescence in situ hybridization (FISH)2.6.4 Antigen receptor gene rearrangement of lymphocytes2.6.5 Others.

Correlation between the Human Development Index and the Incidence and Mortality of Non-Hodgkin Lymphoma

Objective This study was to examine the relationship between socioeconomic status and the incidence and mortality of non-Hodgkin lymphoma(NHL).Methods We compared the age-standardized incidence rate(ASIR),age-standardized mortality rate(ASMR),and the ASMR to ASIR ratio(MIR)at national and regional levels and studied the correlation between the MIR and the human development index(HDI)in 2012 and 2018.Results The highest ASIR was in North America in 2012 and in Australia in 2018,and the lowest ASIR was in Central and South Asia in both 2012 and 2018.The highest ASMR was in North Africa in both 2012 and 2018,and the lowest ASMR was in Eastern Asia and South-Central Asia in 2012 and in South-Central Asia in 2018.The lowest MIR was in Australia in both 2012 and 2018,and the highest MIR was in Western Africa in both 2012 and 2018.HDI was strongly negatively correlated with MIR(r:−0.8810,P<0.0001,2012;r:−0.8895,P<0.0001,2018).Compared to the 2012 data,the MIR in the intermediate HDI countries significantly deceased and the HDI in low and high HDI countries significantly increased in 2018.Conclusion The MIR is negatively correlated with HDI.Increasing the HDI in low and intermediate HDI countries may reduce the MIR and increase the survival of patients with NHL.

Primary Lymphoma of Bone: Imaging Findings to Improve Diagnosis of a Rarely Considered Disease Prior to Biopsy

Objective: Primary lymphoma of bone (PLB) is a rare malignant bone tumor often presenting in the fifth-sixth decades involving appendicular long bones. Published radiological findings indicate that PLB typically presents as a moth-eaten osteolytic lesion with periosteal reaction, while MRI commonly demonstrates marrow infiltration with extraosseous extension. Given rarity and variable appearances, PLB may not be primarily considered prior to biopsy. Our objective was to evaluate preoperative imaging findings in effort to increase awareness and improve a perceived deficiency in preoperative diagnosis. Materials and Methods: Following IRB approval, retrospective review identified 60 patients with newly diagnosed bone lesions proven to represent PLB in accordance with WHO definition. Preoperative radiographs (n = 46), MRI (n = 33) and PET (n = 37) were independently reviewed by two radiologists. At radiography, lesions were classified: purely lytic, mixed, purely sclerotic, or occult;lytic lesions were graded utilizing Lodwick’s classification. At MRI, lesions were defined as focal or infiltrative and the presence or absence of extraosseous disease was recorded. Extraosseous masses were defined as small (1 cm) and subjectively correlated with degree of cortical destruction. At PET, lesions were recorded as FDG-avid or not. Primary radiograph reports when available (n = 33) were reviewed and exact wording of differential considerations was recorded. Results: Radiographs demonstrated mixed (n = 22), lytic (n = 15), and sclerotic (n = 8) appearances;one radiographically occult lesion was seen by MRI. Lytic lesions were graded: IB (n = 3), IC (n = 5), II (n = 4), and III (n = 3);none were IA. At MRI, 30 lesions were infiltrative and 3 were focal;11 were not associated with extraosseous extension, while 22 showed bony disease with small (n = 7) or large (n = 15) soft tissue mass. Of large masses, 13 demonstrated minimal cortical destruction. At PET, 36 demonstrated FDG uptake;one study was technically limited. Review of reports found that only 5 included “lymphoma” as a diagnostic consideration. Conclusion: Contrary to most published data, we suggest that PLB typically demonstrates some degree of osteosclerosis, often a mixed pattern of sclerosis and lucency;purely lytic lesions may be less common. Similar to existing reports, MRI commonly demonstrates marrow infiltration with extraosseous extension of disease, typically a large soft tissue mass with disproportionate (minimal) cortical destruction. Familiarity with these findings should improve preoperative consideration of PLB in the appropriate clinical scenario when a new osteoblastic lesion is identified.

Primary lymphoma of the liver-A complex diagnosis

A 59-year-old woman presented with the clinical symptoms and radiologic investigations of a liver lesion suspect of metastasis. However, postoperative histopathology revealed a primary hepatic lymphoma (PHL). The case of a patient with a solitary PHL, which was treated by resection and subsequent chemotherapy, will be discussed with a short overview of the literature.

Diagnosis Error: Carcinoma or Primary Breast Lymphoma? A Case Report and Literature Review

Introduction: Breast involvement by non-Hodgkin lymphoma is particularly rare in women. We describe the case of a patient with a rapidly growing, nodule in the right breast. On ultrasonography, the nodule was suspicious for breast carcinoma. Case presentation: A breast biopsy from a 73-year-old Moroccan women answered invasive ductal carcinoma grade 3 from Elston and Ellis. Patey was performed. Microscopic examination showed lymphoid proliferation confirmed on immunohistochemical analysis. Our patient was treated with chemotherapy. Conclusions: The rarity of breast lymphomas, and the problems related to the diagnosis and therapeutic choices with these tumors require molecular techniques in association with classical histological diagnosis.

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.

Absolute Lymphocyte/Monocyte Ratio at Diagnosis and Interim Positron-Emission Tomography Predict Survival in Classical Hodgkin Lymphoma

Interim Positron-Emission Tomography (int-PET) and the peripheral blood absolute lymphocyte/monocyte ratio at di- agnosis (ALC/AMC-DX) have been shown to be predictors for progression-free survival (PFS) and time to progression (TTP) in classical Hodgkin lymphoma (cHL). Therefore, we studied if the combination of ALC/AMC-DX and the (int-PET) can further stratified PFS and TTP in cHL patients. Patients were required to be diagnosed, treated, and followed with int-PET at Mayo Clinic, Rochester, Minnesota. From 2000 until 2008, 111 cHL patients qualified for the study. The median follow-up was 2.8 years (range: 0.3 - 10.4 years). Patients with a negative int-PET (N = 98) pre- sented with a higher ALC/AMC-DX (median of 2.32, range: 0.26 - 37.5) compared with patients with a positive int-PET (N = 13) (median of 0.9, range: 0.29 - 3.10), p 1.1. Group 1 experienced superior PFS and TTP in comparison with the other groups. In conclusion, the combination of ALC/AMC-DX and the int-PET provides a simple model to assess clinical outcomes in cHL.