1
|
Lv J, Jiang Y, Yu T, Gao S, Yin W. Clinical characteristics and prognostic analysis of primary extranodal non-Hodgkin lymphoma of the head and neck. Aging (Albany NY) 2024; 16:6796-6808. [PMID: 38604163 PMCID: PMC11087136 DOI: 10.18632/aging.205726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/29/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Primary extranodal non-Hodgkin's lymphoma (PE-NHL) of the head and neck is the second common site of extranodal lymphoma, accounting for approximately one-third of all extranodal non-Hodgkin's lymphoma (E-NHL). However, in recent years, large-scale PE-NHL case studies in China and worldwide are rare and not comprehensive enough. This work analyzed the clinical manifestations, pathological features, immunophenotypes and diagnosis of PE-NHL, as well as the factors affecting the treatment and prognosis. METHODS A retrospective study was performed on 74 patients who were diagnosed with head and neck PE-NHL and treated for the first time. The clinical manifestations, pathological features, and immunophenotypes were summarized, and the factors related to the treatment and prognosis were analyzed. RESULTS The most common site of this disease was the Waldeyer's ring, followed by the nasal cavity. Diffuse large B-cell lymphoma was the most common type, followed by extranodal NK T-cell lymphoma nasal type. The 1-year, 2-year, and 5-year progression-free survival (PFS) rates were 76.4%, 67.9%, and 59.3%. The 1-year, 2-year, and 5-year overall survival (OS) rates were 89.4%, 85.6%, and 63.2%. ECOG score ≥ 2, Ann Arbor stage III or IV and IPI risk stratification identifying patients as the high-risk group were independent risk factors affecting the OS of patients with PE-NHL of the head and neck. CONCLUSIONS The most common site of PE-NHL in these Chinese patients was the Waldeyer's ring, but the incidence in the nasal cavity was higher than that reported in Western countries. Radiotherapy combined with chemotherapy had better efficacy than chemotherapy alone, and the prognosis depended on the ECOG score and clinical stage. IPI had a better prognostic value in patients in the high-risk group of head and neck PE-NHL.
Collapse
Affiliation(s)
- Jiamu Lv
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| | - Yining Jiang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Tingting Yu
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| | - Shengrui Gao
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| | - Wanzhong Yin
- Department of Otolaryngology Head and Neck Surgery, First Hospital of Jilin University, Changchun, China
| |
Collapse
|
2
|
Hong SA, Simpson MC, Du EY, Ward GM. Epidemiology and Prognostic Indicators of Survival in Tongue Lymphoma. Ann Otol Rhinol Laryngol 2023; 132:190-199. [PMID: 35373599 DOI: 10.1177/00034894221088175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Lymphoma, categorized as either non-Hodgkin's lymphoma or Hodgkin's lymphoma, is the second most common malignancy in the head and neck. Primary tongue lymphoma is exceedingly rare, with only case reports or small case series in the literature. This population-based analysis is the first to report the epidemiology and prognostic factors of survival in patients with primary tongue lymphoma. METHODS The Surveillance, Epidemiology, and End Results 18 database from the National Cancer Institute was queried for patients diagnosed between the years 2000 and 2016 with tongue lymphoma. Outcomes of interest were overall and disease-specific survival. Independent variables included age at diagnosis, sex, race, marital status, primary subsite, histologic subtype, stage, and treatment type. RESULTS AND CONCLUSION Seven hundred forty patients met criteria; the male-female ratio was 1.5:1 and the mean age at diagnosis was 67.8 years. The majority of lesions localized to the base of tongue (90.0%), were histologically diffuse large B-cell lymphoma (59.5%), and presented at stage I or II (77.9%). Most early-stage lymphomas were treated with chemotherapy only (40.5%) or a combination of both chemotherapy and radiation (31.3%), while late-stage cancers were primarily treated with chemotherapy alone (68.5%). In multivariate analysis, younger age at diagnosis, female sex, married/partnered marital status, mucosa-associated lymphoid tissue histologic subtype, and earlier cancer stage were found to be associated with improved survival. Chemotherapy treatment with or without radiation was also associated with better survival compared to no treatment or radiation alone, though data regarding immunotherapy was unavailable.
Collapse
Affiliation(s)
- Scott A Hong
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University Hospital, St. Louis, MO, USA
| | - Matthew C Simpson
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University Hospital, St. Louis, MO, USA
| | - Eric Y Du
- Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Gregory M Ward
- Department of Otolaryngology - Head and Neck Surgery, St. Louis University Hospital, St. Louis, MO, USA
| |
Collapse
|
3
|
Song S, Feng X, Liu X, Wang G, Xue L. A Submucosal Tumor-like Lesion of the Cervical Esophagus Similar to the Tonsillar Structures of Waldeyer's Ring: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1804. [PMID: 36557006 PMCID: PMC9781067 DOI: 10.3390/medicina58121804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/27/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Esophageal submucosal tumors are rare, but their pathological types are diverse. In addition to the relatively common leiomyomas, some rare submucosal lesions are occasionally reported. Waldeyer's ring is described as a unique subtype of mucosa-associated lymphoid tissue, located in the naso-oropharynx. Studies have reported that Waldeyer's ring is the most common site of primary extranodal lymphoma in the head and neck. Interestingly, we encountered an esophageal submucosal tumor-like lesion similar to the tonsillar structures of Waldeyer's ring. A 38-year-old man underwent esophagoscopy after experiencing swallowing discomfort for 3 months. A protruding submucosal mass with slightly rough mucosa was found at the cervical esophagus approximately 20 cm from the incisors. Considering the possibility of the coexistence of a submucosal tumor and a mucosal lesion, as well as the continuous symptoms of swallowing discomfort, the patient underwent endoscopic submucosal dissection. The lesion was removed en bloc. However, histology revealed a lesion similar to the tonsillar structure of Waldeyer's ring between the lamina propria and submucosa. The patient was followed up for 6 months without recurrence or complaints. We report a new submucosal lesion and discuss its origin and treatment. Diagnostic ESD might be an effective option until its malignant potential is clarified.
Collapse
Affiliation(s)
- Shibo Song
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (S.S.); (X.L.)
| | - Xiaolong Feng
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
| | - Xudong Liu
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (S.S.); (X.L.)
| | - Guiqi Wang
- Department of Endoscopy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China; (S.S.); (X.L.)
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
| |
Collapse
|
4
|
Ren Q, Wei W, Zhang R, Qi Y, Wang Z. New Perspective on Hodgkin's Lymphoma of the Nasopharynx: Case Report With Review of the Literature. EAR, NOSE & THROAT JOURNAL 2022:1455613221113804. [PMID: 35818666 DOI: 10.1177/01455613221113804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Nasopharyngeal Hodgkin's lymphoma is a rare disorder. We describe a case of a 24-year-old male with Hodgkin's lymphoma (HL) primarily originating from the nasopharynx. He presented with symptoms including snoring and bilateral nasal congestion. After evaluation, endoscopic surgery was performed. Surprisingly, the pathological result proved to be classic HL. Postoperative MRI showed that the tumor was completely resected, and PET-CT was further examined. No lesions were found in other places. Shortly thereafter, the patient was transferred to the hematology department for chemotherapy, and the patient was followed up for 5 months without tumor recurrence. As new problems have been detected in medical management, it is vital to put the HL of the nasopharynx into a new perspective.
Collapse
Affiliation(s)
- Qinzhan Ren
- Skull Base Surgery Center, Department of Otorhinolaryngology-Head and Neck Surgery, Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Wei Wei
- Skull Base Surgery Center, Department of Otorhinolaryngology-Head and Neck Surgery, Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Ruxiang Zhang
- Skull Base Surgery Center, Department of Otorhinolaryngology-Head and Neck Surgery, Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Yan Qi
- Skull Base Surgery Center, Department of Otorhinolaryngology-Head and Neck Surgery, Capital Medical University, Xuanwu Hospital, Beijing, China
| | - Zhenlin Wang
- Skull Base Surgery Center, Department of Otorhinolaryngology-Head and Neck Surgery, Capital Medical University, Xuanwu Hospital, Beijing, China
| |
Collapse
|
5
|
Abstract
OBJECTIVE To identify the factors associated with the survival of malignant Hodgkin and non-Hodgkin lymphomas in oral and nasal cavities.Study design. Retrospective cohort survival analysis. METHODS The Surveillance, Epidemiology and End Results 18 database was used to analyse the factors associated with the 5-year survival rate of malignant lymphomas diagnosed in the oral cavity and pharynx (OCP) and nasal cavity and sinus (NCS) regions from 1988 to 2011 for all patients in the USA. Multivariable Cox regression models were used to calculate the HR of malignant lymphoma death overall and by the site of cancer diagnosis. RESULTS Among the 8785 patients included in the analysis, 4103 (46.7%) were women, 6096 (69.4%) were non-Hispanic (NH) white, 635 (7.2%) were NH black and 1209 (13.8%) were Hispanic patients of all races. We found that a higher 5-year survival rate of malignant lymphoma is associated with: female gender; younger age at diagnosis; NH white race/ethnicity; diagnosis in the oral cavity; receiving surgery/radiation and surgery/radiation, surgery and chemotherapy as the treatment; diagnosis at a localised stage and diagnosis in later calendar years. No association with lymphoma subtype was observed. CONCLUSION We have identified several demographics and prognosis factors associated with the 5-year survival rate of malignant lymphomas in the OCP and NCS regions. These findings warrant greater public health attention on the prognosis of malignant lymphomas in the OCP and NCS regions among the most vulnerable populations.
Collapse
Affiliation(s)
- Feifei Jiang
- Department of Otorhinolaryngology, The First Hospital of China Medical University, Shenyang, China
| | - Ai-Hui Yan
- Department of Otorhinolaryngology, The First Hospital of China Medical University, Shenyang, China
| |
Collapse
|
6
|
Jia J, Chen W. Role of radiation therapy in primary tonsil large B cell lymphoma: a SEER-based analysis. Radiat Oncol 2021; 16:193. [PMID: 34600539 PMCID: PMC8487472 DOI: 10.1186/s13014-021-01919-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
Backgroud Primary tonsil diffuse large B cell lymphoma (PT-DLBCL) is an uncommon disease entity. The role of radiation therapy (RT) in PT-DLBCL is debatable in both the pre- and post- rituximab era. The purpose of this study was to evaluate the treatment outcome and establish a prognostic model in PT-DLBCL based on the Surveillance, Epidemiology, and End Results (SEER) database. Materials and methods Data of 1214 PT-DLBCL patients diagnosed between 1975 and 2016 were extracted from SEER 18. The effect of RT was assessed for the entire cohort and subgroups by stages using univariate, multivariate Cox regression analyses and propensity score matching (PSM). Results The entire cohort included 1043 patients with early-stage (ES) PT-DLBCL and 171 patients with advanced-stage (AS) disease. A decreasing trend of RT utilization in the ES cohort after 2002 was observed. 47.4% of patients in ES received RT, whereas 25.1% in AS underwent RT. RT significantly improved overall survival in both univariate (P < 0.001) and multivariate (P = 0.002) analyses. PSM analysis further validated the survival advantage of RT (P = 0.002). A nomogram was established to predict the potential survival benefit. Subgroup analysis revealed RT was significantly associated with overall survival in ES patients of PT-DLBCL (P = 0.001) and in the rituximab era (P = 0.001) but not in those with AS disease (P = 0.241). Conclusions This population-based study encloses the largest sample of PT-DLBCL to date and demonstrates a favorable survival role of RT in early stages rather than advanced stages. The established nomogram helps to identify high risk patients to improve prognosis.
Collapse
Affiliation(s)
- Jing Jia
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Wenming Chen
- Department of Hematology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
7
|
Guan Q, Hong Y, Hu G, Zhou Q, Li L, Qian Z, Zhou S, Ren X, Qiu L, Wang X, Zhang H. Reduced radiotherapy clinical benefit for primary Waldeyer's ring diffuse large B-cell lymphoma in the rituximab era. Hematol Oncol 2021; 39:490-497. [PMID: 33908077 DOI: 10.1002/hon.2869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 11/09/2022]
Abstract
This study aimed to identify the prognostic factors in patients with Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL), comparing the efficacy of radiotherapy (RT) for the WR-DLBCL patients in the pre-rituximab and rituximab eras. We conducted a retrospective analysis of 134 patients diagnosed with WR-DLBCL. Univariate and multivariate analyses were performed to identify the prognostic factors for WR-DLBCL. Then, we divided these patients into the rituximab plus chemotherapy group (R-chemotherapy) (n = 88) and chemotherapy group (n = 46), and the Kaplan-Meier and Cox regression model analyses were applied to investigate the treatment value of RT in both the groups. Multivariate analysis revealed international prognostic index (IPI) ≥ 3 and chemotherapy without rituximab as significant risk factors for the progression-free survival (PFS, IPI ≥ 3: p = 0.001; chemotherapy without rituximab: p = 0.002) and overall survival (OS, IPI ≥ 3, p < 0.001; chemotherapy without rituximab, p = 0.024). Rituximab combined with chemotherapy significantly improved PFS (p = 0.002) and OS (p = 0.006) in these patients. RT did not significantly contribute to the survival in the overall cohort analysis, whereas in the subgroup analysis, RT significantly improved the PFS (p = 0.025) and OS (p = 0.029) for the patients in the chemotherapy group, but not in the R-chemotherapy group. In conclusion, the WR-DLBCL patients could benefit from RT in the pre-rituximab era, whereas the addition of rituximab to chemotherapy significantly improved the survival of WR-DLBCL patients, and the clinical benefit of RT was reduced.
Collapse
Affiliation(s)
- Qingpei Guan
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Yuheng Hong
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Ge Hu
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Qiqi Zhou
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Lanfang Li
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Zhengzi Qian
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Shiyong Zhou
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xiubao Ren
- Departments of Immunology/Biotherapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lihua Qiu
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Xianhuo Wang
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| | - Huilai Zhang
- Departments of Lymphoma, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, the Sino-US Center for Lymphoma and Leukemia Research, Tianjin, China
| |
Collapse
|
8
|
Kurtoğlu E, Göçer M. Clinical Significance of Increased FDG Uptake in the Waldeyer Ring and the Nasopharynx Region Identified by PET-CT in Postchemotherapy Follow-up in Patients With Lymphoma: When Should We Perform Biopsy? CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:830-835. [PMID: 32917575 DOI: 10.1016/j.clml.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE To identify whether fluorodeoxyglucose (FDG) uptake in the Waldeyer ring (WR)/nasopharyngeal (NP) region by positron emission tomography-computed tomography (PET-CT) was physiologic or pathologic in the follow-up of lymphoma patients receiving postchemotherapy treatment. PATIENTS AND METHODS We retrospectively examined FDG uptake in the WR/NP region in 534 patients with lymphoma as assessed by PET-CT used for both diagnosis and follow-up. RESULTS Forty-nine patients had FDG uptake in the WR/NP region by PET-CT performed after completion of a chemotherapy regimen. Biopsy was performed for 11 of these patients in whom the uptake was considered to be pathologic, and results indicated the presence of reactive follicular hyperplasia. It was considered to be physiologic in 38 patients. PET-CT was repeated after 1 year, and no significant difference was identified between the standardized maximum uptake values (SUVmax; P = .107). The initial diagnosis of 20 patients was made via biopsy performed in the WR/NP region. The SUVmax for the FDG uptake in these patients, asymmetry, SUVmax of the coexisting lymphadenopathies in the neck, and FDG uptake with a counterpart finding by CT were significantly higher than other groups (P = .047, .001, and .005). CONCLUSION When deciding whether to resample after treatment completion, it should be taken into account that, in addition to the SUVmax of the lesion, asymmetry, and the SUVmax of the coexisting lymphadenopathy in the neck, a crucial criterion is whether the FDG uptake has a counterpart finding by CT.
Collapse
Affiliation(s)
- Erdal Kurtoğlu
- Division of Hematology, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey.
| | - Mesut Göçer
- Division of Hematology, Department of Internal Medicine, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
9
|
Büyüktaş D, Örnek S, Tokat F, Tecimer T, Ferhanoğlu B. IRF4-Rearranged Large B-Cell Lymphoma on Waldeyer’s Ring: A Case Report. Turk J Haematol 2020; 37:292-294. [PMID: 32349466 PMCID: PMC7702643 DOI: 10.4274/tjh.galenos.2020.2020.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Deram Büyüktaş
- Koç University Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| | - Serdar Örnek
- American Hospital, Clinic of Hematology, İstanbul, Turkey
| | - Fatma Tokat
- Acıbadem University Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Tülay Tecimer
- Acıbadem Health Group, Pathology Laboratory, İstanbul, Turkey
| | - Burhan Ferhanoğlu
- Koç University Faculty of Medicine, Department of Hematology, İstanbul, Turkey
| |
Collapse
|
10
|
Ren X, Cheng Y, Wu S, Zeng X, Shi X, Ling Q, Li Z, Liang Z, Wang B. Primary non-Hodgkin lymphoma of the tongue base: the clinicopathology of seven cases and evaluation of HPV and EBV status. Diagn Pathol 2020; 15:30. [PMID: 32238190 PMCID: PMC7110811 DOI: 10.1186/s13000-020-00936-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/06/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives Non-Hodgkin’s lymphoma (NHL) primarily derived from the base of the tongue, is rare. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are important aetiological risk factors for tumours of the head and neck. This study describes the clinicopathological features of NHL in the tongue base and the status of HPV and EBV in these cases. Methods Seven cases were identified from the Pathological Registry Database at Peking Union Medical College Hospital (PUMCH). The study utilized immunochemistry, in situ hybridization (ISH), and gene rearrangement to confirm the disease and and performed a clinical follow up for each case. Results All 7 lymphomas were localized at the base of the tongue. Six of the cases exhibited tongue base masses with smooth surface membranes. One case presented as multiple deep ulcers. The most common histologic subtype was diffuse large B-cell lymphoma (DLBCL), which occurred in five cases. The other two cases were mantle cell lymphoma (MCL) and peripheral T cell lymphoma, not otherwise specified (PTCL, NOS). One of the DLBCL cases was positive for HPV DNA and diffusely expressed P16 protein. During the follow up period, the MCL patient and an elderly DLBCL patient died. The remaining five patients were alive through the end of follow up. Conclusions Most lymphomas of the tongue base manifest as an endogenous mass without membranous change. The most common subtype of NHLs of the tongue base is DLBCL, and the occurrence at this site may have a good prognosis. With proper therapy, even late stage tongue base lymphomas can be suppressed and remain in remission.
Collapse
Affiliation(s)
- Xinyu Ren
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Yin Cheng
- Departments of Pathology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Shafei Wu
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Xuan Zeng
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Xiaohua Shi
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Qing Ling
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China
| | - Zongzhu Li
- Department of Biochemistry and Molecular Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Zhiyong Liang
- Departments of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Dongdan district Shuaifuyuan 1st, 100730, Beijing, China.
| | - Beverly Wang
- Department of Pathology and Otolaryngology, UC Irvine School of Medicine, UC Irvine Medical Center, Irvine, USA.
| |
Collapse
|
11
|
Differentiation between nasopharyngeal carcinoma and lymphoma at the primary site using whole-tumor histogram analysis of apparent diffusion coefficient maps. Radiol Med 2020; 125:647-653. [PMID: 32072391 DOI: 10.1007/s11547-020-01152-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/06/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION To determine the value of whole-tumor histogram analysis of apparent diffusion coefficient (ADC) maps in differentiating nasopharyngeal carcinoma (NPC) from lymphoma (NPL) at the primary site METHOD AND MATERIALS: One hundred forty-seven patients with nasopharyngeal tumors (89 NPCs and 38 NPLs) who had undergone magnetic resonance imaging (MRI) and diffusion-weighted imaging were retrospectively analyzed. ADC histogram-derived parameters were compared between the NPC and NPL groups by using the Mann-Whitney U test. Receiver operating characteristic (ROC) curves of the histogram parameters were plotted for diagnostic accuracy. Sensitivity and specificity were calculated for each histogram parameter. RESULTS In whole-tumor histogram analysis, the mean, median, and 10th and 25th percentiles of ADC were all significantly higher in NPC than NPL (P = 0.045, P = 0.035, P = 0.005, and P = 0.016, respectively). Uniformity was significantly higher in NPC than NPL (P = 0.001). Skewness was significantly lower in NPC than NPL (P = 0.039). For the conventional ROI-based method, ADCmean values were significantly higher in NPC than in NPL (P = 0.009). The ROC curve analysis showed that uniformity yielded the largest area under the curve (AUC = 0.768) for differentiating NPC from NPL among all ADC metrics, followed by 10th percentiles of ADC (AUC = 0.725); sensitivity and specificity were 76.5% and 71.4%, respectively. CONCLUSION Whole-tumor histogram analysis of ADC maps could be helpful for differentiating NPC from NPL.
Collapse
|
12
|
Clinical pathology conference case 5: bilateral maxillary sinus resorptive disease with palatal ulceration in a 42-year-old patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2019. [DOI: 10.1016/j.oooo.2019.02.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
13
|
Plata AM, Pollard RE, Fang Y, Khalid A, Estalilla OC, Jelic TM. Three Synchronous Primary Extranodal Mantle Cell Lymphomas Involving Torus Tubarius, Posterior Nasopharynx, and Base of the Tongue 65 Years After Treatment of Chronic Sinusitis with Nasopharyngeal Radium Irradiation. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1063-1070. [PMID: 31326974 PMCID: PMC6664868 DOI: 10.12659/ajcr.915742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Patient: Male, 81 Final Diagnosis: Mantle cell lymphoma Symptoms: Dificulty in swallowing and pain in the right ear Medication: — Clinical Procedure: Otorhinolaryngology panendoscopy • biopsy of the tumors Specialty: Otolaryngology
Collapse
Affiliation(s)
- Andrew M Plata
- Department of Pathology, Anatomy and Laboratory Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA
| | - Robert E Pollard
- Ear, Nose and Throat Physicians and Surgeons of Charleston, Charleston, WV, USA
| | - Yan Fang
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Ahmed Khalid
- Cancer Center, Charleston Area Medical Center, Charleston, WV, USA
| | - Oscar C Estalilla
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| | - Tomislav M Jelic
- Department of Pathology and Laboratory Medicine, Charleston Area Medical Center, Charleston, WV, USA
| |
Collapse
|
14
|
Frata P, Buglione M, Grisanti S, Bonetti B, Vitali E, De Stefani A, Magri E, Peveri A, Marini G, Rossi G, Magrini SM. Localized Extranodal Lymphoma of the Head and Neck: Retrospective Analysis of a Series of 107 Patients from a Single Institution. TUMORI JOURNAL 2019; 91:456-62. [PMID: 16457141 DOI: 10.1177/030089160509100602] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To retrospectively analyze the outcome and patterns of relapse in localized extranodal non-Hodgkin's lymphoma of the head and neck (HN-NHL) after radiotherapy alone or combined modality treatment. Patients and Methods A retrospective analysis of 107 patients with HN-NHL was performed. Relapse patterns, overall survival (OS) and relapse-free survival (RFS) were analyzed. Only stage I (n = 50) and stage II (n = 57) patients were included with either low-grade (n = 21) or high-grade (n = 86) lymphoma. Fifty-nine patients were treated with radiotherapy (RT) alone and 48 patients received combined-modality treatment (CMT) consisting of chemotherapy (CHOP or CHOP-like) followed by radiotherapy. The volumes of irradiation included local field (n = 24), involved field (n = 13) and extended field (n = 70). The median age at diagnosis was 63 years (range, 17-86 years). Results The overall response rates (CR+PR) in the radiotherapy group and the combined modality group were 100% and 96%, respectively. With a median follow-up of 49.4 months, 29 of 59 patients after RT alone (37%) and 30 of 48 patients after CMT (62%) were disease-free. In the whole series the projected five-year OS and RFS were 58.7% and 61.8%. At univariate analysis of clinical variables with potential impact on survival including age, stage, histology, IPI score, single or combined treatment and volumes of irradiation, only age and, to a limited extent, type of treatment influenced OS (age ≤60 years 79%, >60 years 41%, P<0.001; RT alone 54.9%, CMT 62.8%, P = 0.0487) and RFS (≤60 years 75%, >60 years 50%, P<0.001; RT alone 54%, CMT 71%, P = 0.039). Better OS and RFS rates were obtained in patients with stage II and high-grade disease treated with CMT (five-year OS and RFS 63% and 69%, respectively; the corresponding values for RT alone were 38% and 34%). The final model of the multivariate analysis retained only age (≤60 years) as a significant prognostic factor for both RFS and OS ( P<0.001). In the whole series, the sites of relapse were mainly systemic (n = 32/40, 80%) and in-field relapses were rare (n = 3/40, 7.5%). Conclusion HN-NHL is characterized by a high risk of relapse, particularly at distant sites. Older patients have a significantly worse prognosis. Radiotherapy offers a very good local control rate although combined modality treatment possibly produces better RFS and OS, especially for stage II and high-grade disease. Better systemic approaches are warranted for a more consistent impact on survival in this particular subset of extranodal lymphoma. However, radiotherapy alone may offer a feasible and effective modality for patients who cannot tolerate more aggressive treatments. Extended-field radiotherapy and the treatment of a larger number of uninvolved lymph nodal regions does not confer a RFS or OS advantage, either after RT alone or after CMT.
Collapse
Affiliation(s)
- Paolo Frata
- University Department of Radiation Oncology, Istituto del Radio O. Alberti, Spedali Civili, Brescia, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
The Role of Radiotherapy in Early-stage Primary Diffuse Large B-Cell Lymphoma of the Waldeyer Ring. Am J Clin Oncol 2018; 41:802-806. [DOI: 10.1097/coc.0000000000000375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Lo Pinto S, Barranco R, Cuccì M, Caputo F, Fossati F, Orcioni GF, Ventura F. Sudden Death Secondary to an Undiagnosed B-Cell Lymphoma of the Hypopharynx and Infiltration of the Inferior Constrictor Muscle. J Forensic Sci 2017; 63:1303-1306. [PMID: 28973786 DOI: 10.1111/1556-4029.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/13/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022]
Abstract
The aim of this presentation was to share an uncommon form of sudden death, suffered by a 64-year-old woman, due to a mechanical obstruction of hypopharynx by an undiagnosed B-cell lymphoma, infiltrating the inferior pharyngeal constrictor muscle. A forensic approach by means of scene investigation, circumstantial data collection, autopsy, and histological and toxicological investigations led to conclude that the cause of death was asphyxia, correlated with B-cell lymphoma of the hypopharynx. The autopsy examination highlighted the presence of a wall thickening, infiltrating, and projecting into the hypopharynx lumen. The histological analysis showed the essential finding of a B-cell lymphoma of the hypopharynx, diffusely infiltrating the inferior pharyngeal constrictor muscle. To conclude, this case demonstrates once more that in the absence of specific data, a thorough forensic investigation including autopsy, histological examination, and circumstantial data collection is mandatory to reach a correct cause of death.
Collapse
Affiliation(s)
- Sara Lo Pinto
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, Genova, 16132, Italy
| | - Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, Genova, 16132, Italy
| | - Maria Cuccì
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, Genova, 16132, Italy
| | - Fiorella Caputo
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, Genova, 16132, Italy
| | - Francesca Fossati
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, Genova, 16132, Italy
| | | | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Via De' Toni 12, Genova, 16132, Italy
| |
Collapse
|
17
|
Alagöz E, Okuyucu K, İnce S, Kantarcıoğlu M, Özaydın Ş, Heper C, Türker T, Arslan N. Uptake Patterns of Untreated Primary Gastrointestinal Extranodal Lymphomas on Initial Staging 18F-FDG PET/CT and Metabolic Tumor Parameters. Mol Imaging Radionucl Ther 2017; 26:83-92. [PMID: 28976330 PMCID: PMC5643944 DOI: 10.4274/mirt.48658] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: Non-Hodgkin’s lymphomas arising from tissues other than primary lymphatic sites are classified as primary extranodal lymphomas (PEL). PELs of the gastrointestinal system (PGISL) originate from the lymphatic tissues within the gastrointestinal tract. The prognostic value of 18F-FDG PET/CT in lymphomas is high in terms of both overall survival (OS) and disease-free survival (DFS). Our aim was to investigate the uptake patterns and properties of low-grade and high-grade PGISL on primary staging 18F-FDG PET/CT, as well as the prognostic significance of metabolic tumor parameters in high grade PGISL. Methods: Thirty-nine patients with PGISL were enrolled in this retrospective cohort study between 2004-2015. Primary staging 18F-FDG PET/CT have been performed and quantitative parameters of SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) have been calculated for all patients prior to treatment. Low-grade and high-grade PGISL were compared in terms of metabolic tumor parameters. Cox regression models were performed to determine factors that correlate with DFS in high-grade PGISL. Results: There were statistically significant differences between high-grade and low-grade PGISL in terms of SUVmax, SUVmean, MTV, TLG, recurrence, mortality, DFS and OS. None of the potential risk factors (sex, age, site, SUVmax, SUVmean, MTV, TLG) for recurrence and metastasis in high grade PGISL was identified as a risk factor on univariate and multivariate Cox regression analysis. Conclusion: Metabolic tumor parameters are not predictive markers in high-grade PGISL, especially in diffuse large B cell variant and primary gastric lymphoma. The first implications suggest they will not play a role in patient management.
Collapse
Affiliation(s)
- Engin Alagöz
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Kürşat Okuyucu
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Semra İnce
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| | - Murat Kantarcıoğlu
- Gülhane Training and Research Hospital, Clinic of Gastroenterology, Ankara, Turkey
| | - Şükrü Özaydın
- Gülhane Training and Research Hospital, Clinic of Medical Oncology, Ankara, Turkey
| | - Cumhur Heper
- İstanbul University Institute of Cardiology, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Türker Türker
- Gülhane Training and Research Hospital, Clinic of Public Health, Ankara, Turkey
| | - Nuri Arslan
- Gülhane Training and Research Hospital, Clinic of Nuclear Medicine, Ankara, Turkey
| |
Collapse
|
18
|
Han AY, Kuan EC, Alonso JE, Badran KW, St John MA. Epidemiology of Nasopharyngeal Lymphoma in the United States: A Population-Based Analysis of 1119 Cases. Otolaryngol Head Neck Surg 2017; 156:870-876. [PMID: 28322119 DOI: 10.1177/0194599817695808] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To describe the incidence and determinants of survival of patients with nasopharyngeal lymphoma (NPL) between 1973 and 2012 using the Surveillance, Epidemiology, and End Results (SEER) database. Study Design Retrospective cohort study using a national database. Methods The SEER registry was used to calculate survival trends for patients with NPL between 1973 and 2012. Patient data were then analyzed with respect to histopathology, age, sex, race, histologic subtype, Ann Arbor stage, and whether radiation therapy was given. Overall survival (OS) and disease-specific survival (DSS) were calculated. Results A total of 1119 cases of NPL were identified. The cohort was composed of 58.8% males. The mean age at diagnosis was 59.3 years. The median OS was 8.2 years. B-cell non-Hodgkin's lymphomas (NHLs) accounted for most cases (77.5%), with natural killer (NK)/T-cell lymphomas comprising 6.0% of cases. A total of 41.5% patients received radiation therapy. OS at 2, 5, and 10 years was 70%, 57%, and 45%, respectively. On multivariate analysis, advanced age and NK/T-cell NHL histologic subtype were associated with worse OS and DSS, while radiation therapy was associated with improved OS and DSS (all P < .05). Conclusion With the exception of NK/T-cell NHL subtypes, NPL is associated with a fair prognosis, with younger age, low Ann Arbor stage, and radiation therapy being independent positive prognosticators for survival.
Collapse
Affiliation(s)
- Albert Y Han
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Edward C Kuan
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Jose E Alonso
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Karam W Badran
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Maie A St John
- 1 Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, California, USA.,2 Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California, USA.,3 UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California, USA
| |
Collapse
|
19
|
Xu YG, Qi SN, Wang SL, Liu YP, Wang WH, Jin J, Song YW, Ren H, Fang H, He XH, Dong M, Chen B, Lu NN, Li N, Tang Y, Tang Y, Dai JR, Li YX. Dosimetric and Clinical Outcomes With Intensity Modulated Radiation Therapy After Chemotherapy for Patients With Early-Stage Diffuse Large B-cell Lymphoma of Waldeyer Ring. Int J Radiat Oncol Biol Phys 2016; 96:379-386. [PMID: 27478171 DOI: 10.1016/j.ijrobp.2016.05.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 05/04/2016] [Accepted: 05/23/2016] [Indexed: 01/09/2023]
|
20
|
Okuyucu K, Ozaydın S, Alagoz E, Ozgur G, Ince S, Oysul FG, Ozmen O, Tuncel M, Ozturk M, Arslan N. Prognosis estimation under the light of metabolic tumor parameters on initial FDG-PET/CT in patients with primary extranodal lymphoma. Radiol Oncol 2016; 50:360-369. [PMID: 27904443 PMCID: PMC5120580 DOI: 10.1515/raon-2016-0045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 06/16/2016] [Indexed: 02/04/2023] Open
Abstract
Background Non-Hodgkin’s lymphomas arising from the tissues other than primary lymphatic organs are named primary extranodal lymphoma. Most of the studies evaluated metabolic tumor parameters in different organs and histopathologic variants of this disease generally for treatment response. We aimed to evaluate the prognostic value of metabolic tumor parameters derived from initial FDG-PET/CT in patients with a medley of primary extranodal lymphoma in this study. Patients and methods There were 67 patients with primary extranodal lymphoma for whom FDG-PET/CT was requested for primary staging. Quantitative PET/CT parameters: maximum standardized uptake value (SUVmax), average standardized uptake value (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were used to estimate disease-free survival and overall survival. Results SUVmean, MTV and TLG were found statistically significant after multivariate analysis. SUVmean remained significant after ROC curve analysis. Sensitivity and specificity were calculated as 88% and 64%, respectively, when the cut-off value of SUVmean was chosen as 5.15. After the investigation of primary presentation sites and histo-pathological variants according to recurrence, there is no difference amongst the variants. Primary site of extranodal lymphomas however, is statistically important (p = 0.014). Testis and central nervous system lymphomas have higher recurrence rate (62.5%, 73%, respectively). Conclusions High SUVmean, MTV and TLG values obtained from primary staging FDG-PET/CT are potential risk factors for both disease-free survival and overall survival in primary extranodal lymphoma. SUVmean is the most significant one amongst them for estimating recurrence/metastasis.
Collapse
Affiliation(s)
- Kursat Okuyucu
- Department of Nuclear Medicine, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Sukru Ozaydın
- Department of Medical Oncology, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Engin Alagoz
- Department of Nuclear Medicine, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Gokhan Ozgur
- Department of Haematology, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Semra Ince
- Department of Nuclear Medicine, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Fahrettin Guven Oysul
- Department of Public Health, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Ozlem Ozmen
- Department of Nuclear Medicine, Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Kecioren, Ankara, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University, Ankara, Turkey
| | - Mustafa Ozturk
- Department of Medical Oncology, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| | - Nuri Arslan
- Department of Nuclear Medicine, Gulhane Military Medical Academy (GATA), Ankara, Turkey
| |
Collapse
|
21
|
An Unusual Presentation of B-Cell Lymphoma as a Large Isolated Epiglottic Mass: Case Report and Literature Review. Case Rep Otolaryngol 2016; 2016:9787432. [PMID: 27213065 PMCID: PMC4861795 DOI: 10.1155/2016/9787432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 03/19/2016] [Accepted: 04/10/2016] [Indexed: 11/17/2022] Open
Abstract
Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses.
Collapse
|
22
|
Simsek E, Ozmen HK, Bilen Y, Calik M, GüNDOGDU B, Erdemci B. Cystic isolated lymphoma of the base of the tongue: A case report. Oncol Lett 2016; 11:2539-2541. [PMID: 27073513 DOI: 10.3892/ol.2016.4224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 01/13/2016] [Indexed: 11/05/2022] Open
Abstract
Isolated lymphoma of the base of the tongue is a relatively rare condition. The clinical presentation may vary from a submucosal mass with a cystic appearance to an ulcerated lesion. In the present case, a cystic mass was identified in a patient admitted with a sore throat. Pathological examination confirmed diffuse large B-cell lymphoma. The clinical and pathological picture of lymphomas covers a wide spectrum and the rate of occurrence in the oral cavity is 3-5%. Among all malignant tumors of the oral cavity, lymphomas represent the third most common type of tumor, following squamous cell carcinoma and salivary gland neoplasms. Lymphomas of the oral cavity mostly arise from the Waldeyer ring, which is a lymphoid tissue. In our case, no recurrence was observed during the 8-month follow-up period after the patient was administered chemotherapy followed by radiotherapy. In conclusion, although isolated lymphoma of the base of the tongue is extremely rare, it should always be considered in patients presenting with a sore throat and the sensation of a foreign body in the throat.
Collapse
Affiliation(s)
- Eda Simsek
- Ear, Nose and Throat Clinic, Education and Research Hospital, Erzurum 25240, Turkey
| | - Hilal Kiziltunc Ozmen
- Department of Radiation Oncology, Ataturk University Medical School, Erzurum 25170, Turkey
| | - Yusuf Bilen
- Department of Hematology and Oncology, Ataturk University Medical School, Erzurum 25170, Turkey
| | - Muhammed Calik
- Department of Pathology, Ataturk University Medical School, Erzurum 25170, Turkey
| | - Betül GüNDOGDU
- Department of Pathology, Ataturk University Medical School, Erzurum 25170, Turkey
| | - Burak Erdemci
- Department of Radiation Oncology, Ataturk University Medical School, Erzurum 25170, Turkey
| |
Collapse
|
23
|
Long-term Tumor-free Survival With Untreated Primary Diffuse Large B-cell Lymphoma of the Tonsil. Am J Surg Pathol 2015; 39:1493-501. [DOI: 10.1097/pas.0000000000000541] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
24
|
Yahalom J, Illidge T, Specht L, Hoppe RT, Li YX, Tsang R, Wirth A. Modern radiation therapy for extranodal lymphomas: field and dose guidelines from the International Lymphoma Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2015; 92:11-31. [PMID: 25863750 DOI: 10.1016/j.ijrobp.2015.01.009] [Citation(s) in RCA: 247] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 12/14/2015] [Accepted: 01/10/2015] [Indexed: 12/11/2022]
Abstract
Extranodal lymphomas (ENLs) comprise about a third of all non-Hodgkin lymphomas (NHL). Radiation therapy (RT) is frequently used as either primary therapy (particularly for indolent ENL), consolidation after systemic therapy, salvage treatment, or palliation. The wide range of presentations of ENL, involving any organ in the body and the spectrum of histological sub-types, poses a challenge both for routine clinical care and for the conduct of prospective and retrospective studies. This has led to uncertainty and lack of consistency in RT approaches between centers and clinicians. Thus far there is a lack of guidelines for the use of RT in the management of ENL. This report presents an effort by the International Lymphoma Radiation Oncology Group (ILROG) to harmonize and standardize the principles of treatment of ENL, and to address the technical challenges of simulation, volume definition and treatment planning for the most frequently involved organs. Specifically, detailed recommendations for RT volumes are provided. We have applied the same modern principles of involved site radiation therapy as previously developed and published as guidelines for Hodgkin lymphoma and nodal NHL. We have adopted RT volume definitions based on the International Commission on Radiation Units and Measurements (ICRU), as has been widely adopted by the field of radiation oncology for solid tumors. Organ-specific recommendations take into account histological subtype, anatomy, the treatment intent, and other treatment modalities that may be have been used before RT.
Collapse
Affiliation(s)
- Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York.
| | - Tim Illidge
- Institute of Cancer Sciences, University of Manchester, Manchester Academic Health Sciences Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom
| | - Lena Specht
- Department of Oncology and Hematology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Ye-Xiong Li
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Richard Tsang
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Wirth
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East Melbourne, Australia
| | | |
Collapse
|
25
|
Kato H, Kanematsu M, Watanabe H, Kawaguchi S, Mizuta K, Aoki M. Differentiation of extranodal non-Hodgkins lymphoma from squamous cell carcinoma of the maxillary sinus: a multimodality imaging approach. SPRINGERPLUS 2015; 4:228. [PMID: 26120502 PMCID: PMC4478190 DOI: 10.1186/s40064-015-0974-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/09/2015] [Indexed: 01/13/2023]
Abstract
This study aimed to assess the efficacy of a multimodality imaging approach for differentiating between primary extranodal non-Hodgkin’s lymphoma (NHL) and squamous cell carcinoma (SCC) of the maxillary sinus. Twelve NHLs and 29 SCCs of the maxillary sinus were included. CT findings, MR signal intensities, apparent diffusion coefficients (ADCs), and maximum standardized uptake values (SUVmax) were correlated with two pathologies. On CT, permeative growth frequency was greater among NHLs than among SCCs (50 % vs. 10 %; p < 0.01), whereas destructive growth frequency was greater among SCCs than among NHLs (83 % vs. 33 %; p < 0.01). On CT, remaining sinus wall within the tumor was more frequent with NHLs than with SCCs (92 % vs. 34 %; p < 0.01), whereas intratumoral necrosis was more frequent with SCCs than with NHLs (86 % vs. 17 %; p < 0.01). ADCs were lower for NHLs than for SCCs (0.61 vs. 0.95 × 10–3 mm2/s; p < 0.01). No significant differences in MR signal intensities and SUVmax were observed. Tumor growth pattern, remaining sinus wall within the tumor, and intratumoral necrosis were useful CT findings for differentiating between NHLs and SCCs. ADC measurements could assist the differentiation of NHL from SCC.
Collapse
Affiliation(s)
- Hiroki Kato
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Masayuki Kanematsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan ; High-level Imaging Diagnosis Center, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194 Japan
| | - Haruo Watanabe
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu, 501-1194 Japan
| | | | - Keisuke Mizuta
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| | - Mitsuhiro Aoki
- Department of Otolaryngology, Gifu University School of Medicine, Gifu, Japan
| |
Collapse
|
26
|
Prognostic CT and MR imaging features in patients with untreated extranodal non-Hodgkin lymphoma of the head and neck region. Eur Radiol 2015; 25:3035-42. [PMID: 25809745 DOI: 10.1007/s00330-015-3708-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/24/2015] [Accepted: 03/05/2015] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the prognostic CT and MR imaging features of extranodal non-Hodgkin lymphoma in the head and neck region. METHODS The clinical data and CT and MR imaging features of 59 patients with histologically confirmed extranodal non-Hodgkin lymphoma in the head and neck region were retrospectively reviewed. Subjects included 27 male and 32 female patients between 13 and 81 years of age, with a mean age of 60.3 years. The clinical outcomes were categorized according to whether relapse or metastasis occurred within 2 years after therapy. The association between the clinical outcome and radiologic factors including tumour size, margin, shape, local tumour invasiveness, regional lymph node involvement, number of involvement sites, and contrast enhancement patterns was determined using univariate and multiple logistic regression analysis. RESULTS Radiologic factors including tumour size, margin, shape, and local tumour invasiveness were associated with poor clinical outcomes, as determined by univariate analysis (P < 0.05). Only the lesion margin category (ill-defined) remained an independent risk factor for clinical outcome in multivariate logistic regression analysis, with an OR of 8.14 (P < 0.05). CONCLUSION Ill-defined margin of the primary lesion was indicative of unfavourable survival outcome for patients with extranodal non-Hodgkin lymphoma of the head and neck region. KEY POINTS • Tumour size, margin, shape and local tumour invasiveness were prognostically relevant. • Tumour margin was an independent risk factor for clinical outcome. • Ill-defined margin of primary lesion was indicative of unfavourable survival outcome.
Collapse
|
27
|
Extranodal and nodal diffuse large B cell lymphoma of the head and neck: two different entities? Ann Hematol 2014; 94:609-16. [DOI: 10.1007/s00277-014-2256-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 11/08/2014] [Indexed: 10/24/2022]
|
28
|
Lee SJ, Suh CW, Lee SI, Kim WS, Lee WS, Kim HJ, Choi CW, Kim JS, Shin HJ. Clinical characteristics, pathological distribution, and prognostic factors in non-Hodgkin lymphoma of Waldeyer's ring: nationwide Korean study. Korean J Intern Med 2014; 29:352-60. [PMID: 24851070 PMCID: PMC4028525 DOI: 10.3904/kjim.2014.29.3.352] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 07/22/2013] [Accepted: 10/04/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND/AIMS In Asia, the incidence of non-Hodgkin lymphoma (NHL) has increased in recent decades. Waldeyer's ring (WR) is the most common site of NHL involving the head and neck. In this study, the pathological distribution of WR-NHL and its clinical features were analyzed retrospectively. METHODS From January 2000 through December 2010, we analyzed the medical records of 328 patients from nine Korean institutions who were diagnosed with WR-NHL. RESULTS The study group comprised 197 male and 131 female patients with a median age of 58 years (range, 14 to 89). The rate of localized disease (stage I/II) was 64.9%, and that of low-risk disease (low/low-intermediate, as defined by the International Prognostic Index) was 76.8%. Diffuse large B-cell lymphoma (DLBCL; 240 patients, 73.2%) was the most common pathologic subtype, followed by peripheral T-cell lymphoma (14 patients, 4.3%) and nasal NK/T-cell lymphoma (14 patients, 4.3%). WR-NHL occurred most frequently in the tonsils (199 patients, 60.6%). Extranodal involvement was greater with the T-cell subtype (20 patients, 42.5%) compared with the B-cell subtype (69 patients, 24.5%). Multivariate analyses showed that age ≥ 62 years, T-cell subtype, and failure to achieve complete remission were significant risk factors for overall survival. CONCLUSIONS DLBCL was found to have a higher incidence in Korea than those incidences reported by other WR-NHL studies. T-cell lymphoma occurred more frequently than did follicular lymphoma. T-cell subtype, age ≥ 62 years, and complete remission failure after first-line treatment were significant poor prognostic factors for overall survival according to the multivariate analysis.
Collapse
Affiliation(s)
- Seong Jun Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Cheol Won Suh
- Department of Internal Medicine, Asan Medical Center, Seoul, Korea
| | - Soon Il Lee
- Department of Internal Medicine, Dankook University Hospital, Cheonan, Korea
| | - Won Seog Kim
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Seoul, Korea
| | - Chul Won Choi
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jin Seok Kim
- Department of Internal Medicine, Severance Hospital, Seoul, Korea
| | - Ho-Jin Shin
- Division of Hematology-Oncology, Department of Internal Medicine, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | | |
Collapse
|
29
|
|
30
|
Castillo JJ, Winer ES, Olszewski AJ. Sites of extranodal involvement are prognostic in patients with diffuse large B-cell lymphoma in the rituximab era: an analysis of the Surveillance, Epidemiology and End Results database. Am J Hematol 2014; 89:310-4. [PMID: 24273125 DOI: 10.1002/ajh.23638] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/05/2013] [Accepted: 11/19/2013] [Indexed: 01/08/2023]
Abstract
Approximately a third of the patients with diffuse large B-cell lymphoma present with extranodal involvement. Our study aims to identify primary extranodal sites of disease associated with prognosis in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era. A secondary objective is to describe epidemiological and clinical characteristics of patients with extranodal DLBCL. We included adult patients from the Surveillance, Epidemiology and End Results (SEER) database (2004-2009) in whom DLBCL was the first malignancy diagnosed. Extranodal primary sites were divided into 12 groups according to the topography code reported by SEER. Multivariate overall survival (OS) analyses were performed using Cox proportional-hazard regression models adjusted for age, sex, race, and stage. From a total of 25,992 adult DLBCL patients included in our analysis, 32% presented with extranodal primary sites. Gastrointestinal tract (34%), head/neck (H&N; 14%), and skin/soft tissue (11%) were the most common. In comparison with nodal DLBCL, patients with extranodal involvement were older (with exception of skeletal sites) and presented with earlier stages. In the multivariate analysis, sites associated with worse OS rates were gastrointestinal (Hazard ratio (HR) 1.24, 95% confidence interval (CI) 1.15-1.33; P <0.001), pulmonary (HR 1.59, 95% CI 1.38-1.83; P <0.001), and liver/pancreas (HR 1.58, 95% CI 1.35-1.85; P <0.001), whereas H&N was associated with better survival (HR 0.79, 95% CI 0.70-0.89; P <0.001). In this population-based study, primary extranodal sites of involvement are associated with distinct outcomes in patients with DLBCL. Gastrointestinal, pulmonary, and liver/pancreas sites had a significant worse outcome than nodal sites.
Collapse
Affiliation(s)
- Jorge J. Castillo
- Division of Hematologic Malignancies; Dana-Farber Cancer Institute; Boston Massachusetts
| | - Eric S. Winer
- Division of Hematology and Oncology; Rhode Island Hospital and The Miriam Hospital; Providence Rhode Island
| | - Adam J. Olszewski
- Division of Hematology and Oncology; Memorial Hospital of Rhode Island; Pawtucket Rhode Island
| |
Collapse
|
31
|
Mian M, Capello D, Ventre MB, Grazio D, Svaldi M, Rossi A, Tsang R, Gospodarowicz MK, Oldani E, Federico M, Luminari S, Marcheselli L, Pogliani EM, Rossini F, Cabrera ME, Martelli M, Gutierrez-Garcia G, Busetto M, Visco C, Fiegl M, Rossi D, Gaidano G, Cavalli F, Zucca E, Rambaldi A, Cortelazzo S. Early-stage diffuse large B cell lymphoma of the head and neck: clinico-biological characterization and 18 year follow-up of 488 patients (IELSG 23 study). Ann Hematol 2013; 93:221-231. [PMID: 23959436 DOI: 10.1007/s00277-013-1856-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022]
Abstract
It is known that extranodal head and neck diffuse large B cell lymphomas (eHN-DLBCL) can affect various anatomical structures what is not well-known, however, is whether they differ in terms of clinical presentation and outcome. Clinical data of the multi-institutional series, the largest of its kind as yet, has been analysed with the aim of answering these open questions and providing long-term follow-up information. Data from 488 patients affected by stage I/II eHN-DLBCL was collected: 300 of the Waldeyer's Ring (WR), 38 of the parotid and salivary glands (PSG), 48 of the thyroid gland (TG), 53 of the nasal cavity and paranasal sinuses (NPS), 24 of the palate and oral cavity (POC) and 25 with more than one involved site. Different eHN-DLBCL arising have distinct characteristics at presentation. The intermediate high risk-modified IPI was 67 % in TG, 44 % in WR, 38 % in PSG and POC and 20 % in MS. The worst 5-year survival rate had TG-DLBCL (61 %) due to the 61 % of patients with a mIPI >1. The addition of radiotherapy (cRT) to remitters did not translate into a survival advantage (5-year disease-free survival of 67 % in the cRT group vs. 70 % in the other). Three of four central nervous system recurrences occurred in NPS-DLBCL. Survival of HN-DLBCL was inferior to nodal DLBCL. This study showed that eHN-DLBCL remitters have an inferior survival when compared to nodal DLBCL, and that the addition of cRT does not provide a survival advantage. Since the standard of care nowadays is chemo-immunotherapy, survival of these patients might have been improved.
Collapse
Affiliation(s)
- M Mian
- Division of Hematology, Azienda Ospedaliera S. Maurizio, Bolzano/Bozen, Italy,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Kato H, Kanematsu M, Kawaguchi S, Watanabe H, Mizuta K, Aoki M. Evaluation of imaging findings differentiating extranodal non-Hodgkin's lymphoma from squamous cell carcinoma in naso- and oropharynx. Clin Imaging 2013; 37:657-63. [DOI: 10.1016/j.clinimag.2012.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 10/21/2012] [Accepted: 11/20/2012] [Indexed: 02/07/2023]
|
33
|
Xie CM, Liu XW, Mo YX, Li H, Geng ZJ, Zheng L, Lv YC, Ban XH, Zhang R. Primary nasopharyngeal non-Hodgkin’s lymphoma: imaging patterns on MR imaging. Clin Imaging 2013; 37:458-64. [DOI: 10.1016/j.clinimag.2012.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/20/2012] [Accepted: 07/25/2012] [Indexed: 11/24/2022]
|
34
|
Oh MY, Chung JS, Song MK, Shin HJ, Lee HS, Lee SM, Lee GW, Lee SE. Prognostic value of Waldeyer's ring involvement of diffuse large B-cell lymphoma treated with R-CHOP. Int J Hematol 2013; 97:397-402. [PMID: 23400410 DOI: 10.1007/s12185-013-1282-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 01/16/2013] [Accepted: 01/20/2013] [Indexed: 11/27/2022]
Abstract
The objective of present study was to compare the prognosis of diffuse large B-cell lymphoma (DLBCL) with Waldeyer's ring involvement (WR-DLBCL) to that of nodal DLBCL (N-DLBCL) without WR involvement. Between July 2004 and October 2009, medical records and metabolic tumor volume (MTV) measured by 2-[fluorine-18]-fluoro-2-deoxy-D-glucose ((18)F-FDG) positron emission tomography /computed tomography were collected from patients confirmed with DLBCL. All patients received six or eight cycles of R-CHOP therapy. One hundred and eight patients were included and categorized into WR-DLBCL and N-DLBCL groups. WR involvement and other prognostic factors were analyzed for survivals. High international prognostic index score and high MTV were independent poor prognostic factors. However, WR involvement was a good prognostic factor only in univariate analysis. This study suggests that tumor burden appeared to be more important than specific organ involvement for the prognosis of DLBCL.
Collapse
Affiliation(s)
- Min-Young Oh
- Department of Hematology-Oncology, School of Medicine, Pusan National University Hospital Medical Research Institute, 1-10 Ami-dong, Seo-gu, Busan, 602-739, Republic of Korea.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
de Leval L, Bonnet C, Copie-Bergman C, Seidel L, Baia M, Brière J, Molina TJ, Fabiani B, Petrella T, Bosq J, Gisselbrecht C, Siebert R, Tilly H, Haioun C, Fillet G, Gaulard P. Diffuse large B-cell lymphoma of Waldeyer's ring has distinct clinicopathologic features: a GELA study. Ann Oncol 2012; 23:3143-3151. [PMID: 22700993 DOI: 10.1093/annonc/mds150] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphomas (DLBCLs) arising in specific extranodal sites have peculiar clinicopathologic features. PATIENTS AND METHODS We analyzed a cohort of 187 primary Waldeyer's ring (WR) DLBCLs retrieved from GELA protocols using anthracyclin-based polychemotherapy. RESULTS Most patients (92%) had stage I-II disease. A germinal center B-cell-like (GCB) immunophenotype was observed in 61%, and BCL2 expression in 55%, of WR DLBCLs. BCL2, BCL6, IRF4 and MYC breakpoints were observed in, respectively, 3 of 42 (7%), 9 of 36 (25%), 2 of 26 (8%) and 4 of 40 (10%) contributive cases. A variable follicular pattern was evidenced in 30 of 68 (44%) large biopsy specimens. The 5-year progression-free survival (PFS) and the overall survival (OS) of 153 WR DLBCL patients with survival information were 69.5% and 77.8%, respectively. The GCB immunophenotype correlated with a better OS (P = 0.0015), while BCL2 expression predicted a worse OS (P = 0.037), an effect overcome by the GCB/non-GCB classification. Compared with matched nodal DLBCLs, WR DLBCLs with no age-adjusted international prognostic index factor disclosed a better 5-year PFS rate (77.5% versus 70.7%; P = 0.03). CONCLUSIONS WR DLBCLs display distinct clinicopathologic features compared with conventional DLBCLs, with usual localized-stage disease, common follicular features and a high frequency of GCB immunophenotype contrasting with a low rate of BCL2 rearrangements. In addition, they seem to be associated with a better outcome than their nodal counterpart.
Collapse
Affiliation(s)
- L de Leval
- Department of Laboratories, Institute of Pathology, C.H.U.V. Lausanne, Lausanne, Switzerland.
| | - C Bonnet
- Department of Clinical Hematology, C.H.U. of Liège, Liège, Belgium
| | - C Copie-Bergman
- Lymphoid Malignancies Unit, Henri-Mondor Hospital, AP-HP, Créteil; INSERM U955, Henri-Mondor Hospital, Créteil; Department of Medicine, Paris-Est University, Créteil, France
| | - L Seidel
- Department of Biostatistics, Liège University, Liège, Belgium
| | - M Baia
- Lymphoid Malignancies Unit, Henri-Mondor Hospital, AP-HP, Créteil; INSERM U955, Henri-Mondor Hospital, Créteil
| | - J Brière
- INSERM U728, Saint-Louis Hospital, Paris; Department of Pathology, Saint Louis Hospital, AP-HP, Paris
| | - T J Molina
- Department of Pathology, Hôtel-Dieu Hospital, AP-HP, Paris Descartes University, Paris
| | - B Fabiani
- Department of Pathology, Saint-Antoine Hospital, Paris
| | | | - J Bosq
- Department of Biopathology, Morpological Unit, Gustave Roussy Institute, Villejuif, France
| | | | - R Siebert
- Institute of Human Genetics, Christian-Albrechts-University, Kiel; University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - H Tilly
- Department of Hematology, UMR918, Henri Becquerel Center, Rouen University, Rouen, France
| | - C Haioun
- Lymphoid Malignancies Unit, Henri-Mondor Hospital, AP-HP, Créteil; INSERM U955, Henri-Mondor Hospital, Créteil; Department of Medicine, Paris-Est University, Créteil, France
| | - G Fillet
- Department of Clinical Hematology, C.H.U. of Liège, Liège, Belgium
| | - P Gaulard
- Lymphoid Malignancies Unit, Henri-Mondor Hospital, AP-HP, Créteil; INSERM U955, Henri-Mondor Hospital, Créteil; Department of Medicine, Paris-Est University, Créteil, France
| |
Collapse
|
36
|
Oh SY, Kim WS, Kim JS, Kim SJ, Lee S, Lee DH, Lee SI, Kang HJ, Choi CW, Park J, Song MK, Kim HJ, Kwon JH, Kwak JY, Bae SH, Park BB, Do YR, Lee HS, Jeong SH, Suh C, Kim HJ. Waldeyer's ring marginal zone B cell lymphoma: are the clinical and prognostic features nodal or extranodal? A study by the Consortium for Improving Survival of Lymphoma (CISL). Int J Hematol 2012; 96:631-7. [PMID: 23065471 DOI: 10.1007/s12185-012-1200-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 10/27/2022]
Abstract
There has been controversy surrounding Waldeyer's ring (WR), especially focused on the question of whether it should be regarded as a nodal or an extranodal site. We conducted retrospective analyses of marginal zone B cell lymphomas involving WR (WR-MZLs) to observe their clinical features and prognosis, with specific regard to the nodal-or-extranodal question. A total of 52 patients with histological diagnosis of WR-MZL were retrospectively analyzed. The most common involvement site was the tonsil (40.4 %). Ann Arbor stage III/VI disease was present in 48.1 % (25 of 52). The response rate of the 27 stage I/II patients was 88.9 %, with 21 complete remissions and three partial remissions. The median time to progression (TTP) was 3.7 years (95 % CI 2.5-4.9 years). The estimated 5-year TTP and overall survival rates were 39.4 and 90.5 %, respectively. In a comparison with the historical data regarding extra-WR MALT lymphoma and nodal MZL (N-MZL), MALT lymphoma showed better TTP results than did WR-MZL and N-MZL (P < 0.001).
Collapse
Affiliation(s)
- Sung Yong Oh
- Department of Internal Medicine, Dong-A University College of Medicine, 3-1 Dongdaeshin-dong, Seo-gu, Busan 602-715, Korea
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Mian M, Ferreri AJM, Rossi A, Conconi A, Tsang R, Gospodarowicz MK, Oldani E, Federico M, Luminari S, Pogliani EM, Rossini F, Cabrera ME, Martelli M, Gutierrez-Garcia G, Busetto M, Cavalli F, Zucca E, Rambaldi A, Cortelazzo S. Role of radiotherapy in patients with early-stage diffuse large B-cell lymphoma of Waldeyer's ring in remission after anthracycline-containing chemotherapy. Leuk Lymphoma 2012; 54:62-8. [DOI: 10.3109/10428194.2012.710907] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
38
|
Specht L. Radiotherapy Studies and Extra-nodal Non-Hodgkin Lymphomas, Progress and Challenges. Clin Oncol (R Coll Radiol) 2012; 24:313-8. [DOI: 10.1016/j.clon.2012.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 02/06/2012] [Accepted: 02/24/2012] [Indexed: 12/14/2022]
|
39
|
Chi HS, Lee KW, Chiang FY, Tai CF, Wang LF, Yang SF, Lin SF, Kuo WR. Head and neck extranodal lymphoma in a single institute: a 17-year retrospective analysis. Kaohsiung J Med Sci 2012; 28:435-41. [PMID: 22892165 DOI: 10.1016/j.kjms.2012.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 09/01/2011] [Indexed: 11/26/2022] Open
Abstract
The study's purposes are to identify patient characteristics, treatment response and survival rate, and to describe the important prognostic factors for our patients with extranodal head and neck lymphoma. Furthermore, no study has systemically discussed the overall figure of this disease in Taiwan and we analyzed our data on this topic. A retrospective review was performed for 86 patients with extranodal head and neck lymphoma, diagnosed in Kaohsiung Medical University Hospital, between 1990 and 2007. We evaluated the medical records and analyzed the possible factors affecting treatment outcomes, survival rate, and free-from-disease (FFD) survival rate. Forty-nine male and 37 female patients were included with a male:female ratio of 1.32:1. The most frequent histologic type was diffuse large B cell lymphoma, accounting for 41.9% of the total. The most common primary site involved with extranodal head and neck non-Hodgkin's lymphoma was a tonsil with 27 cases (31.4%). Stage, international prognostic index (IPI) score, B symptoms, lactate dehydrogenase (LDH) level, and lymph node status significantly affected treatment response. The overall 5- and 10-year survival rates were 68.0% and 57.8%, respectively. The FFD survival rate was 53.6% and 49.3% at 5 and 10 years, respectively. Factors including stage, lymph node status, LDH level, and IPI score produced significant differences in both overall survival and FFD survival. Our analyzed information is similar to other previously presented studies. Stage, IPI score, B symptoms, LDH level, and neck nodal status can be used to evaluate the treatment outcomes. Neck nodal status and stage are the two significant prognostic factors for overall survival.
Collapse
Affiliation(s)
- Hung-Sheng Chi
- Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Fitzpatrick S, Al-Quran S, Fetner A, Kuklan R, Cohen D, Bhattacharyya I. Mantle cell lymphoma of the hard palate: a series of 4 cases. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1752-248x.2012.01150.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
41
|
Liu XW, Xie CM, Mo YX, Zhang R, Li H, Huang ZL, Geng ZJ, Zheng L, Lv YC, Wu PH. Magnetic resonance imaging features of nasopharyngeal carcinoma and nasopharyngeal non-Hodgkin's lymphoma: are there differences? Eur J Radiol 2011; 81:1146-54. [PMID: 21864999 DOI: 10.1016/j.ejrad.2011.03.066] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/12/2011] [Accepted: 03/16/2011] [Indexed: 12/19/2022]
Abstract
PURPOSE To describe differences in the primary tumour and distribution of cervical lymphadenopathy for cases of nasopharyngeal carcinoma (NPC) and nasopharyngeal non-Hodgkin's lymphoma (NPNHL) using magnetic resonance (MR) imaging. MATERIALS AND METHODS MR images of patients with NPC (n = 272) and NPNHL (n = 118) were independently reviewed by two experienced radiologists. RESULTS NPC had a higher incidence of tumour invasion associated with the levator and tensor muscles of the velum palatine, the longus colli and medial pterygoid muscles, the base of the pterygoid process, the clivus, the base and greater wing of the sphenoid bone, the petrous apex, the foramen lacerum, the foramen ovale, the hypoglossal canal, and intracranial infiltration. In contrast, NPNHL had a higher incidence of tumour invasion associated with the hypopharynx, the palatine and lingual tonsils, as well as the ethmoid and maxillary sinuses. NPNHL also had a higher incidence of extensive and irregular bilateral lymphadenopathy, and lymphadenopathy in the parotid. CONCLUSIONS NPC more often involved an unsymmetrical tumour with a propensity to invade both widely and deeply into muscle tissue, the fat space, the neural foramen, and the skull base bone. In contrast, NPNHL tended to be a symmetrical and diffuse tumour with a propensity to spread laterally through the fat space and along the mucosa to the tonsils of the oropharynx and hypopharynx. These differences facilitate a differentiation of these diseases using MR images, and enhance our understanding of the biological behavior of these malignant tumours of the nasopharynx.
Collapse
Affiliation(s)
- Xue-wen Liu
- State Key Laboratory of Oncology in Southern China and Medical Imaging and Minimally Invasive Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
B lymphoblastic lymphoma presenting as a tumor of the nasopharynx in an adult patient. Head Neck Pathol 2010; 4:318-23. [PMID: 20730608 PMCID: PMC2996508 DOI: 10.1007/s12105-010-0206-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 08/10/2010] [Indexed: 10/19/2022]
Abstract
In adults, non-Hodgkin's lymphoma (NHL) is the second most common neoplasm found in the head and neck region after squamous cell carcinoma. Within this region, primary NHL of the nasopharynx is rare. We report the case of a 28-year-old male diagnosed with a B lymphoblastic lymphoma (CD20-; CD79a+; CD3-; CD10+; PAX5+, CyclinD1-; TdT+) of the nasopharynx extending to the deep and superficial structures of the right hemiface, to the skull base with an intracranial component and a small but detectable bone marrow involvement, who was started on chemotherapy with a complete response. To the best of our knowledge, this is the first case of a primary nasopharynx B-LBL in an adult patient with such aggressive regional spread to be reported in the literature.
Collapse
|
43
|
Schrepfer T, Haerle SK, Strobel K, Schaefer N, Hälg RA, Huber GF. The value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for staging of primary extranodal head and neck lymphomas. Laryngoscope 2010; 120:937-44. [PMID: 20422687 DOI: 10.1002/lary.20843] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES/HYPOTHESIS Using a retrospective approach, the aim of this study was to confirm the previously described value of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in patients with primary extranodal lymphoma of the head and neck region. Additionally, the clinical significance of the semiquantitative analysis of the standardized uptake value (SUV), its predictive role in the follow-up setting, and its value in detection of synchronous primaries were studied. STUDY DESIGN Retrospective chart review. METHODS Twenty-six patients with a primary extranodal head and neck lymphoma (22 diffuse large B-cell lymphoma, one Hodgkin's lymphoma, three malignant T-cell lymphomas) were included. We retrospectively evaluated the clinical outcomes according to the maximum standardized uptake values of the primary lesion (SUV(max)) and whether a positron emission tomography/computed tomography (PET/CT) was performed or not in the follow-up studies. The median SUV(max) was chosen as the cutoff value. The patients were then grouped as those with either low or high SUV(max), respective to the cutoff value. Event-free survival and cumulative survival were endpoints of interest. RESULTS Nineteen patients (73%) were above the age of 60 years; the median age was 70 years (range, 28-87 years). Most primary sites were in the Waldeyer's ring (15 patients, 60%), whereas in four patients (27%) only the palatine tonsil was affected. The SUV(max) ranged from 5.8 to 33.9. In one patient, relevant fluorodeoxyglucose (FDG) uptake within the intestine revealed a cecal adenocarcinoma as a secondary primary. Twenty of the 25 clinically followed patients (80%) achieved complete remission after treatment. Patients with high SUV(max) showed favorable survival (log-rank test, P = .044). A tendency for longer survival within the group with follow-up PET/CT studies could be noted but with no significant statistical difference (P = .349). CONCLUSIONS (18)F-FDG-PET/CT imaging is a potent primary staging tool. It also has application as an instrument for evaluation of follow-up and response to therapy in patients suffering from primary extranodal lymphoma and for detection of secondary malignancies. Furthermore, (18)F-FDG uptake by the primary lesion may be related to better survival.
Collapse
Affiliation(s)
- Thomas Schrepfer
- Department of Otorhinolaryngology-Head and Neck Surgery,University Hospital Zurich, Switzerland
| | | | | | | | | | | |
Collapse
|
44
|
Mohammadianpanah M, Daneshbod Y, Ramzi M, Hamidizadeh N, Dehghani SJ, Bidouei F, Khademi B, Ahmadloo N, Ansari M, Omidvari S, Mosalaei A, Dehghani M. Primary tonsillar lymphomas according to the new World Health Organization classification: to report 87 cases and literature review and analysis. Ann Hematol 2010; 89:993-1001. [PMID: 20440503 DOI: 10.1007/s00277-010-0970-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 04/19/2010] [Indexed: 12/16/2022]
Abstract
The present study aimed to define the natural history, World Health Organization (WHO) classification, prognostic factors, and treatment outcome of 87 patients with primary lymphoma of the palatine tonsil and literature review and analysis. Between 1990 and March 2008, 87 consecutive patients diagnosed with primary lymphoid malignancy of the palatine tonsil. All pathologic specimens were reviewed and reclassified according to the recent WHO classification. To investigate the association of tonsillar lymphomas with Epstein-Barr virus (EBV), in situ hybridization was performed for 24 tonsillar lymphomas (23 diffuse large B-cell lymphoma (DLBC) and one classic Hodgkin's disease) and ten normal tonsils as control group. In literature review, we found 26 major related series including 1,602 patients with primary tonsillar lymphoma. The median age of our patients was 52 years (range 11-86 years). There were 39 women and 48 men with a median follow-up of 67 months for living patients. The vast majority (95%) of patients had B-cell phenotype. DLBC was the most frequent histology. In situ hybridization revealed none of 23 DLBC to be positive for EBV. The 5-year disease-free and overall survival rates were 78.9% and 86%, respectively. In the literature review and by analyzing the data collection from 26 major reported series, the median age was 55 years and male/female ratio was 1.3:1. Intermediate grade tumors consisted of 72% of all tonsillar lymphomas and B-cell lymphomas constituted 82% of all cell immunophenotypes. The 5-year disease-free and overall survival rates were 61% and 67%, respectively. The vast majority of tonsillar lymphomas are of B-cell origin and with intermediate to high-grade histology. These neoplasms tend to present in early stage disease and to have favorable outcome. WHO classification predicts more accurately treatment outcome of patients with tonsillar lymphoma. The association of DLBC in the palatine tonsil with EBV infection is infrequent.
Collapse
Affiliation(s)
- Mohammad Mohammadianpanah
- Hematology Research Center, Department of Radiation Oncology, Shiraz University of Medical Sciences, Iran
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Siddiqui NA, Branstetter BF, Hamilton BE, Ginsberg LE, Glastonbury CM, Harnsberger HR, Barnes EL, Myers EN. Imaging characteristics of primary laryngeal lymphoma. AJNR Am J Neuroradiol 2010; 31:1261-5. [PMID: 20360337 DOI: 10.3174/ajnr.a2085] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The larynx is a rare site for primary NHL. Fewer than 100 cases have been reported in the literature, with the largest imaging review involving only 4 patients. We describe the findings of laryngeal lymphoma on CT, PET, and MR imaging and identify features that may distinguish laryngeal lymphoma from the far more common laryngeal squamous cell carcinoma. MATERIALS AND METHODS Multi-institutional retrospective chart review revealed 20 patients with histopathologically proved laryngeal lymphoma. Pretreatment CT, PET, and MR images were reviewed by a head and neck radiologist, focusing on extent of tumor, cervical lymph node involvement, and enhancement patterns. RESULTS Patients ranged from 30 to 90 years of age with a mean of 63 years at the time of initial diagnosis and a 2:1 female predominance. The average tumor size was 37 +/- 19 mm. In all patients, laryngeal lymphoma involved the supraglottis but also extended into the glottis (65%) and hypopharynx (60%). The subglottis was less frequently involved (35%). Laryngeal cartilage invasion and cervical lymphadenopathy were each seen in 20% of patients. Lymphoma was consistently FDG-avid (100%) and usually enhanced uniformly with iodinated contrast (73%). Necrosis and calcification were not seen in any cases. CONCLUSIONS Although laryngeal lymphoma is rare, particular imaging features suggest this diagnosis. A large uniformly enhancing supraglottic tumor without central necrosis and without cervical lymphadenopathy is a characteristic finding of lymphoma. Similar to squamous cell carcinoma, lymphoma may extend into the subglottis, pharynx, and laryngeal cartilages.
Collapse
Affiliation(s)
- N A Siddiqui
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Qi SN, Li YX, Wang H, Wang WH, Jin J, Song YW, Wang SL, Liu YP, Zhou LQ, Yu ZH. Diffuse large B-cell lymphoma. Cancer 2009; 115:4980-9. [DOI: 10.1002/cncr.24557] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
47
|
Tempescul A, Querellou S, Ianotto JC, Boisramé S, Valette G, Berthou C. 18F-FDG PET/CT in primary non-Hodgkin's lymphoma of the sinonasal tract. Ann Hematol 2009; 89:635-7. [PMID: 19844711 DOI: 10.1007/s00277-009-0842-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 09/21/2009] [Indexed: 11/25/2022]
|
48
|
Costes V. Pathologie lymphoïde de la tête et du cou. Ann Pathol 2009; 29:323-34. [DOI: 10.1016/j.annpat.2009.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2009] [Accepted: 07/22/2009] [Indexed: 02/05/2023]
|
49
|
Chierigo P, Nicolardi L, Rahmati M, Lazzarotto M, Brotza D, Bassan F, Franzolin N. Testicular Localization of Extranodal Multifocal Non-Hodgkin Lymphoma. Report of Two Cases, Review of the Literature and Clinical Considerations. Urologia 2009. [DOI: 10.1177/039156030907600220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of our study is to describe two cases of testicular localization of non-Hodgkin Lymphoma associated with the involvement of other extranodal organs, and to investigate the possible causes of this association according to the evidences found in literature. Non-Hodgkin Lymphoma is extranodal in 25% of cases. Most of the times the organs involved are stomach, bowel, skin, central nervous system. About urological localizations, the most common is testis. Very rare is to find lymphoma in kidney, prostate, urinary bladder, and ureter. Testicular lymphoma is about 5% of testis malignancies; it is more frequent in the 7th and in the 8th decade. Metastases of testicular non-Hodgkin lymphoma are described also many years later, and also in distant organs. Primary forms are usually “diffuse large B cell”, a high-grade histotype; metastatic ones often show Burkitt cells. The standard therapy used for non-Hodgkin Lymphomas does not reach testis and central nervous system, so that these sites are called “Therapeutic Shrines”. Therefore, in order to prevent testicular localization, it is necessary to use radiotherapy, and for nervous system prophylaxis it is necessary to administer intrathecal chemotherapy. More than one localization of non-Hodgkin lymphoma simultaneously found may indicate not only a metastatic spread, but also a multicentric origin. We describe two patients who had one testis removed because of a big mass that turned out to be a non-Hodgkin lymphoma. The first patient had been treated for a non-Hodgkin lymphoma of maxillary sinus 20 months before. The second patient showed contemporary involvement of other organs. In both cases the different localizations of non-Hodgkin lymphoma showed the same histological features and cellular immunophenotype. It is important to underline that in the former patient staging TC, repeated many times, had always been negative, but physical examination of testis had been omitted, so that sinonasal localization, assumed to be the first one, really might have been the spread of an undetected testis lymphoma. In conclusion, in case of extranodal non-Hodgkin lymphoma or any other malignancies, manual or ultrasound examination of testis should never be omitted, because standard techniques of staging (TC, RMN, PET) cannot explore this organ.
Collapse
Affiliation(s)
- P. Chierigo
- Unità Operativa Complessa di Urologia, Dipartimento di Chirurgia, Ospedale De Lellis, Schio (VI)
| | - L. Nicolardi
- Unità Operativa Complessa di Oncologia, Dipartimento di Medicina, Ospedale Boldrini, Thiene (VI) Azienda Ulss 4 “Alto Vicentino (Thiene – Schio)
| | - M. Rahmati
- Unità Operativa Complessa di Urologia, Dipartimento di Chirurgia, Ospedale De Lellis, Schio (VI)
| | - M. Lazzarotto
- Unità Operativa Complessa di Urologia, Dipartimento di Chirurgia, Ospedale De Lellis, Schio (VI)
| | - D. Brotza
- Unità Operativa Complessa di Urologia, Dipartimento di Chirurgia, Ospedale De Lellis, Schio (VI)
| | - F. Bassan
- Unità Operativa Complessa di Oncologia, Dipartimento di Medicina, Ospedale Boldrini, Thiene (VI) Azienda Ulss 4 “Alto Vicentino (Thiene – Schio)
| | - N. Franzolin
- Unità Operativa Complessa di Urologia, Dipartimento di Chirurgia, Ospedale De Lellis, Schio (VI)
| |
Collapse
|
50
|
Laskar S, Mohindra P, Gupta S, Shet T, Muckaden MA. Non-Hodgkin lymphoma of the Waldeyer's ring: clinicopathologic and therapeutic issues. Leuk Lymphoma 2009; 49:2263-71. [PMID: 19052973 DOI: 10.1080/10428190802493686] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Extranodal non-Hodgkin lymphoma (NHL) in head and neck region is most commonly seen in the Waldeyer's ring. Waldeyer's ring is a unique subtype of mucosa associated lymphoid tissue (MALT), which shows rarity of low-grade or MALT-type lymphomas and a high incidence of diffuse large B cell lymphoma (DLBCL). The commonest histology is DLBCL with natural history similar to primary nodal NHL. However, high association with gastrointestinal involvement is reported. The diagnostic workup is similar to that of the usual nodal NHL, and in absence of a specific staging system, the Ann Arbor staging is followed. As compared with T-cell subtypes, B-cell phenotypes are less likely to present with mucosal ulceration, epitheliotropism and angioinvasion. Stage of disease, histology and use of combined modality treatment have been proposed as significant prognostic factors. Treatment has evolved from the use of extended field radiotherapy (RT) alone to the use of combined chemotherapy and RT leading to almost doubling of survival. Advances in pathology and further risk stratification of patients into prognostic groups could lead to the development of novel therapeutic strategies to improve outcome.
Collapse
Affiliation(s)
- Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India.
| | | | | | | | | |
Collapse
|