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Shimada K, Ohmachi K, Machida R, Ota S, Itamura H, Tsujimura H, Takayama N, Shimada T, Kurosawa M, Tabayashi T, Shimoyama T, Ohshima K, Miyazaki K, Maruyama D, Kinoshita T, Ando K, Hotta T, Tsukasaki K, Nagai H. Secondary central nervous system involvement in patients with diffuse large B-cell lymphoma treated with rituximab combined CHOP therapy - a supplementary analysis of JCOG0601. Ann Hematol 2024; 103:2021-2031. [PMID: 38280061 DOI: 10.1007/s00277-024-05620-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
Secondary central nervous system involvement (sCNSi) in diffuse large B-cell lymphoma (DLBCL) is fatal. However, its features in patients with sCNSi who are categorized as lower risk by international prognostic index (IPI) or CNS-IPI are not yet fully understood. In the present analysis, we evaluated DLBCL patients who developed sCNSi at their first progression and who participated in JCOG0601, most of whom were lower risk by IPI. Of 409 patients, 21 (5.1%) developed sCNSi during a median follow-up of 4.9 years. Five-year cumulative incidence of sCNSi were 5.1%; and 4.0%, 5.3%, and 11.5% at low, intermediate, and high risk of CNS-IPI, respectively. The most common locations of extranodal lesions at the time of registration in patients with sCNSi were the stomach (n = 4), paranasal cavity (n = 3), and bone marrow (n = 2). In univariable analysis, paranasal cavity lesion was a high-risk factor for sCNSi (subdistribution hazard ratio, 4.34 [95% confidence interval 1.28-14.73]). Median overall survival after sCNSi was 1.3 years, with a 2-year overall survival rate of 39.3%. The incidence of sCNSi in DLBCL patients at lower risk of CNS-IPI was low, as previously reported, but paranasal cavity lesion might indicate high risk for organ involvement. CLINICAL TRIAL REGISTRATION: JCOG0601 was registered in the UMIN Clinical Trials Registry (UMIN000000929, date of registration; December 04, 2007) and the Japan Registry of Clinical Trials (jRCTs031180139, date of registration; February 20, 2019).
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Affiliation(s)
- Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, Aichi, 466-8550, Japan.
| | - Ken Ohmachi
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Ryunosuke Machida
- Japan Clinical Oncology Group Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Hidekazu Itamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hideki Tsujimura
- Department of Hematology-Oncology, Chiba Cancer Center, Chiba, Japan
| | - Nobuyuki Takayama
- Department of Hematology, Faculty of Medicine, Kyorin University, Mitaka, Japan
| | - Takaki Shimada
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Mitsutoshi Kurosawa
- Department of Hematology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Takayuki Tabayashi
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Tatsu Shimoyama
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Dai Maruyama
- Department of Hematology Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tomohiro Kinoshita
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kiyoshi Ando
- Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan
| | - Tomomitsu Hotta
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kunihiro Tsukasaki
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Ma W, Hong R, Lou P, Yao M, Wu S, Lin C, Wang C, Chang C, Cheng A, Kuo S. Improved outcomes of localized diffuse large B-cell lymphoma at the Waldeyer ring in comparison to the sinonasal area in the rituximab era. Cancer Med 2023; 13:e6851. [PMID: 38148602 PMCID: PMC10807621 DOI: 10.1002/cam4.6851] [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: 03/27/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) of the head-and-neck area primarily involves the Waldeyer ring (WR) and sinonasal area (SN). However, the differential clinical outcomes between patients with WR-DLBCL and those with SN-DLBCL in the rituximab era remain unclear. METHODS To avoid confounding factors contributed by advanced DLBCL with WR and SN involvement, we assessed the clinical outcomes of patients with stage I/II WR-DLBCL and SN-DLBCL and compared them with those having corresponding stages of DLBCL in the lymph nodes but without other extranodal involvement (LN-DLBCL) in the same period. We compared the patients' clinical characteristics, treatment modalities, event-free survival (EFS), and overall survival (OS) among the three subgroups. RESULTS We analyzed 67, 15, and 106 patients with WR-DLBCL, SN-DLBCL, and LN-DLBCL, respectively, between January 2000 and December 2019. All patients received front-line rituximab-based regimens, and > 80% received rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone-based regimens. More patients with SN-DLBCL had revised International Prognostic Index (R-IPI) score 3 (27%) when compared with those with WR-DLBCL (7%) and those with LN-DLBCL (10%, p = 0.181). Patients with WR-DLBCL, LN-DLBCL, and SN-DLBCL had 5-year EFS and OS rates of 80.7%, 59.5%, and 41.9% (p = 0.021) and 83.7%, 70.8%, and 55.8% (p = 0.032), respectively. Compared to patients with LN-DLBCL, those with WR-DLBCL also had a significantly favorable 5-year EFS rate (p = 0.021) and 5-year OS rate (p = 0.023). Three of the 15 patients with SN-DLBCL experienced lymphoma recurrence in the brain after front-line treatment. In multivariate analyses, R-IPI scores of 1-2 and 3 served as significantly poor prognostic factors for patients with poor EFS and OS. CONCLUSIONS Compared to patients with LN-DLBCL, patients with WR-DLBCL receiving front-line rituximab-based treatments had favorable clinical outcomes; however, patients with SN-DLBCL had worse clinical outcomes. Further studies on molecular prognostic factors and treatment strategies for SN-DLBCL are warranted.
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Affiliation(s)
- Wei‐Li Ma
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Ruey‐long Hong
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Medical OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
| | - Pei‐Jen Lou
- Department of OtolaryngologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ming Yao
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Shang‐Ju Wu
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Chung‐Wu Lin
- Department of PathologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Pathology and Laboratory MedicineKoo Foundation Sun Yat‐Sen Cancer CenterTaipei CityTaiwan
| | - Chun‐Wei Wang
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
| | - Chin‐Hao Chang
- Department of Medical ResearchNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Ann‐Lii Cheng
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
- Department of Medical OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
- Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
| | - Sung‐Hsin Kuo
- Department of OncologyNational Taiwan University Hospital and National Taiwan University College of MedicineTaipei CityTaiwan
- Cancer Research CenterNational Taiwan University College of MedicineTaipei CityTaiwan
- Graduate Institute of OncologyNational Taiwan University College of MedicineTaipei CityTaiwan
- Department of Radiation OncologyNational Taiwan University Cancer Center, National Taiwan University College of MedicineTaipei CityTaiwan
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Kuceki G, Nguyen C, Ng D, Wada D, Mathis J. Oral diffuse large B-cell lymphoma presenting as a bland nodule. JAAD Case Rep 2023; 36:34-37. [PMID: 37215296 PMCID: PMC10195845 DOI: 10.1016/j.jdcr.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Guilherme Kuceki
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Cassidy Nguyen
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - David Ng
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - David Wada
- Department of Dermatology, University of Utah, Salt Lake City, Utah
| | - Jason Mathis
- Department of Dermatology, University of Utah, Salt Lake City, Utah
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Höglund Wetter M, Mattsson U. Oral manifestations of extranodal lymphomas - a review of the literature with emphasis on clinical implications for the practicing dentist. Acta Odontol Scand 2022; 80:401-410. [PMID: 35108151 DOI: 10.1080/00016357.2021.2020896] [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: 11/01/2022]
Abstract
OBJECTIVE Lymphoma is a heterogenous group of malignant tumours with proliferation of lymphoid cells or their precursors. Lymphomas in the head and neck region are usually found in Waldeyer's ring. Intraoral lymphomas are rare and the clinical presentation and roentgenological appearance may resemble other and benign conditions, entailing a risk for diagnostic delay. The objective of the present literature review was to identify subjective symptoms, clinical presentations and roentgenological appearances which should raise suspicion of lymphoma. MATERIALS AND METHODS The literature review identified 41 case series with head and neck lymphomas (n = 3880) and 384 case reports (n = 567 cases) of intraoral lymphomas. Information of demographics, clinical presentation, subjective symptoms and roentgenological appearance was registered. RESULTS The most common clinical presentation was a broad-based swelling or bulging mass with or without simultaneous ulceration, frequently with a relatively rapid growth pattern. Subjective symptoms varied considerably. Intraosseous lymphomas were frequently associated with paresthaesia or numbness. The most common roentgenological finding was a radiolucency with diffuse demarcation. CONCLUSIONS The clinical presentation, symptomatology and roentgenological appearance of intraoral lymphomas varied. Diagnostic delay was usually associated with a lymphoma initially misdiagnosed as a lesion of dental aetiology or a reactive lesion. Inadequate healing after tooth extraction or symptoms of numbness or pain without obvious dental origin should merit further clinical and roentgenological examination. Biopsy is indicated when there is the slightest doubt of the true nature of mucosal lesion.
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Affiliation(s)
| | - Ulf Mattsson
- Clinic of Medical Dentistry, Central Hospital, Karlstad, Sweden
- Department of Oral pathology, Faculty of Odontology, Malmö University, Sweden
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Eriksen PRG, Clasen-Linde E, Nully Brown PD, Haunstrup L, Christoffersen M, Asdahl P, Thomsen TM, Harwood CD, Heegaard S, Buchwald CV. Sinonasal B-cell lymphomas: A nationwide cohort study, with an emphasis on the prognosis and the recurrence pattern of primary diffuse large B-cell lymphoma. Hematol Oncol 2022; 40:160-171. [PMID: 35104916 PMCID: PMC9303446 DOI: 10.1002/hon.2968] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/04/2022] [Accepted: 01/24/2022] [Indexed: 02/06/2023]
Abstract
Lymphomas of the nasal cavity and paranasal sinuses (NPS) are rare. Knowledge on sinonasal B‐cell lymphoma (SNBCL) primarily comes from case series or single‐center studies on small cohorts. We sought to determine the subtype distribution, clinical characteristics, disease behavior, and prognosis on a nationwide scale, with an emphasis on prognostic factors for the most common sinonasal lymphoma, primary sinonasal diffuse large B‐cell lymphoma (PSDLBCL). We collated all data from medical records and national databases on patients registered with SNBCL from 1980 through 2018 in the national pathology registry and collected all tissue samples for validation of diagnosis. We included 205 patients and found 10 different subtypes of lymphoma. Diffuse large B‐cell lymphoma (DLBCL) was the predominant subtype (80%). The incidence of SNBCL was 0.14/100,000 person‐years. The five‐year progression‐free survival (PFS) and overall survival rates for PSDLBCL were 50% and 56%, respectively. For PSDLBCL, Rituximab showed a statistically significant effect (Hazard Ratio 0.22, p < 0.001), whereas consolidative radiotherapy combined with immunochemotherapy was of limited value (PFS, p = 0.93). When treatment failure occurred, DLBCL showed a distinct pattern of recurrence/dissemination to the NPS, skin, breast, central nervous system (CNS), and/or testis. Collectively, DLBCL comprised a clear majority of SNBCLs, although nine other subtypes were represented. Data showed that immunochemotherapy increased survival for PSDLBCL and that the addition of radiotherapy did not benefit patients. Furthermore, treatment failure for sinonasal DLBCL showed a possible common pathogenesis with primary extranodal lymphomas of specific locations (e.g., CNS, skin, breast, and testis).
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Affiliation(s)
- Patrick R G Eriksen
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Erik Clasen-Linde
- Hematopathology Section, Department of Pathology, Rigshospitalet, Kobenhavn, Denmark
| | - Peter de Nully Brown
- Department of Hematology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
| | - Laura Haunstrup
- Department of Hematology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Peter Asdahl
- Department of Hematology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Cecilie Dupont Harwood
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Eye Pathology Section, Department of Pathology, Rigshospitalet, University of Copenhagen, Kobenhavn, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
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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.
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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
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Abstract
Lymphoepithelial carcinoma of salivary glands (LECSG) is an uncommon neoplasm. This article summarizes the findings of 438 cases in a review of the literature. Concurrent lymphoepithelial lesions may suggest a primary tumor. The tumor shows a nonkeratinizing carcinoma intimately associated with a rich lymphohistiocytic infiltrate, destroying adjacent salivary gland tissue. Irrespective of race or ethnicity, the tumors usually express Epstein-Barr virus, with Epstein-Barr virus encoded small RNA (EBER) and/or latent membrane protein-1 (LMP-1), although a subset does not. There is an overall good prognosis of about 80% at 5 years.
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Oral and oropharyngeal diffuse large B-cell lymphoma and high-grade B-cell lymphoma: A clinicopathologic and prognostic study of 69 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2020; 131:452-462.e4. [PMID: 33610538 DOI: 10.1016/j.oooo.2020.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The objective of this study was to describe the clinicopathological, molecular, and prognostic features of oral/oropharyngeal diffuse large B-cell lymphoma (DLBCL) and high-grade B-cell lymphoma. STUDY DESIGN All cases were retrieved from 7 Brazilian institutions. Immunohistochemical reactions were performed to confirm the diagnoses and to categorize the tumors. In situ hybridization was used to detect Epstein-Barr virus (EBV) and fluorescence in situ hybridization was used to identify gene rearrangements. RESULTS Most cases involved the oral cavity (76.8%). Males and females, with a mean age of 60 years, were evenly affected. Tumors mostly presented as painful swellings. Forty cases represented germinal center B-cell type (58%). Five cases presented double-hit translocation and 3 harbored rearrangement for MYC/BCL2/BCL6. EBV was detected in 3 cases (4.3%). The 5-year overall survival was 44.4%. Female sex, presence of pain and ulcer, microscopic "starry sky pattern" and necrosis, co-expression of c-Myc/Bcl2, and translocation of MYC were associated with a lower survival in univariate analysis (P = .05, P = .01, P = .01, P = .03, P = .05, P = .006, P = .05, respectively). CONCLUSION Patients affected by oral/oropharyngeal DLBCL have a low survival rate. High-grade B-cell lymphoma (17.7%) and EBV-positive DLBCL, not otherwise specified (4.3%) account for a small number of cases.
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Xia S, Yue J, Chen X, Hu Y, Guo F, Zhang J. Clinicopathological and genetic characteristics of diffuse large B-cell lymphoma of the oropharyngeal and maxillofacial region. Oral Dis 2020; 27:448-456. [PMID: 32731312 DOI: 10.1111/odi.13578] [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: 04/03/2020] [Revised: 06/23/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study was aimed to analyze the clinicopathological and molecular pathological features of diffuse large B-cell lymphoma (DLBCL) in the oropharyngeal and maxillofacial region. SUBJECTS AND METHODS A retrospective review was performed with 36 patients who were diagnosed with primary DLBCL of the oropharyngeal and maxillofacial region from 2009 to 2017 in the Department of Pathology at the Hospital of Stomatology, Wuhan University. Immunohistochemistry and fluorescence in situ hybridization were performed. RESULTS Gene rearrangements of BCL2, BCL6, and MYC were observed in 5.6%, 33.3%, and 22.2%, respectively, including two double-hit and one triple-hit DLBCL (8.3%). There was a significant correlation between MYC protein expression and gene translocation (rs = 0.679, p < .001). However, 25% of cases with MYC rearrangement showed low MYC protein expression. In univariate analysis, MYC protein expression, BCL2 rearrangement, MYC rearrangement, and double/triple-hit DLBCL were associated with shorter overall survival, whereas only MYC protein expression was an independent prognostic value in multivariate model. CONCLUSIONS MYC protein expression was an essential prognostic marker of DLBCL in the oropharyngeal and maxillofacial region. Notably, immunohistochemical staining of MYC, BCL2, and BCL6 could not predict their gene rearrangements, although MYC protein expression was correlated with gene translocation.
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Affiliation(s)
- Shu Xia
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Junqiu Yue
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinming Chen
- Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yaying Hu
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Guo
- Department of Pathology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiali Zhang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei_MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan, China.,Oral Histopathology Department, School and Hospital of Stomatology, Wuhan University, Wuhan, China
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10
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Investigation of the treatment modality in primary lymphoma of the salivary glands. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:248-255. [PMID: 32681985 DOI: 10.1016/j.jormas.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/24/2020] [Accepted: 07/09/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To review our experience in managing primary lymphoma of the major salivary glands by analysing the treatment modality of patients. METHODS In this study, we reviewed the medical records of 26 patients with primary malignant lymphoma of the major salivary glands who were treated at Beijing Stomatological Hospital of Capital Medical University from January 1999 to March 2015. The predictor variable was treatment modality. The outcome variables were overall survival (OS), disease-free survival (DFS), disease-special survival (DSS) and local control (LC). Other relevant variables were as follows: age, sex, pathological pattern, tumour site, clinical features, source, IPI and Ann-Arbor stage. The data were analysed by the χ2 test, log-rank test, and univariate analysis. RESULTS Of the 26 patients, 14 received surgery only, four received initial surgery combined with adjuvant radiotherapy, five received adjuvant chemotherapy, and three received adjuvant radiochemotherapy. During the median follow-up period of 104 months, the overall estimates of OS, DFS, DSS and LC were 84.6, 84.6, 88.5 and 92.3%, respectively. Good outcomes were achieved in patients who received surgery combined with postoperative RT, followed by surgery only. MALT lymphoma had a better prognosis than the other pathological patterns. Mass, swelling, pathological pattern and Ann-Arbor stage were important prognostic factors. CONCLUSION Surgery combined with postoperative radiotherapy may be an appropriate choice for patients with MALT lymphoma. The pathological pattern, mass, swelling and Ann-Arbor stage were associated with an unfavourable prognosis.
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11
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Whaley RD, Carlos R, Bishop JA, Rooper L, Thompson LDR. Lymphoepithelial Carcinoma of Salivary Gland EBV-association in Endemic versus Non-Endemic Patients: A Report of 16 Cases. Head Neck Pathol 2020; 14:1001-1012. [PMID: 32462279 PMCID: PMC7669917 DOI: 10.1007/s12105-020-01172-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/11/2020] [Indexed: 02/07/2023]
Abstract
Lymphoepithelial carcinoma of salivary glands (LECSG) are rare neoplasms, reported in endemic populations (southeastern Chinese) with a strong Epstein-Barr virus (EBV) association. A retrospective series comparing EBV status within an ethnically diverse population (endemic vs. non-endemic patients) has not been reported. Sixteen LECSG were equally distributed between males (n = 8) and females (n = 8) with a median age of 54 years (range 18 to 85 years) at initial diagnosis. Ten patients were white, 4 Asian, and 2 black. The patients typically presented with swelling or mass for an average of 11.6 months. Tumors affected only major salivary glands: parotid (n = 13); submandibular (n = 3). Tumors were an average of 2.9 cm (range 1.5 to 5.8 cm). Nine of 16 (56%) patients had cervical lymph node metastases at presentation. No patients had nasopharyngeal or oropharyngeal tumors. Microscopically, the tumors were widely infiltrative, characterized by large polygonal to spindled cells arranged in a syncytial, lattice-like network in a background of lymphoplasmacytic cells. The neoplastic cells showed an open-vesicular nuclear chromatin to a more basaloid-morphology, the latter showing hyperchromatic nuclei and less cytoplasm, while nearly all of the cases had associated lymphoepithelial lesions/sialadenitis. By in situ hybridization, 8 of 16 cases had a strong, diffuse EBER expression (4 of 4 Asians; 4 of 12 non-Asians), while with immunohistochemistry all cases tested were pan-cytokeratin, CK5/6 and p63 reactive; none of the cases tested were p16 reactive. All patients were managed with wide or radical excision, 4 with concurrent chemoradiation, and 6 with radiation alone. Distant metastasis (lung, brain, and bone) developed in 2 patients. Overall follow-up (mean 3.8 years) revealed 12 patients alive and 2 dead, none with evidence of disease (mean 4.3 years); one white male alive with disease at 1.9 years, and one Asian female dead of disease at 4.2 years; both of these latter patients had Group IV stage disease. High stage (Group IV) patients had a shorter mean survival than lower stage patients: 3.1 versus 4.8 years, respectively. In conclusion, LECSG are uncommon primary neoplasms. Concurrent lymphoepithelial lesions may help suggest a primary tumor. The tumors, irrespective of race or ethnicity, may express EBER. There is an overall good survival, perhaps better for EBV-negative patients and for those with lower stage disease.
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Affiliation(s)
- Rumeal D. Whaley
- grid.257413.60000 0001 2287 3919Department of Pathology & Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN USA
| | - Roman Carlos
- Centro Clinico de Cabeza Y Cuello, Guatemala City, Guatemala
| | - Justin A. Bishop
- grid.267313.20000 0000 9482 7121Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX USA
| | - Lisa Rooper
- grid.411935.b0000 0001 2192 2723Department of Pathology, Johns Hopkins Hospital, Baltimore, MD USA
| | - Lester D. R. Thompson
- grid.280062.e0000 0000 9957 7758Southern California Permanente Medical Group, Department of Pathology, 5601 De Soto Avenue, Woodland Hills, CA 91365 USA
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12
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Clinicopathologic characteristics and novel biomarkers of aggressive B-cell lymphomas in the nasopharynx. Ann Diagn Pathol 2019; 41:129-135. [PMID: 31247533 DOI: 10.1016/j.anndiagpath.2019.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/20/2019] [Accepted: 06/15/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The most common nasopharyngeal lymphoma in the United States are B-cell non-Hodgkin lymphomas (B-NHL). Relatively little is known about the clinicopathologic features of these cases. In this study, we characterize a bi-institutional cohort of aggressive B-NHL primary to the nasopharyngeal area. We compare and contrast EBV-positive versus EBV-negative cases and evaluate expression of SSTR2, CD30, and PD-L1, potential markers for targeted therapeutics. METHODS AND RESULTS We retrieved 53 cases of aggressive B-NHL from the two institutions. Staining was performed for in situ EBV (EBER), CD30, SSTR2 and PD-L1. The response to initial therapy, disease-free interval, and survival at two- and five-year following initial diagnosis were used as primary clinical outcome. Overall, 13 out of 53 cases (23%) were EBV positive. CD30 expression was more frequent in EBV-positive than in EBV-negative cases (4/6 vs 1/17). Seven of 14 (50%) cases tested demonstrated expression of PD-L1 within tumor cells; the two EBV-positive DLBCL tested showed substantial PD-L1 reactivity. Six of 15 (40%) cases tested were positive for SSTR2. The three EBV-positive patients with available outcome data died within one year of diagnosis; in contrast, the EBV-negative cases showed survival rate of 100% (8/8) and 83% (5/6) at two- and five-year follow-up, respectively. DISCUSSION The aggressive B-NHLs of the nasopharynx show differences between EBV-positive versus EBV-negative cases. The association of EBV-positive cases with expression of CD30 and PD-L1 may be particularly informative for targeted therapies. A significant number of cases expresses SSTR2, which could render them susceptible to somatostatin analogue and peptide receptor radionuclide therapies. Finally, our limited case series suggest that EBV negativity may be associated with a better prognosis.
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13
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Vähämurto P, Mannisto S, Pollari M, Karjalainen-Lindsberg ML, Mäkitie AA, Leppä S. Clinical features and outcome of the patients with sinonasal tract diffuse large B-cell lymphoma in the pre-rituximab and rituximab eras. Eur J Haematol 2019; 102:457-464. [PMID: 30834564 DOI: 10.1111/ejh.13225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/10/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE Sinonasal tract diffuse large B-cell lymphoma (SNT-DLBCL), a rare extranodal lymphoma, is not well characterized. We performed a population-based study to determine cell-of-origin, clinical presentation and impact of rituximab (R) and central nervous system (CNS) directed chemotherapy on survival. PATIENTS AND METHODS Patients with SNT-DLBCL were identified from pathology databases. Clinical information was collected and outcomes between different treatment modalities evaluated. RESULTS Thirty-two percent of the patients had germinal centre B-cell phenotype. Forty-six patients were treated with curative intent using CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) or CHOP-like chemotherapy, 21 (46%) before and 25 (54%) in the R-era. Additionally, 24 (52%) received CNS-directed chemotherapy. Addition of R to chemotherapy reduced the risk of progression (RR = 0.368, 95% CI 0.138-0.976, P = 0.045) and death (RR = 0.245, 95% CI 0.068-0.883, P = 0.032), and translated into better survival (5-year PFS, 67% vs 38%, P = 0.037; 5-year OS, 81% vs 48%, P = 0.020). CNS-directed chemotherapy reduced the risk of progression (RR = 0.404, 95% CI 0.159-1.029, P = 0.057) and death (RR = 0.298, 95% CI 0.093-0.950, P = 0.041), and translated into favorable survival (5-year PFS, 67% vs 32%, P = 0.050; 5-year OS 82% vs 43%, P = 0.030). CONCLUSION Patients with SNT-DLBCL benefit from rituximab and CNS-directed chemotherapy.
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Affiliation(s)
- Pauli Vähämurto
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Susanna Mannisto
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjukka Pollari
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Oncology, University of Tampere and Tampere University Hospital, Tampere, Finland
| | | | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery and Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Sirpa Leppä
- Department of Oncology, Helsinki University Hospital Comprehensive Cancer Center and Research Program in Applied Tumor Genomics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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14
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Extranodal involvement of diffuse large B-cell lymphoma in the head and neck: An indicator of good prognosis. Auris Nasus Larynx 2019; 46:114-121. [DOI: 10.1016/j.anl.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/17/2018] [Accepted: 05/17/2018] [Indexed: 02/06/2023]
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15
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Peng C, Ho J, Bai HX, Huang Y, Huang RY, Yang L. Adjuvant radiotherapy and chemotherapy in early-stage diffuse large B cell lymphoma of head and neck with extranodal involvement. Hematology 2019; 24:268-275. [PMID: 31793408 DOI: 10.1080/16078454.2019.1565148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Cuiying Peng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Joshua Ho
- School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Harrison X. Bai
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Yuqian Huang
- Department of Neurology, The First Xiangya Hospital, Central South University, Changsha, People’s Republic of China
| | - Raymond Y. Huang
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | - Li Yang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, People’s Republic of China
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16
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Rodrigues‐Fernandes CI, Souza LL, Santos‐Costa SFD, Pontes HAR, Almeida OP, Vargas PA, Henao JR, Rahimi S, Brennan PA, Fonseca FP. Clinicopathological analysis of oral diffuse large B‐cell lymphoma, NOS: A systematic review. J Oral Pathol Med 2018; 48:185-191. [DOI: 10.1111/jop.12802] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lucas Lacerda Souza
- Service of Oral Pathology João de Barros Barreto University Hospital Federal University of Pará Belém Brazil
| | | | | | - Oslei Paes Almeida
- Department of Oral Diagnosis Piracicaba Dental School University of Campinas Piracicaba Brazil
| | - Pablo Agustin Vargas
- Department of Oral Diagnosis Piracicaba Dental School University of Campinas Piracicaba Brazil
| | | | - Siavash Rahimi
- Department of Histopathology Queen Alexandra Hospital Portsmouth UK
| | - Peter A. Brennan
- Department of Oral and Maxillofacial Surgery Queen Alexandra Hospital Portsmouth UK
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis Piracicaba Dental School University of Campinas Piracicaba Brazil
- Department of Oral Surgery and Pathology School of Dentistry Universidade Federal de Minas Gerais Belo Horizonte Brazil
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17
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Peña C, Russo M, Martinez V, Cabrera ME. Extranodal lymphomas in the public health system in Chile: Analysis of 1251 patients from the National Adult Cancer Program. Hematol Oncol 2018; 37:47-53. [PMID: 30117170 DOI: 10.1002/hon.2547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/26/2018] [Accepted: 06/30/2018] [Indexed: 12/17/2022]
Abstract
The aim of the study was to describe the clinical and epidemiological characteristics, anatomic and histologic distribution, and treatment results of extranodal lymphomas (ENLs), diagnosed and treated in the public health system in Chile. We included patients with ENL diagnosed from 1998 to 2014, in 17 cancer centers, registered prospectively in the database of the National Adult Cancer Program (PANDA) of the Ministry of Health. Treatment was based on the local protocols for each lymphoma subtype. Extranodal lymphoma was documented in 1215 of 4907 non-Hodgkin lymphomas diagnosed in that period (25%). Median age was 59 years (range, 16-95), and 55% were female. The gastrointestinal (GI) tract was the most common location (38%), followed by the head and neck (24%) and the skin (15%). B-cell lymphomas accounted for 78% of cases, diffuse large B-cell lymphoma being the most common histologic subtype (68%). Mycosis fungoides/Sezary syndrome was the most frequent T-cell subtype (36%), followed by NK/T-cell lymphomanasal type (24%). In comparison with western countries, Chile showed a significantly high prevalence of NK/T-cell lymphoma nasal type, while the frequency of B-cell ENL and the anatomic distribution appeared similar, being GI the most commonly involved site.
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Affiliation(s)
- Camila Peña
- Medicine Service, Hematology Section, Hospital del Salvador, Santiago, Chile
| | - Moises Russo
- Radiation Oncology, Fundación Arturo Lopez Perez, Faculty of Medicine, Diego Portales University, Santiago, Chile
| | | | - Maria Elena Cabrera
- Medicine Service, Hematology Section, Hospital del Salvador, University of Chile, Santiago, Chile
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18
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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]
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19
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Abstract
Purpose This meta-analysis aimed to review the published outcomes of parotid
non-Hodgkin lymphoma (NHL) pertaining to different treatment modalities. Materials and Methods A total of 48 journal articles published between 1993 and 2015, comprising
742 cases of parotid NHL, were initially evaluated. In total, 108 patients
from 12 studies who had sufficient data for analysis, including age, tumor
histopathology, treatment modality, and outcome at final follow-up, were
included. Patients were randomly assigned to different categories on the
basis of histopathology and treatment modality. Groups were compared using
Kaplan-Meier survival curve analysis and the Mann-Whitney U
test. Results Log-rank tests demonstrated that for early-stage (I and II) parotid NHL of
all histopathology variants, radiation therapy significantly improved the
survival rate versus chemotherapy (P = .043), as well as
combined treatment with chemotherapy and radiation therapy
(P = .023). For early-stage diffuse large B-cell
lymphoma, combined treatment significantly improved survival versus single
treatment (P = .028). No treatment was received by seven
patients with early-stage mucosa-associated lymphoid tissue lymphoma after
undergoing parotidectomy. When the clinical outcomes of these patients were
compared with those of other patients with the same histology who underwent
further treatment, no significant differences were noted in survival
outcomes. Conclusion Radiation therapy seems to be a valid treatment of early-stage parotid NHL.
However, for diffuse large B-cell lymphoma, survival was higher with
combined treatment versus single treatment. For early-stage parotid
mucosa-associated lymphoid tissue lymphoma, complete excision of the tumor
through superficial parotidectomy may have similar survival outcome.
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Affiliation(s)
- Basem Jamal
- Basem Jamal, King Abdulazziz University, Jeddah, Makkah, Saudi Arabia
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20
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How I treat patients with aggressive lymphoma at high risk of CNS relapse. Blood 2017; 130:867-874. [PMID: 28611025 DOI: 10.1182/blood-2017-03-737460] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/11/2017] [Indexed: 12/25/2022] Open
Abstract
Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis.
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21
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Yao S, Li J, Yao Z, Xu Y, Chu J, Zhang J, Jin S, Huang Y, Zhang J, Ma J, Zhao Y, Yang S, Liu Y. Extranodal involvement in young patients with diffuse large B-cell lymphoma: distribution, prognostic value and treatment options. Chin J Cancer Res 2017; 29:57-65. [PMID: 28373754 PMCID: PMC5348476 DOI: 10.21147/j.issn.1000-9604.2017.01.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Extranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma (DLBCL). Previous studies have suggested that older patients are more prone to extranodal involvement. This study retrospectively addressed the distribution, prognostic value and treatment options of extranodal involvement in young patients with DLBCL. METHODS A total of 329 patients were enrolled according to the inclusion requirements. The effects of gender, extranodal involvement, age-adjusted international prognostic index (aaIPI), rituximab infusion and radiotherapy on patient outcomes were evaluated. RESULTS Among these patients, 59% presented extranodal involvement in 16 anatomic sites. More than one instance was linked to many poorer clinical characteristics and poorer survival compared with either nodal disease or one instance. In patients with one extranodal lesion, multivariate analysis revealed that the site of extranodal involvement, but not the aaIPI or rituximab infusion, was independently related to the outcome, and radiotherapy had a negative influence on survival. CONCLUSIONS Extranodal involvement is common in younger patients and exhibits a ubiquitous distribution. The site of extranodal involvement is of strong prognostic significance. Radiotherapy for extranodal lesions does not improve patient outcomes.
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Affiliation(s)
- Shuna Yao
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Junbo Li
- Department of Internal Medicine, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Zhihua Yao
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Yuanlin Xu
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Junfeng Chu
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Jiuyang Zhang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Shuiling Jin
- Department of Internal Medicine, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
| | - Yangyang Huang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Jianbo Zhang
- Department of Pathology, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Jie Ma
- Department of Pathology, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Yan Zhao
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Shujun Yang
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
| | - Yanyan Liu
- Department of Internal Medicine, Henan Cancer Hospital & Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
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22
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Patini R, Coviello V, Riminucci M, Corsi A, Cicconetti A. Early-stage diffuse large B-cell lymphoma of the submental region: a case report and review of the literature. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/ors.12221] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R. Patini
- Department of Surgical Sciences for Head and Neck Diseases; School of Dentistry; Catholic University of Sacred Heart; Rome Italy
| | - V. Coviello
- Department of Oral and Maxillofacial Sciences; School of Dentistry; ‘Sapienza’ University of Rome; Rome Italy
| | - M. Riminucci
- Department of Sperimental Medicine and Pathology; ‘Sapienza’ University of Rome; ‘Umberto I’ Polyclinic in Rome; Rome Italy
| | - A. Corsi
- Department of Sperimental Medicine and Pathology; ‘Sapienza’ University of Rome; ‘Umberto I’ Polyclinic in Rome; Rome Italy
| | - A. Cicconetti
- Department of Oral and Maxillofacial Sciences; School of Dentistry; ‘Sapienza’ University of Rome; Rome Italy
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23
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Abstract
Various hematolymphoid lesions involve the sinonasal tract, including aggressive B, T, and NK-cell neoplasms; myeloid sarcoma; low-grade lymphomas; indolent T-lymphoblastic proliferations; and Rosai-Dorfman disease. Differentiating aggressive lymphomas from non-hematopoietic neoplasms such as poorly differentiated squamous cell carcinoma, olfactory neuroblastoma, or sinonasal undifferentiated carcinoma may pose diagnostic challenges. In addition, the necrosis, vascular damage, and inflammatory infiltrates that are associated with some hematolymphoid disorders can result in misdiagnosis as infectious, autoimmune, or inflammatory conditions. Here, we review hematolymphoid disorders involving the sinonasal tract including their key clinical and histopathologic features.
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Affiliation(s)
- Genevieve M Crane
- Department of Pathology, The Johns Hopkins Medical Institutions, Weinberg 2242, 401 N Broadway, Baltimore, Maryland 21231-2410
| | - Amy S Duffield
- Department of Pathology, The Johns Hopkins Medical Institutions, Weinberg 2242, 401 N Broadway, Baltimore, Maryland 21231-2410.
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24
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Longo DL. Combined-Modality Therapy for Early-Stage Diffuse Large B-Cell Lymphoma: Knowing When to Quit. J Clin Oncol 2015; 33:3684-5. [PMID: 26282641 DOI: 10.1200/jco.2015.63.0285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Dan L Longo
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA
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25
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Thakral B, Zhou J, Medeiros LJ. Extranodal hematopoietic neoplasms and mimics in the head and neck: an update. Hum Pathol 2015; 46:1079-100. [PMID: 26118762 DOI: 10.1016/j.humpath.2015.05.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/03/2015] [Accepted: 05/08/2015] [Indexed: 12/30/2022]
Abstract
The head and neck region is a common site for extranodal lymphomas, second only to the gastrointestinal tract; and 12% to 15% of all head and neck tumors are lymphomas. Non-Hodgkin lymphomas are most common, and Hodgkin lymphoma occurs rarely at extranodal sites in the head and neck. Most non-Hodgkin lymphomas of the head and neck region are of B-cell lineage, and the Waldeyer ring is the most common site. Head and neck lymphomas have distinctive epidemiological and clinicopathologic features, including an association with immunosuppression, infectious organisms, or autoimmune disorders; site-specific differences (eg, thyroid gland versus ocular adnexa) for common lymphomas, such as extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; and genetic differences that provide insights into etiology. Furthermore, the diagnosis of non-Hodgkin lymphomas at extranodal sites implies differences in prognosis and therapeutic implications with lymphomas at nodal sites. In this review, we discuss various types of non-Hodgkin lymphomas and Hodgkin lymphoma, focusing on unique aspects related to the head and neck region. We also discuss a number of newer entities that are clinically indolent as well as mimics of lymphoma that can occur in the head and neck region, including infectious mononucleosis, Kikuchi-Fujimoto disease, Kimura disease, Castleman disease, and immunoglobulin G4-related disease.
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Affiliation(s)
- Beenu Thakral
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| | - Jane Zhou
- Tufts Medical Center/Tufts University Medical School, 800 Washington Street, Box 802, Boston, MA 02111
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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26
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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]
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27
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Nakajima Y, Tomita N, Itabashi M, Miyashita K, Watanabe R, Miyazaki T, Tachibana T, Takasaki H, Kawasaki R, Tanaka M, Hashimoto C, Yamazaki E, Taguchi J, Fujimaki K, Sakai R, Fujita H, Fujisawa S, Harano H, Motomura S, Ishigatsubo Y. Analysis of outcomes in patients with supra-diaphragmatic vs infra-diaphragmatic diffuse large B cell lymphoma treated with R-CHOP therapy. Leuk Res 2014; 39:198-203. [PMID: 25541027 DOI: 10.1016/j.leukres.2014.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 11/24/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
The prognostic implications of infra-diaphragmatic (InD) versus supra-diaphragmatic (SpD) primary lesions in limited-stage diffuse large B-cell lymphoma (DLBCL) remains unknown. This retrospective study aimed to assess the prognostic impact of spD and InD lesions as well as presence of gastrointestinal (GI) involvements in adults with limited-stage DLBCL. We analyzed data from 178 patients with limited-stage DLBCL who were treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy at 7 institutions of the Yokohama City University Hematology Group between 2003 and 2009. The median age was 63 years (range, 18-80 years). The primary sites were SpD in 109 patients, and InD in 69. No statistical differences in progression-free survival (PFS) or overall survival (OS) were observed between patients with SpD lesions and those with InD lesions. However, when patients with SpD lesions, InD lesions with (n=35), and without (n=34) GI involvement were compared, the presence of GI lesions was associated with favorable PFS. The multivariate analysis revealed that SpD or InD localization had no independent effect on PFS or OS, whereas the presence of GI lesions was correlated with favorable PFS (P=0.024, HR 0.09).
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Affiliation(s)
- Yuki Nakajima
- Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
| | - Naoto Tomita
- Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Megumi Itabashi
- Department of Hematology, Yokohama City University, Medical Center, Yokohama, Japan
| | - Kazuho Miyashita
- Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan
| | - Reina Watanabe
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takuya Miyazaki
- Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Takayoshi Tachibana
- Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Hirotaka Takasaki
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Rika Kawasaki
- Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Yokohama City University, Medical Center, Yokohama, Japan
| | - Chizuko Hashimoto
- Department of Hematology/Oncology, Yamato Municipal Hospital, Yamato, Japan
| | - Etsuko Yamazaki
- Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Jun Taguchi
- Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Katsumichi Fujimaki
- Department of Hematology/Immunology, Fujisawa City Hospital, Fujisawa, Japan
| | - Rika Sakai
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Shizuoka Red Cross Hospital, Shizuoka, Japan
| | - Shin Fujisawa
- Department of Hematology, Yokohama City University, Medical Center, Yokohama, Japan
| | - Hiroshi Harano
- Department of Hematology, Yokosuka City Hospital, Yokosuka, Japan
| | - Shigeki Motomura
- Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
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Giran G, Merlet FL, Bonnet R, Guiziou N, Clairand R, Arzul L. [Diffuse enlargement of salivary glands]. ACTA ACUST UNITED AC 2014; 115:e43-5. [PMID: 25458597 DOI: 10.1016/j.revsto.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 08/12/2014] [Accepted: 09/26/2014] [Indexed: 11/16/2022]
Affiliation(s)
- G Giran
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - F L Merlet
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - R Bonnet
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - N Guiziou
- Service de médecine polyvalente d'urgence, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - R Clairand
- Service de médecine polyvalente d'urgence, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - L Arzul
- Service de chirurgie maxillo-faciale et stomatologie, centre hospitalier universitaire de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
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