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Kwak K, Yoo KH, Choi YS, Park Y, Kim BS, Yoon SE, Kim WS, Kang KW, Kim SJ. Long-term survival outcomes of 'watch and wait' in patients with bronchus-associated lymphoid tissue lymphoma: a multicenter real-world data analysis in Korea. Ann Hematol 2024:10.1007/s00277-024-05902-w. [PMID: 39075295 DOI: 10.1007/s00277-024-05902-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
Bronchus-associated lymphoid tissue (BALT) is a rare cause of extranodal marginal zone lymphoma (MZL). Although most patients with BALT lymphoma (BALToma) show an indolent clinical course and are monitored without treatment, there are limited real-world data on the long-term outcome of "watch-and-wait' strategy in comparison with other treatments. The survival outcomes of patients newly diagnosed with BALToma at three tertiary hospitals in Korea undergoing two treatment strategies were analyzed: group A, patients who were monitored without any treatment or received only radiotherapy after diagnosis; and group B, patients receiving any kind of systemic chemotherapy after diagnosis, regardless of their history of any local treatment such as surgery or radiotherapy. Of the 67 patients included in our analysis, the 10-year progression-free survival (PFS) and 10-year overall survival (OS) rates were 65.3% and 83.2%, respectively. The 10-year PFS rates for observation or localized treatment and systemic chemotherapy were 78.7% and 56.9%, respectively (p = 0.044). Ten-year OS rates for observation or localized treatment and systemic chemotherapy were 100% and 71.7%, respectively (p = 0.016). Multivariate analysis showed that bilateral lung (HR 2.462, p = 0.047) and extrapulmonary organ (HR 4.485, p = 0.004) involvement were the only significant factors associated with poor PFS. Prognostic factor analysis for OS did not yield significant results. Patients with BALToma show a favorable prognosis, suggesting that observation or localized therapy alone may be effective for patient management. However, patients with bilateral lung or extrapulmonary involvement may require careful monitoring for disease progression and more aggressive treatment approaches.
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Affiliation(s)
- Kunye Kwak
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Kwai Han Yoo
- Division of Hematology, Department of Internal Medicine, College of Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Yoon Seok Choi
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Yong Park
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Byung Soo Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro Gangnam-gu, Seoul, 06351, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro Gangnam-gu, Seoul, 06351, Korea
| | - Ka-Won Kang
- Division of Hematology and Oncology, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea.
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro Gangnam-gu, Seoul, 06351, Korea.
- Department of Health Sciences and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Korea.
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Hyodo R, Takehara Y, Nishida A, Matsushima M, Naganawa S. "Speckled Enhancement" on Gd-EOB-DTPA Enhanced MR Imaging of Primary Hepatic Mucosa-associated Lymphoid Tissue Lymphoma. Magn Reson Med Sci 2023; 22:273-281. [PMID: 34615837 PMCID: PMC10449559 DOI: 10.2463/mrms.mp.2021-0069] [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: 05/05/2021] [Accepted: 08/28/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To elucidate MRI features of primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma, particularly, the "speckled enhancement" on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI. METHODS The institutional review board approved this retrospective observational study and waived informed consent. Using our picture archiving and communication systems and electronic medical records, five patients histopathologically diagnosed as hepatic MALT lymphoma and clinically confirmed as primary lesions who had undergone dynamic contrast-enhanced (DCE)-CT and DCE-MRI with Gd-EOB-DTPA were identified from September 2009 to December 2020. Two radiologists assessed their CT and MRI data in consensus with a pathologist's advice. RESULTS Overall, five lesions in five patients were included in this study. Precontrast CT showed hypoattenuation in all lesions. In the arterial phase of DCE-CT, four lesions (80%) showed hyperattenuation, whereas all lesions showed iso- to hypoattenuation in the delayed phase. A vessel penetration sign was also observed in all lesions. On MRI, all lesions showed hypointensity on T1-weighted images, hyperintensity on T2-weighted images, and restricted diffusion on diffusion-weighted images. Both DCE-CT and DCE-MRI with Gd-EOB-DTPA showed similar enhancement patterns, except for the hepatocyte phase. Notably, however, four out of five lesions showed characteristic "speckled enhancement" that refers to punctate positive enhancements within the low signal lesions on the hepatobiliary phase of Gd-EOB-DTPA-enhanced MRI pathologically confirmed to be hepatocyte clusters that remained in the tumor. CONCLUSION Primary hepatic MALT lymphomas were characterized by arterial phase enhancement, restricted diffusion, vessel penetration sign, and more specifically "speckled enhancement" in the hepatobiliary phase of DCE-MRI with Gd-EOB-DTPA.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ayumi Nishida
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaya Matsushima
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Briscoe D, Safieh C, Ton Y, Shapiro H, Assia EI, Kidron D. Characteristics of orbital lymphoma: a clinicopathological study of 26 cases. Int Ophthalmol 2017; 38:271-277. [PMID: 28364339 DOI: 10.1007/s10792-017-0457-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Evaluation of the medical data of patients with orbital and adnexal lymphoma. DESIGN Cohort study of all cases diagnosed with orbital or adnexal lymphoma at Meir Medical Center between 1993 and 2007. PARTICIPANTS Twenty-six patients, with intraorbital or subconjunctival masses with orbital involvement, were examined and followed up between 1 and 8 years. MATERIALS AND METHODS Examined data included: clinical presentation, age, gender, imaging, tumor location, surgical management, and pathological diagnosis. RESULTS Presenting signs and symptoms included proptosis, eyelid lesions, tearing, chemosis, decreased visual acuity, ptosis, pain, squint, and optic nerve compression. In five cases, lymphoma was misdiagnosed on neuroimaging. Bone changes were seen in four patients. All cases were B cell lymphomas; with the majority (22 cases) of small B cell type; consisting of primary extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue and two cases of small cell lymphoma. One small cell lymphomas was of follicular type on a background of CLL, and the other was CLL/SLL type. Fourteen cases were primary orbital disease, and 12 cases were systemic disease. Macroscopic appearance of lymphoma at open biopsy was characteristic in most cases. Flow cytometry phenotyping gave rapid reliable diagnosis of the disease. CONCLUSIONS Epiphora or chemosis in the presence of an orbital mass should alert the ophthalmologist to suspect lymphoma. Lymphoma may be easily misinterpreted on neuroimaging for other diseases. Bone changes seen on CT are more common than is generally perceived. Macroscopic appearance at open biopsy was characteristic.
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Affiliation(s)
- Daniel Briscoe
- Department of Ophthalmology, Technion Faculty of Medicine, Emek Medical Center, Afula, Israel. .,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel.
| | - Christine Safieh
- Department of Ophthalmology, Technion Faculty of Medicine, Emek Medical Center, Afula, Israel.,Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Yokrat Ton
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Hava Shapiro
- Department of Haematocytology, Meir Medical Center, Kfar Saba, Israel
| | - Ehud I Assia
- Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel
| | - Dvora Kidron
- Department of Pathology, Meir Medical Center, Kfar Saba, Israel
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Intragumtornchai T, Bunworasate U, Wudhikarn K, Lekhakula A, Julamanee J, Chansung K, Sirijerachai C, Norasetthada L, Nawarawong W, Khuhapinant A, Siritanaratanakul N, Numbenjapon T, Prayongratana K, Chuncharunee S, Niparuck P, Suwanban T, Kanitsap N, Wongkhantee S, Pornvipavee R, Wong P, Makruasi N, Wannakrairot P, Assanasen T, Sukpanichnant S, Boonsakan P, Kanoksil W, Ya-in C, Kayasut K, Mitranun W, Warnnissorn N. Non-Hodgkin lymphoma in South East Asia: An analysis of the histopathology, clinical features, and survival from Thailand. Hematol Oncol 2017; 36:28-36. [DOI: 10.1002/hon.2392] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/23/2017] [Accepted: 02/07/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Tanin Intragumtornchai
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chulalongkorn Universit; Bangkok Thailand
| | - Udomsak Bunworasate
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chulalongkorn Universit; Bangkok Thailand
| | - Kitsada Wudhikarn
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chulalongkorn Universit; Bangkok Thailand
| | - Arnuparp Lekhakula
- Division of Hematology, Department of Medicine, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Jakrawadi Julamanee
- Division of Hematology, Department of Medicine, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Kanchana Chansung
- Division of Hematology, Department of Medicine, Faculty of Medicine; Kon Kaen University; Kon Kaen Thailand
| | - Chittima Sirijerachai
- Division of Hematology, Department of Medicine, Faculty of Medicine; Kon Kaen University; Kon Kaen Thailand
| | - Lalita Norasetthada
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Weerasak Nawarawong
- Division of Hematology, Department of Medicine, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Archrob Khuhapinant
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Noppadol Siritanaratanakul
- Division of Hematology, Department of Medicine, Faculty of Medicine, Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Tontanai Numbenjapon
- Division of Hematology, Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Kannadit Prayongratana
- Division of Hematology, Department of Medicine; Phramongkutklao Hospital and College of Medicine; Bangkok Thailand
| | - Suporn Chuncharunee
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Pimjai Niparuck
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Tawatchai Suwanban
- Division of Hematology, Department of Medicine; Rajvithi Hospital; Bangkok Thailand
| | - Nongluk Kanitsap
- Division of Hematology, Department of Medicine, Faculty of Medicine; Thammasat University; Pathum Thani Thailand
| | - Somchai Wongkhantee
- Division of Hematology, Department of Medicine; Kon Kaen Hospital; Kon Kaen Thailand
| | - Rutchanid Pornvipavee
- Division of Hematology; Bangkok Metropolitan Administration Medical College; Bangkok Thailand
| | - Peerapon Wong
- Division of Hematology, Faculty of Medicine; Naresuan University; Pittsanulok Thailand
| | - Nisa Makruasi
- Division of Hematology, Department of Medicine, Faculty of Medicine; Srinakharinwirot University; Nakohn Nayok Thailand
| | - Pongsak Wannakrairot
- Department of Pathology, Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Thamathorn Assanasen
- Department of Pathology, Faculty of Medicine; Chulalongkorn University; Bangkok Thailand
| | - Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine, Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Paisarn Boonsakan
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Wasana Kanoksil
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
| | - Charin Ya-in
- Department of Pathology, Faculty of Medicine; Chiang Mai University; Chiang Mai Thailand
| | - Kanita Kayasut
- Department of Pathology, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Winyu Mitranun
- Department of Pathology, Faculty of Medicine; Prince of Songkhla University; Songkhla Thailand
| | - Naree Warnnissorn
- Departmentof Pathology, Faculty of Medicine; Thammasat University; Pathum Thani Thailand
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Dong S, Chen L, Chen Y, Chen X. Primary hepatic extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type: A case report and literature review. Medicine (Baltimore) 2017; 96:e6305. [PMID: 28353562 PMCID: PMC5380246 DOI: 10.1097/md.0000000000006305] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare disease. To the best of our knowledge, only 67 cases had been reported in 39 English literatures to date. The aim of this study was to add a new case of this disease to the literature and to review the current literature. PATIENT CONCERNS A 50-year-old man was incidentally identified with a solitary mass of 5 cm in diameter in the left lobe of the liver. DIAGNOSES Based on the results of imaging studies, intrahepatic cholangiocellular carcinoma was suspected, and then surgery was performed. Microscopic findings showed that the tumor was a hepatic MALT lymphoma, and immunohistochemical analysis revealed that the lymphoma cells were CD20+, CD79a+, BCL-2+, CD3-, and CD5-. INTERVENTIONS The patient received rituximab after surgery. OUTCOMES He was free of disease for 13 months at the time of this report. LESSONS Since previously published case reports and our case described nonspecific clinical features of this rare disease, it was usually misdiagnosed before histological confirmation and surgery resection may be a good choice for both diagnosis and local therapy.
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Ishii Y, Tomita N, Suzuki T, Ishiyama Y, Kishimoto K, Yamamoto E, Koyama S, Hattori Y, Nakajima Y, Motohashi K, Takasaki H, Kawasaki R, Hashimoto C, Takemura S, Fujimaki K, Fujita H, Sakai R, Fujisawa S, Motomura S, Ishigatsubo Y. Dissemination pattern of extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. Leuk Lymphoma 2015; 56:2750-2. [PMID: 25644745 DOI: 10.3109/10428194.2015.1010161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Yoshimi Ishii
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama , Japan.,b Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Naoto Tomita
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Taisei Suzuki
- c Department of Hematology , Shizuoka Red Cross Hospital , Shizuoka , Japan
| | - Yasufumi Ishiyama
- d Department of Hematology , Yokosuka City Hospital , Yokosuka , Japan
| | - Kumiko Kishimoto
- b Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Eri Yamamoto
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Satoshi Koyama
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Yukako Hattori
- e Department of Medical Oncology , Kanagawa Cancer Center , Yokohama , Japan
| | - Yuki Nakajima
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kenji Motohashi
- b Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Hirotaka Takasaki
- e Department of Medical Oncology , Kanagawa Cancer Center , Yokohama , Japan
| | - Rika Kawasaki
- f Department of Hematology/Immunology , Fujisawa City Hospital , Fujisawa , Japan
| | - Chizuko Hashimoto
- g Department of Hematology/Oncology , Yamato Municipal Hospital , Yamato , Japan
| | - Sachiya Takemura
- h Department of Internal Medicine , Yokohama Ekisaikai Hospital , Yokohama , Japan
| | - Katsumichi Fujimaki
- f Department of Hematology/Immunology , Fujisawa City Hospital , Fujisawa , Japan
| | - Hiroyuki Fujita
- i Department of Hematology , Saiseikai Yokohama Nanbu Hospital , Yokohama , Japan
| | - Rika Sakai
- e Department of Medical Oncology , Kanagawa Cancer Center , Yokohama , Japan
| | - Shin Fujisawa
- b Department of Hematology , Yokohama City University Medical Center , Yokohama , Japan
| | - Shigeki Motomura
- e Department of Medical Oncology , Kanagawa Cancer Center , Yokohama , Japan
| | - Yoshiaki Ishigatsubo
- a Department of Internal Medicine and Clinical Immunology , Yokohama City University Graduate School of Medicine , Yokohama , Japan
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Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, Chiarenza A, Raimondo CD, Giulietti G, Bonanno G, Palumbo GA, Raimondo FD. Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up. World J Gastroenterol 2014; 20:12993-13005. [PMID: 25278693 PMCID: PMC4177478 DOI: 10.3748/wjg.v20.i36.12993] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.
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MESH Headings
- Animals
- Endoscopy, Gastrointestinal
- Endosonography
- Helicobacter Infections/complications
- Helicobacter Infections/microbiology
- Helicobacter pylori/pathogenicity
- Humans
- Intestinal Neoplasms/diagnostic imaging
- Intestinal Neoplasms/microbiology
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm Grading
- Predictive Value of Tests
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
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Extranodal Marginal Zone Lymphoma Presenting within the Meckel Diverticulum as Diverticulitis: A Case Report. Case Rep Pathol 2014; 2014:374814. [PMID: 24868477 PMCID: PMC4020529 DOI: 10.1155/2014/374814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/09/2014] [Indexed: 11/18/2022] Open
Abstract
Meckel diverticulum is the most common congenital defect of the gastrointestinal tract. It can be asymptomatic or mimic appendicitis and may be complicated by bleeding, diverticulitis, obstruction, and, rarely, neoplasia. We report the first case of extranodal marginal zone lymphoma occupying a Meckel diverticulum. A 44-year-old man with history of colonic diverticulitis presented to the emergency department for evaluation of acute abdominal pain. Radiography showed enteric obstruction, prompting diagnostic laparoscopy. Above the level of mid-ileum an intact Meckel diverticulum was identified. Microscopy showed extensive infiltration of sheets of small lymphocytes with abundant cytoplasm (monocytoid B-cells) prominently in submucosa and focally transmural involving serosal adipose tissue with multiple reactive germinal centers. The immunostains showed positivity for CD20, BCL-2, and CD43 (weak) and negativity for CD3, CD5, BCL-1, CD10, and BCL-6 in monocytoid B-cells. Fluorescence in situ hybridization studies revealed API2-MALT1 fusion signals consistent with t(11;18)(q21;q21), which confirmed the diagnosis of extranodal marginal zone lymphoma, also known as mucosa associated lymphoid tissue lymphoma.
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Bulky pulmonary mucosa-associated lymphoid tissue lymphoma treated with yttrium-90 ibritumomab tiuxetan. Case Rep Hematol 2013; 2013:675187. [PMID: 24371530 PMCID: PMC3858968 DOI: 10.1155/2013/675187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 10/24/2013] [Indexed: 12/03/2022] Open
Abstract
An 84-year-old woman was admitted to our hospital with nonproductive cough and dyspnea on exertion. Computed tomography (CT) scan revealed extensive consolidation in the right lung. She was diagnosed with pulmonary mucosa-associated lymphoid tissue (MALT) lymphoma using CT-guided lung biopsy. Her pulmonary images and respiratory symptoms did not improve two months after receiving 4 cycles of rituximab weekly; therefore, yttrium-90 ibritumomab tiuxetan was chosen as salvage therapy. The abnormal shadow on her pulmonary images was significantly reduced two months later, and she had no symptoms without nonhematological toxicities. She has had no progression for 18 months. Furthermore, radiation pneumonitis has not also been observed. We herein reported bulky pulmonary MALT lymphoma treated with yttrium-90 ibritumomab tiuxetan.
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The recognition and classification of lymphoproliferative disorders of the gut. Hum Pathol 2013; 45:899-916. [PMID: 24613566 DOI: 10.1016/j.humpath.2013.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 12/12/2022]
Abstract
Gastrointestinal lymphomas can be difficult to diagnose, particularly in small samples, when early in development, or when of unusual types. In this review, we describe lymphoid proliferations in the gastrointestinal tract in a location-based manner, including, mouth, esophagus, stomach, small intestine, and large bowel. For the purpose of differential diagnosis, benign mimics of lymphoma are also described. Lymphoma types that are specifically addressed include plasmablastic, extranodal natural killer/T-cell-nasal type, extranodal marginal zone lymphoma (eg, mucosa-associated lymphoid tissue lymphoma), diffuse large B cell, primary follicular of small intestine, enteropathy-associated T cell, and Burkitt and mantle cell. Immunohistochemical markers useful in the diagnostic approach are elaborated in detail.
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Eckardt AM, Lemound J, Rana M, Gellrich NC. Orbital lymphoma: diagnostic approach and treatment outcome. World J Surg Oncol 2013; 11:73. [PMID: 23506357 PMCID: PMC3616859 DOI: 10.1186/1477-7819-11-73] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 02/23/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lymphomas of the orbit and orbital adnexae are rare tumors, comprising only 1% of all non-Hodgkin's lymphoma. The majority of non-Hodgkin's lymphomas of the orbit are extranodal marginal-zone B-cell lymphomas of mucosa-associated lymphoid tissue type. Because of nonspecific clinical signs and symptoms, some diagnostic delay may occur. The purpose of the study was to evaluate the diagnostic approach in orbital lymphomas and to analyze their treatment outcome. METHODS In the period from 2005 to 2012, from a group of 135 patients with tumors of the orbit, we identified 11 patients diagnosed with orbital lymphoma. This patient cohort was reviewed retrospectively. RESULTS The patient group consisted of 11 patients (seven females, male males) with a median age of 57.7 years (range 42 to 88 years). Orbital swelling, pain and motility impairment were the leading clinical symptoms. Diagnosis was confirmed by surgical biopsy. Depending on the anatomic location of the tumor, a surgical biopsy was taken using a blepharoplasty incision, a lateral orbitotomy or a navigation-guided biopsy. The predominant histology was extranodal non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue type (82%). All patients underwent complete clinical staging. These were clinical stage IEA in seven patients, and stages IIEA (n = 2) and IIIEA (n = 2) in four patients . Patients in stage IEA were treated with radiation therapy alone, with radiation doses between 25 and 40 Gy, and patients with stage IIEA received systemic chemotherapy with bendamustin/rituximab. Those two patients diagnosed with diffuse large B-cell lymphoma and mantle cell lymphoma received systemic chemotherapy according to the R-CHOP protocol. CONCLUSIONS Owing to unspecific clinical symptoms, some diagnostic delay may occur in orbital lymphoma. If unspecific orbital symptoms are present, adequate imaging studies followed by early surgical biopsy will contribute to early diagnosis. Once diagnosis is established and staging is complete, radiation therapy is the recommended treatment for stage IEA patients. Systemic chemotherapy is indicated in selected stage IIEA patients and in patients with stage IIIEA disease.
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Affiliation(s)
- André M Eckardt
- Department of Cranio-Maxillofacial Surgery, Hannover Medical School, Hannover, Germany.
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