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Gündüz AK, Mirzayev I, Kuzu I, Gahramanli Z, Mirzayeva L. A rare case of orbital mantle cell lymphoma presenting as a well-demarcated mass on magnetic resonance imaging. Orbit 2024; 43:253-257. [PMID: 36036259 DOI: 10.1080/01676830.2022.2114501] [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: 05/26/2022] [Accepted: 08/13/2022] [Indexed: 10/15/2022]
Abstract
A 71-year-old male presented with painless and slowly progressive proptosis of the right eye. The patient had no history of cancer and was in good health. Orbital magnetic resonance imaging showed a well-demarcated, slightly lobulated intraconal orbital mass hypo-isointense on T1- weighted and isointense on T2-weighted images, demonstrating contrast enhancement in the right orbit. The lesion had a central cavitary region. An anterior orbitotomy with lower lid crease incision was performed and the lesion was excised in toto. Histopathologic examination revealed diffuse infiltration of monomorphic population of small lymphoid cells. Immunohistochemical staining demonstrated diffuse and strong positivity for CD20, CD5, and cyclin D1. Histopathological and immunohistochemical findings were consistent with mantle cell lymphoma. Positron emission tomography-computed tomography did not show systemic involvement. The patient underwent orbital external beam radiotherapy (36 Gy). There was no recurrence and/or systemic involvement at 2.5 years follow-up.
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Affiliation(s)
- Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Private Eye Clinic, Ankara, Turkey
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Işınsu Kuzu
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Leyla Mirzayeva
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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2
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Mautone L, Dierlamm J, Heinrich MC, Viehweger F, Schäfer H, Schüttauf F, Green S, Dulz S. [Immunohistochemical and molecular genetic profile of mantle cell lymphoma of the lacrimal gland: a case series of an uncommon tumour of the lacrimal gland]. Laryngorhinootologie 2023. [PMID: 37726019 DOI: 10.1055/a-2109-6646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Luca Mautone
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dierlamm
- Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marie-Christine Heinrich
- Zentrum für Diagnostik Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Viehweger
- Zentrum für Diagnostik Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Hansjörg Schäfer
- Zentrum für Diagnostik Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Schüttauf
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Sylvia Green
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Dulz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Zanelli M, Lugli A, Palicelli A, Sanguedolce F, Zizzo M, Cresta C, Biancafarina S, Martino G, Crescenzi B, Pancetti S, Broggi G, Caltabiano R, Cimino L, Mecucci C, Ascani S. CD5-Negative Primary Mantle Cell Lymphoma Presenting with a Bilateral Conjunctival Mass: A Potential Diagnostic Pitfall. Curr Oncol 2023; 30:824-831. [PMID: 36661711 PMCID: PMC9857961 DOI: 10.3390/curroncol30010062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/22/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Mantle cell lymphoma is a B-cell malignancy, which, in its classic form, usually involves lymph nodes and extranodal sites, and, among the extranodal sites, the gastrointestinal tract and the Waldeyer's ring are most prevalent. MCL is rarely reported in the ocular adnexa, a site more frequently affected by extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, which is a form of low-grade malignancy. The diagnosis of MCL presenting in the ocular adnexa requires special attention as its rarity in this location combined with the not uncommon CD5 negativity of the disease when occurring in the ocular adnexa, may lead the pathologist to overlook the diagnosis and misinterpret MCL as marginal zone B cell lymphoma, which has a totally different behavior. Herein, we present a case of primary bilateral conjunctival CD5-negative MCL in a patient having no other sites affected by lymphoma and we discuss possible diagnostic pitfalls.
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Affiliation(s)
- Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Alberto Lugli
- Department of Pathological Anatomy, Modena University Hospital, 41125 Modena, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | | | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Camilla Cresta
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Samuele Biancafarina
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Barbara Crescenzi
- Haematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, 06129 Perugia, Italy
| | - Saverio Pancetti
- Pathology Unit, Humanitas University, Pieve Emanuele, 20072 Milan, Italy
- Pathology Unit, Humanitas Research Hospital-IRCCS, Rozzano, 20089 Milan, Italy
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Luca Cimino
- Ocular Immunology Unit, Azienda USL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
- Department of Surgery, Medicine, Dentistry and Morphological Sciences, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Cristina Mecucci
- Haematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, 06129 Perugia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria di Terni, University of Perugia, 05100 Terni, Italy
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Mautone L, Dierlamm J, Heinrich MC, Viehweger F, Schäfer H, Schüttauf F, Green S, Dulz S. [Immunohistochemical and Molecular Genetic Profile of Mantle Cell Lymphoma of the Lacrimal Gland: A Case Series of an Uncommon Tumour of the Lacrimal Gland]. Klin Monbl Augenheilkd 2023; 240:33-38. [PMID: 36706768 DOI: 10.1055/a-1973-0492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mantle cell lymphomas (MCL) represent a rare subclass of Non-Hodgkin Lymphoma affecting the lacrimal gland (GL). AIM To extensively describe the immunohistochemical profile of GL-MCL. MATERIAL UND METHODS Single center, retrospective electronic records review of 3 patients with biopsy proven LG-MCL. RESULTS The herein presented case series of three patients comprises a focal case involving solely the lacrimal gland, a symptomatic LG-MCL manifesting as the first sign of a systemic disease as well as a case of LG-MCL presenting as a relapsed systemic lymphoma. The three patients presented positive CD19 and CD20, negative CD10 and CD23. One patient showed an uncommon negativity for CD5. The increased expression of cyclin D1 caused by the classical translocation t(11;14) (q13;q32) in the fluorescence-in-situ-hybridisation were observed in all cases. B-cell-lymphoma-2 protein (BCL-2) and transcription factor SOX-11 (SOX-11) were also overexpressed. DISCUSSION LG-MCL show an immunohistochemical profile corresponding to the classical profile of MCL. Overexpression of molecules for target therapies was found in all cases (CD20 for rituximab, BCL2 for Bruton-kinase-inhibitors and CD19 for CAR-T cell therapy). The removal of the GL can potentially drive to severe complications, even if aimed to confirm diagnosis. Therefore, the choice between GL-biopsy and exstirpation should be carefully evaluated, especially in cases of suspected lymphoma.
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Affiliation(s)
- Luca Mautone
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Judith Dierlamm
- Zentrum für Onkologie, II. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Marie-Christine Heinrich
- Zentrum für Diagnostik, Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Florian Viehweger
- Zentrum für Diagnostik, Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Hansjörg Schäfer
- Zentrum für Diagnostik, Institut für Pathologie mit den Sektionen Molekularpathologie und Zytopathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Frank Schüttauf
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Sylvia Green
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Simon Dulz
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Linard C, Lasne-Cardon A, Salaun V, Rousselot P, Dorbeau M. [Composite lymphoma: Case report of a coexisting follicular and mantle cell lymphoma in situ in a cervical node]. Ann Pathol 2021; 42:177-182. [PMID: 34949480 DOI: 10.1016/j.annpat.2021.11.006] [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: 06/17/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 11/19/2022]
Abstract
Composite lymphoma represents 1-4% of lymphomas. Only 8 case reports concerned coexisting follicular lymphoma and mantle cell lymphoma. Here, we report the case of an 81 years old man who has been diagnosed with a composite follicular and in situ mantle cell lymphoma. The use of a large panel of immunohistochemical stains associated with the flow cytometry results have allowed us to make this particular diagnosis. We highlight here a common clonal origin of the composite lymphoma's two entities, as described in previous publications.
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Affiliation(s)
- Camille Linard
- Service d'anatomie pathologique, Centre François-Baclesse, 3, avenue du Général Harris, 14000 Caen, France.
| | - Audrey Lasne-Cardon
- Service d'ORL et de chirurgie cervico-faciale, Centre François-Baclesse, 3, avenue du Général Harris, 14000 Caen, France
| | - Véronique Salaun
- Service d'hématologie biologique, Centre hospitalier universitaire de Caen Normandie, avenue de la côte de Nacre, 14000 Caen, France
| | - Pierre Rousselot
- Service d'anatomie pathologique, Centre François-Baclesse, 3, avenue du Général Harris, 14000 Caen, France
| | - Marine Dorbeau
- Service d'anatomie pathologique, Centre François-Baclesse, 3, avenue du Général Harris, 14000 Caen, France
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Bohli M, Jaffel H, El Fida Noubbigh G, Tbessi S, Msadek F, Kochbati L. Synergistic Effect and Tolerance of Concurrent Radiotherapy and Lenalidomide Use in Relapsing Mantle Cell Lymphoma: A Case Report. Perm J 2021; 24:1-6. [PMID: 33482945 DOI: 10.7812/tpp/19.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Mantle cell lymphoma is an aggressive disease. Limited treatment options are available for refractory or relapsing presentation. We report the first case, to the best of our knowledge, of concurrent radiotherapy and lenalidomide use in this setting, focusing on its possible synergy and tolerance. CASE PRESENTATION A 76-year-old man with a history of mantle cell lymphoma presented with ptosis of the left eyelid, eyelid swelling, and nasal obstruction. Results of positron emission tomography-computed tomography revealed a pathologic fluorodeoxyglucose uptake at the pharynx and left eyelid. He received treatment with ibrutinib, which was stopped 3 months later because of digestive toxic effects. Radiotherapy for the eyelid and pharynx was performed at a dose of 18 Gy, with concurrent lenalidomide administration. Evaluation 3 months later revealed complete disappearance of the 2 relapse sites. DISCUSSION This case highlights the role of concomitant lenalidomide treatment and low-dose radiotherapy in patients with relapsing mantle cell lymphoma. Use of this combination treatment has achieved a complete local control with a safe toxicity profile. The case also illustrates the possible lenalidomide-induced radio sensitization.
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Affiliation(s)
- Mariem Bohli
- Radiotherapy Department, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Hager Jaffel
- Radiotherapy Department, Abderrahman Mami Hospital, Ariana, Tunisia
| | | | - Sabrine Tbessi
- Radiotherapy Department, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Fehmi Msadek
- Hematology Department, Military Hospital, Tunis, Tunisia
| | - Lotfi Kochbati
- Radiotherapy Department, Abderrahman Mami Hospital, Ariana, Tunisia
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7
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Pathological and molecular analysis of a composite lymphoma of mantle cell lymphoma and Epstein-Barr virus-positive follicular lymphoma. Int J Hematol 2021; 113:592-599. [PMID: 33387297 DOI: 10.1007/s12185-020-03035-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
Composite lymphoma (CL) is a very rare clinical entity defined by the presence of two or more different subtypes of lymphoma in the same lymph node. We report a case of CL in a 78-year-old male presenting with leukocytosis and swelling of multiple lymph nodes. A left axillary node biopsy showed atypical lymphocytes in both the interfollicular and follicular areas. Immunohistochemistry revealed that mantle cell lymphoma (MCL) was mainly present in the interfollicular area and follicular lymphoma (FL) was present in the follicular area. Polymerase chain reaction analysis of immunoglobulin heavy chain gene rearrangements confirmed that they were clonally related neoplasms. However, Epstein-Barr virus (EBV) DNA was detected in only FL cells, suggesting that MCL and FL had split into two clones in the early steps of pathogenesis. This is the first reported case of CL with EBV-negative B-cell non-Hodgkin lymphoma (NHL) and EBV-positive B-cell NHL with a clonal relationship. We discuss the developmental processes of these two lymphomas.
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8
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Geropoulos G, Psarras K, Vlachaki E, Kakos C, Vetsiou E, Vamvakis K, Sousos N, Mpouras V, Symeonidis N, Pavlidis ET, Pavlidis TE. Cutaneous manifestations of mantle cell lymphoma: an extensive literature review. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [PMID: 33348938 DOI: 10.15570/actaapa.2020.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mantle cell lymphomas account for about 2 to 10% of non-Hodgkin B-cell lymphomas. Despite the cellular maturity of B-cell lymphomas, the disease is aggressive in the majority of cases and its course is unpredictable. The clinical presentation is variable, and multiple nodal and extranodal manifestations have been described. Cutaneous infiltration is an uncommon (2-6%) location of the disease. An extensive review of the literature was performed, and 24 case reports and five case series were found describing cutaneous locations. These data were thoroughly studied in order to present their clinical and laboratory characteristics in this review.
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Affiliation(s)
- Georgios Geropoulos
- Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Kyriakos Psarras
- Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Kakos
- Department of General Surgery, Ulster Hospital, Belfast, UK
| | - Evangelia Vetsiou
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | | | - Nikolaos Sousos
- Second Department of Internal Medicine, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Mpouras
- Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Symeonidis
- Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Efstathios T Pavlidis
- Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Theodoros E Pavlidis
- Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Ippokrateio General Hospital of Thessaloniki, Thessaloniki, Greece
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9
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Ocular adnexal lymphoma: long-term outcome, patterns of failure and prognostic factors in 174 patients. J Hematop 2020. [DOI: 10.1007/s12308-020-00424-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Orbital and Eyelid B-Cell Lymphoma: A Multicenter Retrospective Study. Cancers (Basel) 2020; 12:cancers12092538. [PMID: 32906630 PMCID: PMC7563111 DOI: 10.3390/cancers12092538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/30/2020] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Simple Summary The treatment of orbital and eyelid B-cell lymphoma remains a field of progress. The aim of our study was to analyze patients diagnosed, staged and treated for orbital and eyelid B-cell lymphoma to assess clinical characteristics, treatment outcomes and recurrence patterns. We included in this study 141 cases of orbital and eyelid B-cell lymphoma. We found five lymphoma subtypes and we confirmed that the histopathologic subtype and the type of treatment were found to be the main factors influencing treatment outcome. Abstract Background: The aim of this study was to analyze patients diagnosed, staged and treated for orbital and eyelid B-cell lymphoma (OEL). Methods: One hundred and forty-one cases of OEL were included in this study. Primary endpoints were to analyze the histopathologic findings, the main risk factors and the type of treatment and to correlate them with recurrence of OEL. The secondary endpoint was to determine the progression-free survival (PFS) time. Results: Extranodal marginal zone B-cell lymphoma was the most frequent subtype (66%), followed by small lymphocytic lymphoma (12.7%), diffuse large B-cell lymphoma (DLBCL) (9.2%), follicular lymphoma (6.6%), mantle cell lymphoma (4.3%) and Burkitt lymphoma (1.2%). The probability of relapse was influenced by the histopathologic subtype DLBCL (OR = 7.7, 95% CI 1.8–32.3) and treatment with chemotherapy (OR = 14.9, 95% CI 2.6–83.7). Multivariate analysis showed that the histopathologic subtype DLBCL and chemotherapy treatment retained statistical significance for a poorer PFS, with hazard ratios of 8.581 (p = 0.0112) and 9.239 (p = 0.0094), respectively. Conclusions: Five lymphoma subtypes were found in patients with OEL. The histopathologic subtype and the type of treatment were found to be the main factors influencing treatment outcome.
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Composite follicular lymphoma and "early" (in situ and mantle zone growth pattern) mantle cell neoplasia: A rare entity with peculiar cytogenetic and clinical features. Pathol Res Pract 2020; 216:153067. [PMID: 32825940 DOI: 10.1016/j.prp.2020.153067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/05/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022]
Abstract
Composite follicular lymphoma (FL) and mantle cell lymphoma (MCL) is rare and not fully characterized from a genetic and clinicopathological point of view. We report a composite lymphoma (CL) in which a G1-2 FL was associated with an in situ mantle cell neoplasia (ISMCN) and a mantle zone growth pattern (MZGP) MCL, followed-up for six years after the first diagnosis, until the exitus of the patient. We performed a comprehensive immunohistochemical study and a detailed cytogenetic analysis, including conventional karyotyping, SKY FISH, FISH on metaphases and interphasic separated nuclei, and FISH on histological sections. The study was completed by the review of the 13 published composite FL and MCL. Our results show that this entity generally behaves like an indolent lymphoma, with the outcome of patients driven by the progression of the FL component. The MCL component generally does not evolve in an aggressive disease. Indeed, half of the cases present exclusively ISMCN. In our case, mantle cell neoplasia at diagnosis was represented by ISMCN and MZGP MCL and it was characterized by a simple karyotype, with t(11;14) as the sole cytogenetic abnormality. This cytogenetic aspect well correlates with the indolent behavior of the mantle cell component. Conversely, the complex karyotype of the FL component was associated with disseminated disease that influenced patient's outcome. Finally, we suggest that not only ISMCN, but also isolated MZGP MCL, may be considered as lesions with low potential of transformation in an aggressive MCL.
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12
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Williams KJ, Allen RC, Weng CY. An Orbital Lesion Diagnosed on Routine Fundus Examination. JAMA Ophthalmol 2019; 137:1456-1457. [PMID: 31647505 DOI: 10.1001/jamaophthalmol.2019.4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Katherine J Williams
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Richard C Allen
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
| | - Christina Y Weng
- Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
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13
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White VA. Understanding and Classification of Ocular Lymphomas. Ocul Oncol Pathol 2019; 5:379-386. [PMID: 31768360 PMCID: PMC6872993 DOI: 10.1159/000499845] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lymphomas that involve the tissues of the ocular adnexae and the eye itself can be confusing for both the new and seasoned learner alike. In this review, I present a simple way of classifying these disorders that will help to facilitate understanding of these myriad entities. SUMMARY Classifications of lymphomas have changed significantly over the last 40 years, but in recent decades, the basic structure of the WHO classification has remained the same, facilitating understanding. KEY MESSAGES The ocular lymphomas can be divided into those that are external to the eye (ocular adnexae) and those that are internal (vitreoretinal and uveal). At each of these sites specific subtypes of lymphoma are common. Focusing on these common subtypes can aid the learner to create a scaffold that enables current understanding and upon which they can build for the future.
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Affiliation(s)
- Valerie A. White
- WHO/IARC Classification of Tumours Group, International Agency for Research on Cancer, Lyon, France
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14
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Nishiyama‐Fujita Y, Nakazato T, Ito C, Ogura S, Mizuno K, Kamiya T, Aisa Y, Mori T. Rare case of ocular adnexal relapse with mantle cell lymphoma treated with ibrutinib monotherapy. Intern Med J 2019; 49:1187-1189. [DOI: 10.1111/imj.14432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 05/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
| | - Tomonori Nakazato
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Chisako Ito
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Shinji Ogura
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Kota Mizuno
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Takahiro Kamiya
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Yoshinobu Aisa
- Department of HematologyYokohama Municipal Citizen's Hospital Yokohama Japan
| | - Takehiko Mori
- Division of HematologyKeio University School of Medicine Tokyo Japan
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15
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Sabater-Marco V, Santonja-López N, Ortíz-Zuluaga S, Navarro-Cerveró L, Orero-Castelló MT. Orbital soft tissue composite lymphoma presenting as recurrence of a nodal lymphoma with mantle and follicular cell components: A case report, literature review and guideline for the treatment of patients. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 53:48-54. [PMID: 31932010 DOI: 10.1016/j.patol.2019.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/07/2019] [Indexed: 01/25/2023]
Abstract
Composite lymphoma with mantle and follicular cell components is a challenging diagnosis. Flow cytometry, immunohistochemistry and molecular genetics are required to distinguish the two components, as often the more aggressive one is predominant and masks the other. A 58-year-old man with history of nodal composite lymphoma presented with right exophthalmos and diplopia. A head CT scan showed an orbital tumor. A biopsy of the tumor revealed a mantle cell lymphoma predominating over a follicular lymphoma. Immunoglobulin heavy chain and light chain rearrangements analysis by PCR proved that both components of the orbital tumor were recurrences of the same nodal composite lymphoma diagnosed two years earlier. The nodal lymphoma was composed of a follicular lymphoma and an in situ mantle cell neoplasia. Consensus view is that dominant lymphoma should be treated when needed but taking into account if the mantle cell lymphoma is an in situ neoplasia and if it expresses CD5 and SOX11.
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Knudsen MKH, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Khong JJ, McKelvie PA, Mulay K, Ralfkiaer E, Sjö LD, Vemuganti GK, Thuro BA, Curtin J, Heegaard S. Clinicopathological Features of Ocular Adnexal Mantle-Cell Lymphoma in an International Multicenter Cohort. JAMA Ophthalmol 2019; 135:1367-1374. [PMID: 29121219 DOI: 10.1001/jamaophthalmol.2017.4810] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance To our knowledge, the clinical features of ocular adnexal mantle-cell lymphoma (OA-MCL) have not previously been evaluated in a large multicenter cohort. Objective To characterize the clinical features of OA-MCL. Design, Setting, and Participants This retrospective multicenter study included patient data collected from January 1, 1980, through December 31, 2015, at 6 eye cancer centers in 4 countries. Medical records of 55 patients with OA-MCL were reviewed; the median length of follow-up was 33 months. Main Outcomes and Measures Overall survival, disease-specific survival, and progression-free survival were the primary end points. Results Fifty-five patients were included; ocular adnexal MCL was found to be most common in older individuals (mean age, 70 years) and men (n = 42 of 55; 76%). Patients with OA-MCL frequently presented with disseminated lymphoma (n = 34 of 55; 62%), and were likely to experience stage IVE disease (n = 35 of 55; 64%), with bilateral involvement (n = 27 of 55; 47%), tumor masses (n = 27 of 36; 75%), and involvement of the orbit (n = 32 of 55; 58%). Chemotherapy with or without external beam radiation therapy was the most frequently used treatment. Overall survival rates for the entire cohort were 65% at 3 years (95% CI, 52%-78%) and 34% at 5 years (95% CI, 21%-47%). Disease-specific survival after 5 years was 38% for the entire cohort (95% CI, 25%-51%); the disease-specific survival adjusted by eye cancer center was better in patients who had received rituximab in addition to the chemotherapy regimen (hazard ratio, 3.3; 95% CI, 1.0-14.7; P = .06). The median progression-free survival was 2.3 years (95% CI, 1.8-2.7 years) in patients who experienced recurrence after primary treatment, and 4.1 years (95% CI, 3.9-4.3 years) in patients who presented with a relapse of systemic lymphoma in the ocular adnexal region. Conclusions and Relevance These results suggest that the distinctive features of OA-MCL are its appearance in older male individuals, advanced stage and bilateral manifestation at the time of diagnosis, and aggressive course. The prognosis of patients with OA-MCL might be improved by addition of rituximab to chemotherapy treatment.
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Affiliation(s)
- Marina K H Knudsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter K Rasmussen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sarah E Coupland
- Department of Cellular and Molecular Pathology, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston
| | | | | | | | - Jwu Jin Khong
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penny A McKelvie
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, and Ocular Pathology, LV Prasad Eye Institute, Hyderabad, India
| | - Elisabeth Ralfkiaer
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lene D Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geeta K Vemuganti
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India,School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston
| | - Jeremy Curtin
- Orbital, Plastic, and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
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17
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Olsen TG, Holm F, Mikkelsen LH, Rasmussen PK, Coupland SE, Esmaeli B, Finger PT, Graue GF, Grossniklaus HE, Honavar SG, Khong JJ, McKelvie PA, Mulay K, Sjö LD, Vemuganti GK, Thuro BA, Heegaard S. Orbital Lymphoma-An International Multicenter Retrospective Study. Am J Ophthalmol 2019; 199:44-57. [PMID: 30419193 DOI: 10.1016/j.ajo.2018.11.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE To investigate and characterize the clinical features of subtype-specific orbital lymphoma. DESIGN Retrospective, interventional case series. METHODS The study included 7 international eye cancer centers. Patient data were collected from January 1, 1980 through December 31, 2017. A total of 797 patients with a histologically verified orbital lymphoma were included. The primary endpoints were overall survival, disease-specific survival, and progression-free survival. RESULTS The median age was 64 years, and 51% of patients (n = 407) were male. The majority of lymphomas were of B-cell origin (98%, n = 779). Extranodal marginal zone B-cell lymphoma (EMZL) was the most frequent subtype (57%, n = 452), followed by diffuse large B-cell lymphoma (DLBCL) (15%, n = 118), follicular lymphoma (FL) (11%, n = 91), and mantle cell lymphoma (MCL) (8%, n = 66). Localized Ann Arbor stage IE EMZL and FL were frequently treated with external beam radiation therapy. DLBCL, MCL, and disseminated EMZL and FL were primarily treated with chemotherapy. EMZL and FL patients had a markedly better prognosis (10-year disease-specific survival of 92% and 71%, respectively) than DLBCL and MCL patients (10-year disease-specific survival of 41% and 32%, respectively). CONCLUSIONS Four lymphoma subtypes were primarily found in patients with orbital lymphoma: EMZL, DLBCL, FL, and MCL. The histologic subtype was found to be the main predictor for outcome, with EMZL and FL patients having a markedly better prognosis than DLBCL and MCL.
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MESH Headings
- Aged
- Antineoplastic Agents/therapeutic use
- Brachytherapy
- Disease-Free Survival
- Female
- Humans
- Internationality
- Lymphoma/classification
- Lymphoma/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Mantle-Cell/diagnostic imaging
- Lymphoma, Mantle-Cell/pathology
- Lymphoma, Mantle-Cell/therapy
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Orbital Neoplasms/classification
- Orbital Neoplasms/pathology
- Positron Emission Tomography Computed Tomography
- Retrospective Studies
- Survival Rate
- Tomography, X-Ray Computed
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Holm
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauge Hjorth Mikkelsen
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah E Coupland
- Department of Clinical and Cancer Medicine, University of Liverpool, Liverpool, England
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Paul T Finger
- The New York Eye Cancer Center, New York, New York, USA
| | | | | | - Santosh G Honavar
- Department of Ophthalmic and Facial Plastic Surgery, Orbit and Ocular Oncology, Centre for Sight, Hyderabad, India; Department of Ocular Oncology and Oculoplastics, LV Prasad Eye Institute, Hyderabad, India
| | - Jwu Jin Khong
- Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Penelope A McKelvie
- Orbital, Plastic and Lacrimal Unit, The Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Kaustubh Mulay
- National Reporting Centre for Ophthalmic Pathology, Centre for Sight, Hyderabad, India
| | - Lene Dissing Sjö
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Geeta K Vemuganti
- Visiting Faculty, Ophthalmic Pathology Services, LV Prasad Eye Institute, Hyderabad, India; Kallam Anji Reddy Campus, School of Medical Sciences, University of Hyderabad, Hyderabad, India
| | - Bradley A Thuro
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
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18
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Zhao PY, Kahana A, Kim TN. Blurred Vision and Wrinkled Retinas in an Elderly Man. JAMA Ophthalmol 2019; 137:226-227. [PMID: 30589928 DOI: 10.1001/jamaophthalmol.2018.6254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Peter Y Zhao
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Alon Kahana
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
| | - Tyson N Kim
- Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan, Ann Arbor
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Abstract
Orbital lymphomas constitute 50-60% of ocular adnexal lymphomas. A total of 2211 cases of orbital lymphoma with a known subtype have been reported in the last 24 years (1994-2017). The vast majority of orbital lymphomas are of B-cell origin (97%), of which extranodal marginal zone B-cell lymphoma (EMZL) (59%) is the most common subtype, followed by diffuse large B-cell lymphoma (23%), follicular lymphoma (9%), and mantle cell lymphoma (5%). Orbital lymphoma is primarily a disease of the elderly. Gender distribution varies according to lymphoma subtype. However, extranodal marginal zone B-cell lymphoma (53%) and follicular lymphoma (75%) show a female predominance, whereas diffuse large B-cell lymphoma shows an even gender distribution. Mantle cell lymphoma has a striking male predominance of 80%. The histopathological subtype and the clinical stage of the disease are the best indicators of prognosis and patient outcome. Low-grade lymphomas such as extranodal marginal zone B-cell lymphoma and FL have a good prognosis, whereas high-grade lymphomas (diffuse large B-cell lymphoma and mantle cell lymphoma) are associated with a poor prognosis. When managing solitary low-grade lymphomas, radiotherapy is the treatment of choice. Chemotherapy, with or without radiotherapy, should be chosen for disseminated and high-grade lymphomas.
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Affiliation(s)
- Tine Gadegaard Olsen
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Ophthalmology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
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20
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De Niear MA, Greer JP, Seegmiller A, Mawn LA. Blastic Transformation of a Mantle Cell Lymphoma Presenting as an Enlarging Unilateral Orbital Mass. Ocul Oncol Pathol 2018; 5:245-251. [PMID: 31367585 DOI: 10.1159/000492832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/12/2018] [Indexed: 12/22/2022] Open
Abstract
Mantle cell lymphoma (MCL) is an uncommon form of non-Hodgkin lymphoma predominantly affecting male individuals of advanced age. Approximately 1-9% of cases of lymphoma affecting the orbital and ocular adnexal regions are attributed to MCL. We describe the case of a 65-year-old man with a 24-year history of MCL with initial remission followed by multiple relapses who presented with acute-onset binocular diplopia and proptosis of the left eye. Subsequent imaging demonstrated a new left superior orbital mass. Biopsy of the mass revealed two clonally related, yet distinct cellular components demonstrating the classical mantle cell morphology and large cells that appeared to have transformed to the blastoid variant of MCL. Transformation of classical MCL to the blastoid variant of MCL is rare, with few reports in the literature. The blastoid variant of MCL tends to be aggressive and associated with a poor prognosis. The case we describe represents perhaps the first report of MCL transformation observed in the orbit.
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Affiliation(s)
- Matthew A De Niear
- Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - John P Greer
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Adam Seegmiller
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Louise A Mawn
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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21
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Ana-Magadia MG, Takahashi Y, Valencia MRP, Kakizaki H. Mantle Cell Lymphoma of the Lacrimal Gland. J Craniofac Surg 2018; 30:158-160. [PMID: 30339590 DOI: 10.1097/scs.0000000000004776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The authors present 2 female patients of mantle cell lymphoma (MCL) involving the lacrimal gland. The patients include a 75-year-old female and a 59-year-old female. Both patients presented with palpable upper eyelid masses. The first patient was previously diagnosed with gastric and ileocecal MCLs and underwent chemotherapy with remission. The second patient had distant lesions in the muscular limbs that were confirmed to be MCL after the diagnosis of lacrimal gland MCL. Both patients underwent chemotherapy with complete remission.
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Affiliation(s)
- Marian Grace Ana-Magadia
- Department of Oculoplastic, Orbital, and Lacrimal Surgery, Aichi Medical University Hospital, Aichi, Japan
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22
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Franco P, Filippi AR, Ricca I, Raucci C, Ricardi U. Eyelid Localization in Mantle Cell Lymphoma: Long-Lasting Complete Remission after Surface Brachytherapy. TUMORI JOURNAL 2018; 95:385-8. [DOI: 10.1177/030089160909500321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ocular adnexal lymphoma is the most frequent malignancy occurring in the eye region. With regard to the histology of these lesions, 2% to 7% of non-Hodgkin's lymphomas located in the periocular region are mantle cell lymphomas. A few cases of mantle cell lymphoma characterized by a fairly indolent course and prolonged survival have been described in the medical literature. We here report on a patient with indolent mantle cell lymphoma presenting at relapse with an isolated eyelid mass that was treated with lens-sparing surface brachytherapy resulting in durable locoregional complete remission.
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Affiliation(s)
- Pierfrancesco Franco
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista di Torino, Turin, Italy
| | - Andrea Riccardo Filippi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista di Torino, Turin, Italy
| | - Irene Ricca
- Oncology Unit, Cottolengo Hospital, Turin, Italy
| | - Carlo Raucci
- Oncology Unit, Cottolengo Hospital, Turin, Italy
| | - Umberto Ricardi
- Department of Medical and Surgical Sciences, Radiation Oncology Unit, University of Torino, Ospedale S. Giovanni Battista di Torino, Turin, Italy
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23
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Liu C, Dalm VASH, van Hagen PM, Croon-de Boer F, Paridaens D. Chemotherapy-induced exacerbations of thyroid orbitopathy in a patient with B-cell lymphoma. Orbit 2018; 37:299-302. [PMID: 29300515 DOI: 10.1080/01676830.2017.1423086] [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: 10/18/2022]
Abstract
A 55-year-old woman with concurrent active thyroid orbitopathy and B-cell lymphoma developed acute exacerbation of thyroid orbitopathy after receiving Rituximab, cyclophosphamide, hydroxydaunorubicin, Prednisone (R-CHOP) chemotherapy, presenting with subtotal loss of vision and severe eyelid edema. Intravenous methylprednisolone was fully effective within several hours. Further exacerbations of her orbitopathy were seen following every subsequent chemotherapeutic treatment, but responded well to oral prednisone. This case shows that thyroid orbitopathy may severely and acutely progress after chemotherapy for concurrent B-cell lymphoma. Clinical awareness of this potential complication may prevent blindness in this rare subset of patients.
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Affiliation(s)
- C Liu
- a The Rotterdam Eye Hospital , Rotterdam , the Netherlands
| | - V A S H Dalm
- b Departments of Internal Medicine and Immunology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - P M van Hagen
- b Departments of Internal Medicine and Immunology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - F Croon-de Boer
- c Department of Internal Medicine and Hematology , Ikazia Hospital , Rotterdam , The Netherlands
| | - D Paridaens
- a The Rotterdam Eye Hospital , Rotterdam , the Netherlands
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24
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Shaikh H, Jani P, Shah R, Bilimoria F, Uchin J, Mewawalla P. Mantle Cell Lymphoma Relapsing as Disease of Skin, Orbit and CNS: An Extremely Rare Presentation and a Review of Literature. J Hematol 2018; 7:38-42. [PMID: 32300410 PMCID: PMC7155861 DOI: 10.14740/jh363w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/15/2017] [Indexed: 12/03/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a form of non-Hodgkin’s lymphoma originating from mature B cells. The hallmark gene translocation (11:14) results in overexpression of cyclin D1. Affected extranodal sites include bone marrow and gastrointestinal tract, but skin, orbit or CNS are rarely involved. Twenty-four cases have reported involvement of skin by MCL, while orbital MCL is equally rare. Our case is the first to report relapsed MCL with involvement of the skin and orbit simultaneously without disease in the lymphatic system or the bone marrow. A 53-year-old female with stage IV MCL initially presented with pancytopenia, adenopathy and splenomegaly. She achieved complete remission after six cycles of rituximab and bendamustine. Within 4 weeks of treatment, she developed diplopia and a rash of the left breast. Skin biopsy showed lymphoma infiltrates with B-cell markers for MCL. MRI of the orbits and brain suggested orbital lymphoma. CSF cytology further confirmed MCL cells. At time of relapse, she continued to be in hematologic remission. She initiated intrathecal cytarabine and methotrexate along with ibrutinib. R-CHOP was then added to the regimen. Within 2 weeks of starting treatment, her skin disease resolved and she had improvement in vision. MCL commonly presents as a disseminated disease, resulting in high mortality. Involvement of the skin or orbit has been sparingly reported and always suggests aggressive disease. It thus poses a challenge to diagnose and treat the condition as evidenced by resolution of adenopathy and bone marrow disease. Due to the overall poor prognosis of MCL and its unique presentations, as demonstrated by our case, early detection and prompt treatment are crucial to survival.
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Affiliation(s)
- Hira Shaikh
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Prashant Jani
- Division of Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Rupin Shah
- Division of Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Jeffry Uchin
- Department of Pathology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Prerna Mewawalla
- Division of Hematology-Oncology, Allegheny Health Network, Pittsburgh, PA, USA
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25
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Karlin J, Peck T, Prenshaw K, Portell CA, Kirzhner M. Orbital mantle cell lymphoma presenting as myasthenia gravis. Orbit 2017; 36:365-369. [PMID: 28820310 DOI: 10.1080/01676830.2017.1337202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/28/2017] [Indexed: 06/07/2023]
Abstract
A 69-year-old man, previously treated with pyridostigmine for myasthenia gravis (manifesting as ptosis and diplopia) was evaluated for several concomitant bilateral anterior orbital masses. Imaging revealed 3 discrete, solid masses within and around the orbits. An incisional biopsy demonstrated atypical lymphocytes positive for CD20 and Cyclin-D1, consistent with mantle cell lymphoma. The patient received induction chemotherapy with a rituximab-based regimen. He experienced resolution of his diplopia and ptosis after one cycle of chemotherapy and achieved complete remission of the orbital masses and myasthenia symptoms after 6 cycles. Myasthenia gravis is most commonly associated with thymoma, but may also be observed with other malignancies. Recognition that orbital lymphoma may coexist with myasthenia gravis will help in expediting the diagnosis of future cases and in guiding treatment decisions.
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Affiliation(s)
- Justin Karlin
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| | - Travis Peck
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
| | - Karyn Prenshaw
- b Department of Pathology , University of Virginia , Charlottesville , Virginia , USA
| | - Craig A Portell
- c Division of Hematology and Oncology , University of Virginia , Charlottesville , Virginia , USA
| | - Maria Kirzhner
- a Department of Ophthalmology , University of Virginia , Charlottesville , Virginia , USA
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26
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Verma S, Gupta N, Mohindra S, Sachdeva MS, Rajwanshi A. Primary orbital mantle cell lymphoma: Flow cytometric immunophenotyping as an adjunct to fine-needle aspiration cytology for diagnosis. Cytojournal 2017; 14:2. [PMID: 28217141 PMCID: PMC5288933 DOI: 10.4103/1742-6413.198816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Sangeeta Verma
- Address: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Address: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satyawati Mohindra
- Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manupdesh Singh Sachdeva
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Address: Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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27
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Richards H, Ramsden C, Naidoo R, Yvon C, Jacob E, Mohamedbhai S. Ocular adnexal lymphomas: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2017. [DOI: 10.1080/17469899.2017.1280394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Huw Richards
- North Middlesex University Hospital NHS Trust, London, UK
| | - Conor Ramsden
- Institute of Ophthalmology, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | | | - Camille Yvon
- Institute of Ophthalmology, University College London, London, UK
- Frimley Park Hospital, Portsmouth Road, Frimley, Surrey, UK
| | | | - Sajir Mohamedbhai
- North Middlesex University Hospital NHS Trust, London, UK
- University College Hospital NHS Foundation Trust, London, UK
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28
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Bilateral ocular panadnexal mass as initial presentation of systemic blastoid variant of mantle-cell lymphoma. Surv Ophthalmol 2016; 62:83-88. [PMID: 27256688 DOI: 10.1016/j.survophthal.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 11/21/2022]
Abstract
A 66-year-old man developed a slowly enlarging, bilateral, painless, periorbital, and orbital swelling with ptosis, nonaxial proptosis, chemosis, exposure keratopathy, and decreased vision in both eyes. He had fever, night sweats, and weight loss (B-symptoms), along with lymphadenopathy and elevated serum lactate dehydrogenase, with no prior history of lymphoma. A transpalpebral incisional biopsy revealed a rare case of mantle-cell lymphoma of blastoid variant, stage IVB. The main immunophenotype characteristics were cyclin D1+, CD5+, CD10-, CD23-, Bcl-6-/+, and a high (up to 80%) Ki-67 proliferation index. Following an excellent response to the immune-chemotherapy treatment plan, all ocular adnexal lymphoma manifestations disappeared completely; however, 13 months after the initial presentation, there was a recurrence of the disease with rapid worsening and death. The blastoid variant of mantle cell lymphoma, a rare subtype of mantle-cell lymphoma, is a highly aggressive neoplasm, ultimately having a fatal outcome. As the initial manifestation of the disease, ocular adnexal region blastoid variant of mantle-cell lymphoma is an exceptional event, with only one previous case reported.
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29
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Ramsden CM, Yvon C, Jacob E, Kam R, Anikina E, Khan I. Mantle cell lymphoma masquerading as chalazia, a case report. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1586/17469899.2016.1162096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lee JJ, Kim MS, Choi HY, Park KS, Lee SB. Comparison of Ocular Adnexal Mantle Cell Lymphoma and MALT Lymphoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2015. [DOI: 10.3341/jkos.2015.56.6.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jong Joo Lee
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Min Su Kim
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
| | - Hee Young Choi
- Department of Ophthalmology, Pusan National University School of Medicine, Busan, Korea
| | | | - Sung Bok Lee
- Department of Ophthalmology, Chungnam National University, School of Medicine, Daejeon, Korea
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A rare presentation of in situ mantle cell lymphoma and follicular lymphoma: a case report and review of the literature. Case Rep Hematol 2014; 2014:145129. [PMID: 25478252 PMCID: PMC4249607 DOI: 10.1155/2014/145129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/17/2014] [Accepted: 10/17/2014] [Indexed: 11/30/2022] Open
Abstract
A 65-year-old gentleman presented with left groin swelling over the course of two months. Physical exam revealed nontender left inguinal adenopathy, and computed tomography scans detected multiple lymph nodes in the mesenteric, aortocaval, and right common iliac regions. An excisional lymph node biopsy was performed. Pathologic evaluation demonstrated follicular center site which stained positive for PAX5, CD20, CD10, Bcl-2, Bcl-6, and mantle zone cells. These findings demonstrated CCND1 and CD5 positivity, suggesting composite lymphoma comprising follicular lymphoma (FL) with in situ mantle cell lymphoma (MCLIS). FL is known as indolent non-Hodgkin lymphoma; however, the clinical significance of a coexisting MCLIS continues to be elusive, and optimal management of these patients remains largely unknown. This case illustrates the diagnostic and therapeutic challenges of composite lymphomas. This paper also discusses advances in molecular pathogenesis and lymphoma genomics which offer novel insights into these rare diseases.
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Sahu KK, Uthamalingam P, Sampath S, Jinagal J, Das A, Prakash G, Malhotra P, Varma SC. Ocular adnexal lymphomas: report of 2 cases of mantle cell lymphomas and short review of literature. Indian J Hematol Blood Transfus 2014; 30:163-8. [PMID: 25114401 DOI: 10.1007/s12288-014-0389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/03/2014] [Indexed: 11/26/2022] Open
Abstract
Mantle cell lymphoma in ocular region is a rare phenomenon which can be either primary or secondary. Most of these cases are usually diagnosed after excisional biopsy of the involved area with first visit being in the Ophthalmology OPD. We share our experience of two such cases being referred from Ophthalmology OPD. 1st case is about a 52-year-old man who came for complaints of redness of left eye with excessive lacrimation. Examination revealed congestion of left temporal bulbar conjunctiva and a small pinkish outgrowth 2 × 2 cm adherent to temporal bulbar conjunctiva. 2nd case is a 55-year-old gentlemen who presented with complaints for 8 months duration of swelling left eyelid. Excisional biopsy and histopathological examination in both the cases were done to confirm the diagnosis. CECT head and neck were done at baseline and during follow up. These cases are being presented due to the rarity and dramatic response to chemotherapy.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Preithy Uthamalingam
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Santhosh Sampath
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Jitender Jinagal
- Department of Opthalmology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Ashim Das
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Hematology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
| | - Subhash Chander Varma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012 India
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Wang S, Tzankov A, Xu-Monette ZY, Hoeller S, Wang SA, Richards KL, Zhang S, Said JW, Medeiros LJ, Young KH. Clonally related composite follicular lymphoma and mantle cell lymphoma with clinicopathologic features and biological implications. Hum Pathol 2013; 44:2658-67. [DOI: 10.1016/j.humpath.2013.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 06/29/2013] [Accepted: 07/03/2013] [Indexed: 11/30/2022]
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Yamada T, Goto N, Tsurumi H, Takata K, Sato Y, Yoshino T, Moriwaki H, Kito Y, Takeuchi T, Iwata H. Mantle cell lymphoma with a unique pattern of CD5 expression: a case report with review of the literatures. Med Mol Morphol 2013; 47:169-75. [PMID: 24166616 DOI: 10.1007/s00795-013-0060-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 09/20/2013] [Indexed: 11/30/2022]
Abstract
Mantle cell lymphoma (MCL) is a unique subtype of B-cell non-Hodgkin's lymphoma characterized by chromosomal translocation t(11;14)(q13;q32), positive CD5, and nuclear cyclin D1 overexpression with unfavorable prognosis. We report herein a case of MCL in a 73-year-old male diagnosed with diffuse large B-cell lymphoma (ileal tumor) at another hospital, who subsequently relapsed with CD5-negative MCL. At the 1st relapse, he developed neck lymph node swelling, of which biopsy showed proliferation of atypical large pleomorphic cells with CD5-negativity by both immunohistochemistry and flow cytometry. At the 2nd relapse, he again developed an ileal tumor, of which biopsy showed positivity for CD5, CD20, and cyclin D1. In MCL, CD5-negative expression has sometimes been reported as having pleomorphic and blastoid variants. The present case was also histologically the pleomorphic type, but the CD5 expression changed from negative at the onset and the 1st relapse to positive at the 2nd relapse. This is a rare and interesting case because of the different expression of CD5 at all stage. This phenomenon made the diagnosis of MCL difficult.
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Affiliation(s)
- Toshiki Yamada
- Department of Hematology, Gifu Prefectural General Medical Center, Gifu, Japan
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Walia SS, Stelton CR, Shantha JG, Connors DB, Walia HS. Bilateral proptosis as initial manifestation of mantle cell lymphoma. Am J Med 2013; 126:862-3. [PMID: 23932161 DOI: 10.1016/j.amjmed.2013.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 03/07/2013] [Accepted: 03/07/2013] [Indexed: 11/30/2022]
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Rasmussen PK. Diffuse large B-cell lymphoma and mantle cell lymphoma of the ocular adnexal region, and lymphoma of the lacrimal gland: an investigation of clinical and histopathological features. Acta Ophthalmol 2013; 91 Thesis 5:1-27. [PMID: 24041159 DOI: 10.1111/aos.12189] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
UNLABELLED Diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL) constitute two distinct subtypes of non-Hodgkin lymphoma (NHL) associated with considerable morbidity and mortality. Marked diversities with regard to molecular biology and clinical features are recognized in different subsets of the two lymphomas. Because these differences could be related to the location of the lymphoma, it is of interest to investigate the clinical and histopathological features of DLBCL and MCL involving the ocular adnexal region (i.e. the orbit, eyelids, conjunctiva, lacrimal gland and lacrimal sac). Similarly, the lacrimal gland is the only glandular structure within the orbit. Because the lacrimal gland represents an important part of the immunological system, it is of interest to investigate lymphomas involving this location with regard to clinical and histological characteristics. PURPOSE To characterize the clinical and histopathological features of Danish patients with DLBCL of the ocular adnexal region between 1980 and 2009 and of Danish ocular adnexal MCL patients from 1980 to 2005. Furthermore, the aim of this PhD was to review all specimens from patients with lymphoma of the lacrimal gland in Denmark between 1975 and 2009 to determine the distribution of lymphoma subtypes of the lacrimal gland and to describe the clinicopathological features of these patients. RESULTS A total of 34 patients with DLBCL and 21 with MCL of the ocular adnexal region were identified. Twenty-seven patients had lacrimal gland lymphoma, including four DLBCLs and three MCLs from studies I and II. Elderly patients predominated in all three groups, with median ages of 78, 75 and 69 years in the DLBCL, the MCL and the lacrimal gland lymphoma groups, respectively. MCL patients had a preponderance of males, whereas females prevailed among lacrimal gland lymphoma patients. The orbit was the most common site of involvement in DLBCL and MCL. Most DLBCL patients had unilateral involvement, while MCL patients had a high frequency of bilateral involvement. Similarly, localized lymphoma was relatively frequently seen in DLBCL patients in contrast to the predominance of disseminated lymphoma in the MCL group. The majority of lacrimal gland lymphomas were low grade, and the distribution of subtypes was as follows: extranodal marginal zone lymphoma, 10 (37%); follicular lymphoma, 5 (19%); DLBCL, 4 (15%); MCL, 3 (11%); chronic lymphocytic leukaemia/small lymphatic lymphoma, 2 (7%); and unclassified B-cell lymphoma, 3 (11%). The overall survival rates at 3 and 5 years for the entire study group of DLBCL were 42% and 20%, whereas 58% and 22% of MCL patients were alive 3 and 5 years after the time of diagnosis. The 5-year overall survival rate of lacrimal gland lymphoma patients was 70%. Concordant bone marrow involvement and the International Prognostic Index score were predictive factors for the overall survival in the DLBCL group in Cox regression analysis. Rituximab-containing chemotherapy was associated with an improved survival rate in MCL patients. CONCLUSIONS Diffuse large B-cell lymphoma and MCL involving the ocular adnexal region and lymphoma of the lacrimal gland are prevalent among elderly patients. The overall prognosis in DLBCL and MCL was poor, whereas the prognosis for lacrimal gland lymphoma patients was relatively good. Concordant bone marrow involvement and the International Prognostic Index score were independent predictive factors for mortality in the DLBCL group. Chemotherapy containing rituximab significantly improved survival in the MCL group.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Agents/therapeutic use
- Female
- Humans
- Lacrimal Apparatus/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Leukemia, Lymphocytic, Chronic, B-Cell/mortality
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Mantle-Cell/drug therapy
- Lymphoma, Mantle-Cell/mortality
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Morbidity
- Orbital Neoplasms/drug therapy
- Orbital Neoplasms/mortality
- Orbital Neoplasms/pathology
- Prevalence
- Prognosis
- Registries
- Rituximab
- Survival Rate
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Affiliation(s)
- Peter Kristian Rasmussen
- Eye Pathology Institute, Department of Neuroscience and Pharmacology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Ponzoni M, Govi S, Licata G, Mappa S, Giordano Resti A, Politi LS, Spagnuolo L, Di Cairano E, Doglioni C, Ferreri AJM. A reappraisal of the diagnostic and therapeutic management of uncommon histologies of primary ocular adnexal lymphoma. Oncologist 2013; 18:876-84. [PMID: 23814042 DOI: 10.1634/theoncologist.2012-0425] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%-2% of non-Hodgkin lymphoma and 5%-15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management.
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Affiliation(s)
- Maurilio Ponzoni
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
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38
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Mantle cell lymphoma and involvement of the orbit and ocular adnexa. Case Rep Pathol 2013; 2013:581856. [PMID: 23691402 PMCID: PMC3638508 DOI: 10.1155/2013/581856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 03/20/2013] [Indexed: 11/17/2022] Open
Abstract
Orbital and ocular adnexal lymphomas are rare and represent around 1-2% of lymphomas and about 8% of the extranodal lymphomas. However, these entities represent the majority of orbital malignancies. Lymphomas of the ocular adnexal region are primary or secondary lymphomas, and the majority of them are composed of small, mature lymphocytes, which provide a large differential diagnosis. Thus, these entities are not easily distinguished from indolent lymphoid processes such as reactive lymphoid hyperplasia. Extranodal marginal zone lymphoma is the most common lymphoma in the ocular adnexal region. However, this entity cannot be distinguished from benign lymphoid proliferations or other lymphomas composed of small, mature lymphocytes by routine histopathology. We describe a 78-year-old man who presents with bilateral upper eyelid masses, which had been present and grew in size over the past twelve months prior to his presentation. A biopsy of the mass shows a monotonous population of small, mature lymphocytes. The immunohistochemical studies performed on the eyelid mass confirmed a monoclonal proliferation of B cells expressing cyclin-D1; therefore, a final diagnosis of mantle cell lymphoma was rendered. A literature review of mantle cell lymphoma with orbital and ocular adnexal involvement and the diagnostic pitfalls in this area of hematopathology are discussed.
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39
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Rasmussen PK, Ralfkiaer E, Prause JU, Sjö LD, Toft PB, Siersma VD, Heegaard S. Diffuse large B-cell lymphoma of the ocular adnexal region: a nation-based study. Acta Ophthalmol 2013; 91:163-9. [PMID: 22551232 DOI: 10.1111/j.1755-3768.2011.02337.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize the clinicopathological features of diffuse large B-cell lymphoma (DLBCL) of the ocular adnexal region. METHODS The present series of orbital and adnexal DLBCLs were found by searching the Danish Registry of Pathology between 1980 and 2009. Histological specimens were re-evaluated using a panel of monoclonal antibodies. Clinical files from all patients with confirmed DLBCL were collected. RESULTS A total of 34 patients with DLBCL of the ocular adnexal region were identified. Eighteen of the patients were men. The patients had a median age of 78 years (range 35-97 years). Ninety-seven per cent of the patients had unilateral ocular adnexal region involvement, and the orbit (76%) was the most frequently affected site. Nineteen patients (56%) presented with Stage I lymphoma. Of these, 18 were diagnosed with primary lymphoma. Four patients (12%) had Stage II, one patient (3%) had Stage III and ten patients (29%) presented with Stage IV lymphoma. The 5-year overall survival (OS) rate for the whole study group was 20%. The patients with Stage I lymphoma had a significantly better 5-year OS rate (28%) than patients in Stage II-IV (5-year OS rate, 9%). In Cox regression analysis, concordant bone marrow involvement and the International Prognostic Index (IPI) score were prognostic factors for OS. CONCLUSIONS Diffuse large B-cell lymphoma of the ocular adnexal region is mainly prevalent in elderly patients. Most patients had unilateral orbital involvement. The overall prognosis is poor. Concordant bone marrow involvement and the IPI score were independent prognostic factors for mortality.
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Affiliation(s)
- Peter K Rasmussen
- Department of Neuroscience and Pharmacology, Eye Pathology Institute, University of Copenhagen, Denmark
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40
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El Maaroufi H, El Ouazzani Chahdi K, Doghmi K, Mikdame M. [Orbital mantle cell lymphoma]. J Fr Ophtalmol 2013; 36:e55-7. [PMID: 23433524 DOI: 10.1016/j.jfo.2012.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Revised: 05/24/2012] [Accepted: 06/11/2012] [Indexed: 11/17/2022]
Abstract
Ophthalmological involvement in mantle cell lymphoma is rare. An 84-year-old man presented with bilateral proptosis. Orbital biopsy established the diagnosis of mantle cell lymphoma. The diagnosis of mantle cell lymphoma is anatomopathological and immuno-histochemical. Orbital involvement is found most often in advanced stages of the disease, but may be the presenting sign as in the case of our patient. Treatment has improved with the use of rituximab, especially in elderly patients not eligible for autologous hematopoietic stem cell transplant.
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Affiliation(s)
- H El Maaroufi
- Service d'hématologie clinique, université Mohamed V-Souissi, hôpital militaire d'instruction Mohammed V, Hay Riad, 10100 Rabat, Maroc.
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41
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Khanlari M, Bagheri B, Vojdani R, Mohammadianpanah M, Paydar S, Daneshbod Y. Conjunctival mass as an initial presentation of mantle cell lymphoma: a case report. BMC Res Notes 2012; 5:671. [PMID: 23210924 PMCID: PMC3549763 DOI: 10.1186/1756-0500-5-671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/15/2012] [Indexed: 01/16/2023] Open
Abstract
Background To describe a rare manifestation of mantle cell lymphoma (MCL) in conjunctiva, with clinical, hisologic, immunohistologic and genetic findings together with review of the Literature. Case presentation Most ocular adnexal lymphomas are extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT). A few cases of ocular adnexal mantle cell lymphomas have been reported in the literature. We present a case of mantle cell lymphoma presenting as right conjunctival mass of at least three months duration in a 64-year-old man. Histopathologic examination showed a proliferation of monomorphous small-to-medium-sized lymphoid cells with cleaved nuclei in the subconjunctiva. By immunohistochemistry, the infiltrate was positive for CD20, CD5, BCL-2, cyclin D1, and the transcription factor SOX11. Fluorescent in situ hybridization demonstrated the presence of IGH-CCND1 fusion indicating t(11;14). Conclusion A rigorous approach to initial diagnosis and staging of small cell lymphomas of the ocular adnexa is needed. The recognition of ocular MCL requires appropriate immunohistochemical staining and/or genetic confirmation to differentiate this rare form of presentation of MCL from other more frequent small cell lymphomas.
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Affiliation(s)
- Mahsa Khanlari
- Institute of Hematopathology, Dr Daneshbod Pathology Laboratory, Shiraz, Iran
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42
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Abstract
BACKGROUND The periocular skin is susceptible to numerous benign and malignant neoplasms. Periocular malignancies may present differently, behave more aggressively, and pose greater challenges for treatment and repair than malignancies at other cutaneous sites. Between 5% and 10% of cutaneous malignancies occur periorbitally, with basal cell carcinoma reported as the most common malignant periocular tumor, followed by squamous cell carcinoma, sebaceous gland carcinoma, cutaneous melanoma, Merkel cell carcinoma, and other rare tumors. OBJECTIVE To review the current literature on cutaneous malignancies of the periocular region pertaining to etiology, incidence, clinical presentation, differential diagnosis, complications, and treatment options. MATERIALS AND METHODS An extensive literature review was conducted using PubMed, searching for articles on periocular and periorbital cutaneous malignancies. CONCLUSIONS Timely diagnosis and management of periocular malignancies is essential because of their proximity to and potential to invade vital structures such as the orbit, sinuses, and brain. Surgical excision remains the standard of care for the majority of periorbital malignancies, but given the sensitive anatomic location, tissue-sparing techniques with margin control such as Mohs micrographic surgery are the preferred method for most nonmelanoma skin cancers. Depending on tumor type, other treatment modalities may include radiation, chemotherapy, cryosurgery, topical medications, and photodynamic therapy.
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Affiliation(s)
- Jordan B Slutsky
- Department of Dermatology, Saint Louis University, Saint Louis, Missouri 63104, USA.
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43
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Papathomas TG, Venizelos I, Dunphy CH, Said JW, Wang ML, Campo E, Swerdlow SH, Chan JC, Bueso-Ramos CE, Weisenburger DD, Medeiros LJ, Young KH. Mantle cell lymphoma as a component of composite lymphoma: clinicopathologic parameters and biologic implications. Hum Pathol 2012; 43:467-80. [PMID: 22221705 DOI: 10.1016/j.humpath.2011.08.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 12/22/2022]
Abstract
Composite lymphoma is a rare circumstance in which 2 or more distinct types of lymphoma occur in a single anatomical location. Although composite lymphoma has been increasingly identified with the advent of molecular genetic techniques, this topic has only rarely been a specific focus of the medical scientific literature. In this review, we focus on mantle cell lymphoma occurring as a major pathologic component of composite lymphoma and emphasize the clinicopathologic features of these tumors and associated biologic implications. To date, 26 cases of composite lymphoma including a component of mantle cell lymphoma have been previously published. Issues of clonal relatedness between the individual lymphoma components and emerging biologic implications as well as potential diagnostic pitfalls are evaluated.
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Affiliation(s)
- Thomas G Papathomas
- Department of Pathology, Hippokration General Hospital of Thessaloniki, 54642 Thessaloniki, Greece
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44
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Primary, Unilateral Ocular Adnexal Lymphoma: Disease Progression and Long-Term Survival. Ophthalmic Plast Reconstr Surg 2011; 27:405-9. [DOI: 10.1097/iop.0b013e31821cc4bb] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Ocular Adnexal Lymphoma of the Extraocular Muscles: Case Series From the University of Iowa and Review of the Literature. Ophthalmic Plast Reconstr Surg 2011; 27:471-6. [DOI: 10.1097/iop.0b013e31822e5c1b] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Perivascular mantle cell lymphoma affecting a temporal artery—a highly unusual cause of temporal headache. Cardiovasc Pathol 2011; 20:244-6. [DOI: 10.1016/j.carpath.2010.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Revised: 03/31/2010] [Accepted: 05/06/2010] [Indexed: 11/17/2022] Open
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47
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Tazi I, Nafil H, Mahmal L. Bilateral Orbital Mantle Cell Lymphoma. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2011. [DOI: 10.29333/ejgm/82725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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48
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Ozkan E, Laçin S, Soydal C, Araz M, Küçük NÖ. Ocular Involvement in Mantle Cell Lymphoma Detected by F 18 FDG PET/CT. Mol Imaging Radionucl Ther 2011; 20:36-7. [PMID: 23487006 PMCID: PMC3590938 DOI: 10.4274/mirt.20.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 11/08/2010] [Indexed: 12/01/2022] Open
Abstract
Mantle Cell Lymphoma (MCL) is an uncommon but aggressive form of non-Hodgkin’s lymphoma. The extranodal involvement is not unusual especially in bone marrow, spleen, gastrointestinal tract and Waldeyer’s ring. Ocular involvement is very exceptional and the most commonly affected site is the orbit (90%), followed by the lacrimal gland (50%) and the eyelids (50%). Today, PET/CT is widely used in non-Hodgkin’s lenfoma especially in staging and evaluation of treatment response. Authors report MCL with ocular involvement that was detected on PET/CT scan. Conflict of interest:None declared.
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Affiliation(s)
- Elgin Ozkan
- Ankara University, Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
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49
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Nagel-Esposito AD, Kawasaki B, Jew R, Fujimoto L. Mantle cell lymphoma of the maxillary sinus invading the orbit. ACTA ACUST UNITED AC 2010; 82:22-31. [PMID: 21146791 DOI: 10.1016/j.optm.2010.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2010] [Revised: 05/17/2010] [Accepted: 06/17/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Lymphomas are the most common primary orbital tumor in adults 60 years of age and older. Mantle cell lymphoma (MCL) is a distinct subtype of B-cell non-Hodgkin's lymphoma. This case report describes a presentation of MCL with ocular involvement and discusses the management options. CASE REPORT A 63-year-old black male Vietnam veteran presented with symptoms of numbness of the right tooth and gum area with right maxillary facial pain, which he described as stabbing in nature. After extensive evaluation, the patient's symptoms were found to be caused by MCL of the right maxillary sinus invading the orbit. The lymphoma was treated successfully with a combination of high-dose corticosteroids and intensive chemotherapy and radiation therapy. CONCLUSIONS Because of the aggressive nature of MCL, early detection and diagnosis are keys to the patient's survival. Given the potential for ocular involvement, eye care professionals play an important role in the early detection and management of these patients, ensuring that they are promptly referred to a specialist, e.g., an ophthalmologist or oncologist, for appropriate testing and treatment.
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Roullet MR, Martinez D, Ma L, Fowler MH, McPhail ED, Judkins A, Arber DA, Bagg A. Coexisting follicular and mantle cell lymphoma with each having an in situ component: A novel, curious, and complex consultation case of coincidental, composite, colonizing lymphoma. Am J Clin Pathol 2010; 133:584-91. [PMID: 20231612 DOI: 10.1309/ajcp5rt4mrsdgksx] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
A diagnosis of composite lymphoma is typically prompted by the observation of morphologic discordance. We present a case of a spleen revealing histologic features of follicular lymphoma, without any indication of a second lymphoma. Immunohistochemical stains supported this diagnosis and showed the follicular lymphoma to be BCL2-. However, these studies revealed 2 additional unexpected findings: cyclin D1+ mantle zone cells surrounding neoplastic and reactive follicles (indicative of in situ mantle cell lymphoma) and BCL2-bright, histologically nonneoplastic follicles (indicative of in situ follicular lymphoma). ImmunoFISH and microdissection and polymerase chain reaction analysis documented the clonal nature of the cyclin D1+ mantle zones and illustrated clonal independence from the follicular lymphoma. This case illustrates an uncommon and unusual composite follicular and mantle cell lymphoma, with the follicular lymphoma accompanied by an in situ component, whereas the only manifestation of the mantle cell lymphoma was in situ.
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