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Sarro R, Bisig B, Guey B, Missiaglia E, Cairoli A, Omoumi P, Letovanec I, Ferry JA, Hasserjian RP, de Leval L. Follicular Lymphoma Presenting With Symptomatic Bone Involvement: A Clinicopathologic and Molecular Analysis of 16 Cases. Mod Pathol 2024; 37:100440. [PMID: 38290600 DOI: 10.1016/j.modpat.2024.100440] [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: 11/24/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/01/2024]
Abstract
Primary bone lymphoma (PBL) is rare and mostly represented by diffuse large B-cell lymphomas (DLBCL). Follicular lymphoma (FL), albeit commonly disseminating to the bone marrow, rarely presents primarily as bone lesions. Here, we studied 16 patients (12 men:4 women, median age 60 years) who presented with bone pain and/or skeletal radiologic abnormalities revealing bone FL. Lesions were multifocal in 11 patients (spine ± appendicular skeleton), and unifocal in 5 patients (femoral, tibial, or vertebral). An infiltrate of centrocytes and centroblasts (CD20+ CD5- CD10+ BCL2+ BCL6+) with abundant reactive T cells and an increased reticulin fibrosis massively replaced the marrow spaces between preserved bone trabeculae. The pattern was diffuse ± nodular, often with paratrabecular reinforcement and/or peripheral paratrabecular extension. Ki-67 was usually <15%. Two cases had necrosis. BCL2 rearrangement was demonstrated in 14 of 14 evaluable cases (with concomitant BCL6 rearrangement in one). High-throughput sequencing revealed BCL2, KMT2D, and TNFRSF14 to be the most frequently mutated genes. After staging, 5 qualified for PBL (3 limited stage) and 11 had stage IV systemic FL. All patients received rituximab ± polychemotherapy as firstline treatment, and 7 received local therapy (6 radiotherapy and 2 surgery). Three patients experienced transformation to DLBCL. At the last follow-up (15/16, median 48 months), 11 patients achieved complete remission, including all cases with PBL and most patients with limited extraosseous disease (3-year progression-free survival 71%). One patient died of unrelated cause (3-year overall survival 91%). FL may manifest as a localized or polyostotic bone disease. A minority represent PBL, whereas most reveal systemic disease.
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Affiliation(s)
- Rossella Sarro
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland; Institute of Pathology Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland
| | - Bettina Bisig
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Baptiste Guey
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Edoardo Missiaglia
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Anne Cairoli
- Service of Haematology, Department of Oncology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Igor Letovanec
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland; Department of Pathology, Central Institute, Valais Hospital, Sion, Switzerland
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
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Primary Bone Lymphoma: A Review of the Literature with Emphasis on Histopathology and Histogenesis. Diseases 2023; 11:diseases11010042. [PMID: 36975591 PMCID: PMC10047712 DOI: 10.3390/diseases11010042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/18/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Primary bone lymphoma (PBL) is a rare neoplasm of malignant lymphoid cells presenting with one or more bone lesions without nodal or other extranodal involvement. It accounts for approximately 1% of all lymphomas and 7% of malignant primary bone tumors. Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) represents the predominant histological type and constitutes over 80% of all cases. PBL may occur at all ages with a typical diagnosis age of 45–60 years and a slight male predominance. Local bone pain, soft tissue edema, palpable mass and pathological fracture are the most common clinical features. Diagnosis of the disease, which is frequently delayed due to its non-specific clinical presentation, is based on the combination of clinical examination and imaging studies and confirmed by combined histopathological and immunohistochemical examination. PBL can develop in any part of the skeleton, although it occurs most commonly in the femur, humerus, tibia, spine and pelvis. The imaging appearance of PBL is highly variable and unspecific. In terms of the cell-of-origin, most cases of primary bone DLBCL (PB-DLBCL), NOS belong to the germinal center B-cell-like subtype and specifically originate from germinal center centrocytes. PB-DLBCL, NOS has been considered a distinct clinical entity based on its particular prognosis, histogenesis, gene expression and mutational profile and miRNA signature. PBL carries a favorable prognosis, especially when treated with combined chemoradiotherapy.
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Bhakta P, Youssef A, Bigham L, Mallick J, Bhargava P, Rawas F, Weaver D, Hunzeker ZE, Dong J, Willis M, Qiu S, Nawgiri R, Iguh CCC, Lyapichev KA. Proposal of Diagnostic Approach of Periodontal Primary Non Hodgkin Lymphoma of Bone with Flow Cytometry as an Essential Diagnostic Component. Head Neck Pathol 2022; 16:1091-1102. [PMID: 35802244 PMCID: PMC9729681 DOI: 10.1007/s12105-022-01469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/16/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Primary bone lymphoma is a rare type of lymphoid neoplasm with favorable prognosis, where Primary Non Hodgkin Lymphoma of bone (PB-NHL) is most common with the subtype. Amongst PB-NHL, diffuse large Bcell lymphoma represents the majority of cases. The mandible is a very uncommon site of involvement, presenting as a painful bone mass with high suspicion of osteomyelitis. METHODS We report the case of a 45-year-old male with no significant past medical history who was admitted to the hospital with a large right jaw mass and pain after recent tooth removal. The original tissue biopsy was not diagnostic, and cultures were found to be negative for microorganisms. Due to enlargement of the mass, a fine needle aspiration (FNA) was done. At the time of rapid onsite evaluation of the FNA, atypical lymphoid cells were seen, and material was obtained for flow cytometry (FC) evaluation. This revealed an aberrant clonal B-cell population. The consequent immunohistochemical evaluation of original material supported the diagnosis of PB-NHL. After chemotherapy patient improved. RESULTS After an extensive English language literature review, we identified and summarized the clinical presentations, diagnostic procedures, histopathologic features, treatment methods, and outcomes of forty-two cases of periodontal PB-NHL. Based on our findings, we propose a set of clinical features at initial presentation to increase the clinical suspicion of periodontal PB-NHL for practitioners. CONCLUSION Based on our institution's experience and the literature review conclusions, we propose the University of Texas Medical Branch diagnostic approach for PB-NHL and suggest that FNA and FC should be utilized as the essential diagnostic component. The fast and efficient diagnosis of PB-NHL can facilitate the correct treatment and sufficiently improve patient care.
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Affiliation(s)
- Pooja Bhakta
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Ayman Youssef
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Lindsay Bigham
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Jayati Mallick
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX USA
| | - Faisal Rawas
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Dylan Weaver
- Department of Radiology, University of Texas Medical Branch, Galveston, TX USA
| | - Zachary E. Hunzeker
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Jianli Dong
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Maurice Willis
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX USA
| | - Suimin Qiu
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | - Ranjana Nawgiri
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
| | | | - Kirill A. Lyapichev
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555 USA
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Ayesh Haj Yousef MH, Audat Z, Al-Shorafat DM, Al-Khatib S, Daoud AK. Primary Diffuse Large B Cell Lymphoma of Bone: A Single-Center Experience. J Blood Med 2022; 13:143-149. [PMID: 35330698 PMCID: PMC8939860 DOI: 10.2147/jbm.s350655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Primary diffuse large B-cell lymphoma of the bone (PB-DLBCL) is a rare type of extra-nodal lymphoma. This study aimed to examine the clinical characteristics, outcomes, treatment modalities and risk of central nervous system relapse (CNSR) among adult Jordanian patients with PB-DLBCL. Methods This retrospective study included patients aged >16 years who were diagnosed with PB-DLBCL and treated at our hospital between 2002 and 2021. Clinical characteristics, treatment modalities, outcomes and CNSR events were extracted from the hospital’s data system and analysed. Patients were categorised into unifocal (UF) and multifocal (MF) PB-DLBCL groups according to the number of bone sites involved. The involvement of only one site was defined as UF, whereas the involvement of two or more sites was defined as MF. Results In total, 12 patients were diagnosed with PB-DLBCL. Their median age was 47.5 years (range, 17–80 years). The male:female ratio was 1:1. There were eight patients in the UF PB-DLBCL group and four in the MF PB-DLBCL group. All patients received treatment with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone. In the UF PB-DLBCL group, the male:female ratio was 5:3, the median age was 41 years, and the follow-up duration was 9–135 (mean, 83.3) months. In the MF PB-DLBCL group, the male:female ratio was 1:3, the median age was 51.5 years, and the survival time was 3–11 (mean, 7) months. Three patients with vertebral UF PB-DLBCL underwent early vertebroplasty without complications. The most common site involved was the vertebral column. Most patients with UF PB-DLBCL achieved complete remission (CR), whereas no patients with MF PB-DLBCL achieved CR. Conclusion PB-DLBCL is rare in adult Jordanian patients. UF PB-DLBCL is more common than MF PB-DLBCL. Patients with UF PB-DLBCL had a good prognosis. Patients with MF PB-DLBCL had a high international prognostic index score, risk of CNSR and short survival time.
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Affiliation(s)
- Mahmoud H Ayesh Haj Yousef
- Department of Internal Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
- Correspondence: Mahmoud H Ayesh Haj Yousef, Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan, Email
| | - Ziad Audat
- Department of Special Surgery, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Duha M Al-Shorafat
- Department of Neurology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Al-Khatib
- Department of Pathology and Microbiology, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Ammar K Daoud
- Department of Internal Medicine, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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Mercier M, Orvain C, Drieu La Rochelle L, Marchand T, Nunes Gomes C, Giltat A, Paillassa J, Clavert A, Farhi J, Rousselet MC, Gyan E, Houot R, Moles-Moreau MP, Hunault-Berger M. Impact of High-Dose Methotrexate on the Outcome of Patients with Diffuse Large B-Cell Lymphoma and Skeletal Involvement. Cancers (Basel) 2021; 13:cancers13122945. [PMID: 34204600 PMCID: PMC8231126 DOI: 10.3390/cancers13122945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/04/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) with extra nodal skeletal involvement is rare. It is currently unclear whether these lymphomas should be treated in the same manner as those without skeletal involvement. We retrospectively analyzed the impact of combining high-dose methotrexate (HD-MTX) with an anthracycline-based regimen and rituximab as first-line treatment in a cohort of 93 patients with DLBCL and skeletal involvement with long follow-up. Fifty patients (54%) received upfront HD-MTX for prophylaxis of CNS recurrence (high IPI score and/or epidural involvement) or because of skeletal involvement. After adjusting for age, ECOG, high LDH levels, and type of skeletal involvement, HD-MTX was associated with an improved PFS and OS (HR: 0.2, 95% CI: 0.1-0.3, p < 0.001 and HR: 0.1, 95% CI: 0.04-0.3, p < 0.001, respectively). Patients who received HD-MTX had significantly better 5-year PFS and OS (77% vs. 39%, p <0.001 and 83 vs. 58%, p < 0.001). Radiotherapy was associated with an improved 5-year PFS (74 vs. 48%, p = 0.02), whereas 5-year OS was not significantly different (79% vs. 66%, p = 0.09). A landmark analysis showed that autologous stem cell transplantation was not associated with improved PFS or OS. The combination of high-dose methotrexate and an anthracycline-based immunochemotherapy is associated with an improved outcome in patients with DLBCL and skeletal involvement and should be confirmed in prospective trials.
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Affiliation(s)
- Mélanie Mercier
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Service d’Hématologie, CH Bretagne Atlantique, 56000 Vannes, France
- Correspondence: (M.M.); (C.O.); Tel.: +33-(0)-241-35-44-72 (C.O.); Fax: +33-(0)-241-35-53-81 (C.O.)
| | - Corentin Orvain
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Université d’Angers, Inserm, CRCINA, 49000 Angers, France
- Correspondence: (M.M.); (C.O.); Tel.: +33-(0)-241-35-44-72 (C.O.); Fax: +33-(0)-241-35-53-81 (C.O.)
| | - Laurianne Drieu La Rochelle
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Service d’Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Tony Marchand
- Service d’Hématologie Clinique, CHU de Rennes, 35000 Rennes, France; (T.M.); (R.H.)
| | - Christopher Nunes Gomes
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Aurélien Giltat
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Jérôme Paillassa
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Aline Clavert
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Jonathan Farhi
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | | | - Emmanuel Gyan
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Service d’Hématologie et Thérapie Cellulaire, Centre Hospitalier Universitaire, Université de Tours, 37000 Tours, France
| | - Roch Houot
- Service d’Hématologie Clinique, CHU de Rennes, 35000 Rennes, France; (T.M.); (R.H.)
| | - Marie-Pierre Moles-Moreau
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
| | - Mathilde Hunault-Berger
- Maladies du Sang, CHU d’Angers, 49000 Angers, France; (C.N.G.); (A.G.); (J.P.); (A.C.); (J.F.); (M.-P.M.-M.); (M.H.-B.)
- Fédération Hospitalo-Universitaire Grand-Ouest Acute Leukemia (FHU-GOAL), 49033 Angers, France; (L.D.L.R.); (E.G.)
- Université d’Angers, Inserm, CRCINA, 49000 Angers, France
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Tazi I, Benmoussa A, Boufarissi FZ, RajaaTissir, Lahlimi FZ. [Adult non-Hodgkin bone lymphomas]. Bull Cancer 2021; 108:424-434. [PMID: 33722379 DOI: 10.1016/j.bulcan.2020.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/30/2020] [Accepted: 12/12/2020] [Indexed: 10/21/2022]
Abstract
Two forms of bone lymphomas can be distinguished: the primary bone lymphoma (PBL) and the secondary bone lymphoma (SBL). PBL is a rare disease with a good prognosis. Clinical manifestations and imaging findings are usually non-specific. Patient can present with pain, swelling of affected bone or pathologic fracture. Positron emission tomography-CT scan is a sensitive imaging modality and very useful for staging, restaging, surveillance of recurrence, and monitoring of treatment response of lymphoma. The diagnosis of PBL is often difficult and made after biopsy examination. Most patients have diffuse large B-cell lymphoma. Patients have been treated with radiotherapy, chemotherapy or combination of both. Localized disease, low IPI (International Prognostic Index) and complete remission after initial treatment were associated with a better outcome. Management of late sequelae deserves particular attention. SBL is more common than PBL; this is a disseminated lymphoma with concomitant involvement of the skeleton. We review the clinical, imaging and pathologic features of bone lymphomas; and discuss therapeutic modalities as well as prognosis of these lymphomas in the era of immunochemotherapy.
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Affiliation(s)
- Illias Tazi
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc.
| | - Amine Benmoussa
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
| | - Fatima Zahra Boufarissi
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
| | - RajaaTissir
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
| | - Fatima Zahara Lahlimi
- CHU Mohamed VI, université Cadi Ayyad, faculté de médecine, service d'hématologie clinique, Marrakech, Maroc
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Sica A, Santagata M, Sagnelli C, Rambaldi P, Franco R, Creta M, Vitiello P, Caccavale S, Tammaro V, Sagnelli E, Ronchi A. Primary Extra-Nodal DLBCL of Glands: Our Experiences outside Guidelines of Treatment. Healthcare (Basel) 2021; 9:healthcare9030286. [PMID: 33807793 PMCID: PMC8002204 DOI: 10.3390/healthcare9030286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/02/2021] [Accepted: 03/02/2021] [Indexed: 02/07/2023] Open
Abstract
Lymphomas usually involve lymph nodes and other lymphoid tissues, but sometimes occur in non-lymphoid organs, called extra-nodal sites. Primary diffuse extra-lymph node large B-cell lymphoma (DLBCL) of the thyroid and parotid gland have been observed rarely. According to the most accredited guidelines, primary extra-nodal DLBCL of the parotid and thyroid glands should be treated with three cycles of R-CHOP followed by radiotherapy of the involved site (ISRT). Surgery alone is not enough to treat DLBCL. We describe two unusual cases of primary extra-nodal DLBCL in elderly patients treated exclusively with surgical resection, given the inability to apply chemotherapy. Both patients achieved clinical recovery, which was maintained after a follow-up of more than 18 months, despite not having performed the indicated chemotherapy protocol. The two cases presented here, and a few others reported in the literature, should be considered exceptions to the rule, and do not allow the conclusion that surgery alone might be sufficient for complete remission.
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Affiliation(s)
- Antonello Sica
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.S.); (P.R.)
| | - Mario Santagata
- Multidisciplinary Department of Medical Surgery and Dental Specialties, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;
| | - Caterina Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
- Correspondence: ; Tel.: +39-3332253315 or +39-08119573375
| | - Piero Rambaldi
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (A.S.); (P.R.)
| | - Renato Franco
- Division of Pathology, Department of Mental Health and Preventive, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.F.); (A.R.)
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples “Federico II”, 80131 Naples, Italy;
| | - Paola Vitiello
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.V.); (S.C.)
| | - Stefano Caccavale
- Dermatology Unit, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (P.V.); (S.C.)
| | - Vincenzo Tammaro
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Evangelista Sagnelli
- Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Andrea Ronchi
- Division of Pathology, Department of Mental Health and Preventive, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (R.F.); (A.R.)
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8
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Nguyen CB, Li M, Verstovsek G, Sen U, Swierenga C, Huang Q, Rivero G, Yellapragada SV. Primary bone lymphoma of the ilium successfully treated without radiation. Clin Case Rep 2020; 8:3130-3133. [PMID: 33363894 PMCID: PMC7752449 DOI: 10.1002/ccr3.3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/09/2020] [Accepted: 07/28/2020] [Indexed: 11/25/2022] Open
Abstract
The addition of radiation therapy to chemotherapy and impact on outcomes in primary bone lymphoma is not clear. Nonetheless, tumor location must be considered as radiation to marrow-rich bone areas can lead to myelosuppression and myelotoxicity.
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Affiliation(s)
| | - Monica Li
- Baylor College of MedicineHoustonTXUSA
| | - Gordana Verstovsek
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
- Department of Pathology & ImmunologyBaylor College of MedicineHoustonTXUSA
| | - Urmi Sen
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
- Department of RadiologyBaylor College of MedicineHoustonTXUSA
| | | | - Quillan Huang
- Department of MedicineBaylor College of MedicineHoustonTXUSA
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
- Section of Hematology & OncologyBaylor College of MedicineHoustonTXUSA
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
| | - Gustavo Rivero
- Department of MedicineBaylor College of MedicineHoustonTXUSA
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
- Section of Hematology & OncologyBaylor College of MedicineHoustonTXUSA
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
| | - Sarvari V. Yellapragada
- Department of MedicineBaylor College of MedicineHoustonTXUSA
- Michael E. DeBakey VA Medical CenterHoustonTXUSA
- Section of Hematology & OncologyBaylor College of MedicineHoustonTXUSA
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
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9
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Müller A, Dreyling M, Roeder F, Baur-Melnyk A, Knösel T, Klein A, Birkenmaier C, Jansson V, Dürr HR. Primary bone lymphoma: Clinical presentation and therapeutic considerations. J Bone Oncol 2020; 25:100326. [PMID: 33083218 PMCID: PMC7554647 DOI: 10.1016/j.jbo.2020.100326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
Primary lymphoma of bone is a rare entity with unspecific symptoms. Typical radiology is a large soft-tissue tumor around non-destructed bone. Treatment is based on systemic chemotherapy. Chemotherapy seems to produce a better outcome than radiotherapy alone. Positiv factors: age<60 y, solitary lesion, low LDH, favourable ECOG and IPI scores.
Background Primary lymphoma of bone (PBL) is a rare entity. Due to unspecific clinical signs and equivocal radiographs diagnosis may be delayed. This retrospective report of 109 PBL cases demonstrates typical aspects of the lesion. Treatment and prognostic factors are evaluated. Methods Retrospectively patient records were reviewed. All patients were followed for evidence of local or distant recurrence. Overall survival (OS) was used as clinical outcome. Results The median age of the 109 patients was 62.8 years. The most common symptoms were pain (76%), swelling (29%), neurologic symptoms and pathological fracture (16% each). Mean duration of symptoms was 8 months (0–197 months). 19% of patients had indolent NHL subtypes, 72% aggressive NHL subtypes and 7% cases Hodgkin disease. Cyclophosphamid, doxorubicin, vincristine and prednisone (CHOP) or CHOP plus rituximab (RCHOP) were given in 88 (81%) of patients. Radiotherapy was delivered in 67 (61%) of cases. 51 (47%) patients received both. Surgical interventions were restricted to cases with complications as fractures. The 5-year OS was 66%. The 5-year OS was 66%. In the subgroup of 78 patients with aggressive NHL subtype there was a highly significant benefit for chemotherapy or chemotherapy and radiation in comparison to no treatment or radiation alone. Raised LDH, age, IPI and ECOG performance were prognostic factors. In multivariate analysis, age and raised LDH levels only kept significance. Conclusions In our series of primary bone lymphoma, chemotherapy resulted in a better outcome than Radiotherapy alone. Long-term survival is based on the stage of the disease, favoring younger (<60 years) patients with solitary bone lesions, low level of LDH and favourable ECOG performance status and IPI scores.
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Affiliation(s)
- Annika Müller
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Martin Dreyling
- Department of Medicine III, University Hospital, LMU Munich, Germany
| | - Falk Roeder
- Department of Radiation Oncology, Paracelsus Medizinische Privatuniversität, Landeskrankenhaus, Salzburg, Austria.,CCU Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Thomas Knösel
- Institute of Institute of Pathology, University Hospital, LMU Munich, Germany
| | - Alexander Klein
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Christof Birkenmaier
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Volkmar Jansson
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
| | - Hans Roland Dürr
- Musculoskeletal Oncology, Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Germany
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Sharma A, Ahmed R, Agrawal N, Kapoor J, Sharma A, Khushoo V, Agrawal P, Bhurani D, Mirgh SP. Primary Bone Lymphoma: A 13 Year Retrospective Institutional Analysis in the Chemo-Immunotherapy Era. Indian J Hematol Blood Transfus 2020; 37:240-248. [PMID: 33867730 DOI: 10.1007/s12288-020-01327-3] [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: 05/18/2020] [Accepted: 08/03/2020] [Indexed: 01/15/2023] Open
Abstract
Primary Lymphoma of bone (PBL) is an uncommon extranodal tumor accounting for 1% of all malignant lymphomas. The incidence of PBL is so rare that many of its aspects remain unknown. We retrospectively analysed our data in order to know clinical characteristics and treatment outcome in Indian population in chemo-immunotherapy era. We identified 49 patients [2007-2019] (median age 52 years) of which, 35 (71.4%) were males. Nearly one-third patients (n = 18; 36.8%) were elderly (Age > 60). The most common histological subtype was DLBCL. Local pain /swelling (n = 23; 47%) and B symptoms (n = 20; 44.4%) was the most common presentation. Spine was the most frequently involved site (n = 25; 51%) followed by pelvis (n = 17; 34.7%). One third patients had poor ECOG-PS ≥ 2, (n = 16; 32.6). More than 50% of the population presented with IPI score ≥ 2 (n = 25; 55.5%). Majority of the patients presented with Ann-Arbor stage IV disease (n = 31; 63.2%). (n = 32; 71.1%) cases received chemotherapy alone and (n = 13; 28.9%) patients were treated in combination with local radiotherapy. R-CHOP was the most common treatment regimen given to patients (n = 43; 95.5%). Overall, three-fourth patients (n = 36; 80%) achieved a complete response. At a median follow-up of 45 ± 2 (range 3-144) months, 4-year OS (Overall Survival) and PFS (Progression free survival) was 83.1% and 74.5%, respectively, using Kaplan-Meier survival curves. Prognostic factors for OS on multivariate analysis were ECOG-PS 0-1 [p = 0.05], age < 60 [p = 0.03] and achievement of CR [p = 0.001]. PBL in India is usually of DLBCL subtype, with spine as the most common site. It has an excellent prognosis in the R-CHOP era. Chemo-immunotherapy with 6 R-CHOP followed by addition of Radiotherapy if partial response appears to provide good outcomes. However, the exact role of radiation still needs to be confirmed.
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Affiliation(s)
- Archana Sharma
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Rayaz Ahmed
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Narendra Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Jyotsna Kapoor
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Anurag Sharma
- Department of Research, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Vishvdeep Khushoo
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Pragya Agrawal
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Dinesh Bhurani
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
| | - Sumeet P Mirgh
- Department of Hemato-Oncology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5, Rohini, New Delhi 110085 India
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The incidence and mortality trends of bone lymphoma in the United States: An analysis of the Surveillance, Epidemiology, and End Results database. J Bone Oncol 2020; 24:100306. [PMID: 32760645 PMCID: PMC7390813 DOI: 10.1016/j.jbo.2020.100306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 12/14/2022] Open
Abstract
The incidence rates of bone lymphoma had sharply increased for the early decades. The incidence trend of bone lymphoma has stabilized in recent years. The mortality had sharply increased from 1985 to 2016 without a turn point. The incidence and mortality by various characteristics had similar patterns.
Background In recent years, studies on bone lymphoma and its histologic types have reached a mature stage. However, reports on the incidence and incidence-based mortality trends of bone lymphoma are scanty. Methods Patients with bone lymphoma in the U.S. were selected from Surveillance, Epidemiology, and End Results (SEER) database (1975–2016), and categorized based on age, sex, race, tumor location, SEER Historic Stage A and histologic type. Data on the incidence (1975–2016) and incidence-based mortality (1985–2016) were directly obtained from the SEER program. Annual percentage change (APC) and 95% confidence intervals (CIs) were calculated using the joinpoint regression analysis program. Results Overall, 13,058 bone lymphoma cases diagnosed in resident patients of the U.S. were included in incidence analysis between 1975 and 2016 as follows: 6080 cases in 1975–1999, 3796 cases in 2000–2009, and 3182 cases in 2010–2016. Of these cases, 6888 died of bone lymphoma between 1985 and 2016. The overall incidence rates dramatically increased from 0.89 per 100,000 person-years in 1975 to 1.36 per 100,000 person-years in 2016. Incidence trend sharply increased from 1975 to 2009, and then stabilized between 2009 and 2016. Overall incidence-based mortality trends sharply increased from 1985 to 2016 without a joinpoint. Following the demographic and tumor characteristics, the trends of incidence and incidence-based mortality exhibited similar patterns. Conclusion Considering various characteristics (age, sex, race, tumor location, SEER Historic Stage A, and histologic type), we established that the incidence trend of bone lymphoma has sharply been increasing over the decades, however, in the recent years, the trend has stabilized. Besides, between 1985 and 2016, the incidence-based mortality had been sharply increasing without a turning point. These findings could give insights for clinicians to elaborately assess the epidemiology and risk factors of bone lymphoma.
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Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE To determine the prognostic indicators in patients with bone lymphoma of the spine. SUMMARY OF BACKGROUND DATA To date, prognosis for patients with spinal bone lymphoma is based on results from small series. Large population-based observational studies are lacking. METHODS The Surveillance, Epidemiology, and End Results Registry was used to identify all patients with bone lymphoma of the spine from 1995 through 2014. Overall survival (OS) and disease-specific survival (DSS) estimates were obtained using the Kaplan-Meier method and compared across groups using log-rank test. Association of survival with variables was assessed using Cox proportional-hazards regression analysis. Nomograms were established and validated by R software. RESULTS A total of 1338 patients were identified with bone lymphoma of the spine. The trend of incidence was relative steady from 1995 to 2014. The mean and median age of diagnosis was 62.9 and 66.0 years, respectively. Men constituted a slightly greater proportion (55.5%) of the cohort. The most common subtype of lymphoma was diffuse large B-cell lymphoma (59.8%). The 5- and 10-year OS rates for those patients were 60.6% and 44.7%, respectively. Multivariate analysis revealed that age, sex, marital status, and race were sociodemographic predictors of OS and DSS. Extracompartmental invasion of tumor and stage IV of lymphoma were significantly correlated with poor OS and DSS. Patients without surgery or radiotherapy was linked to a poor OS. Both OS and DSS of patients with spinal bone lymphoma improved in 2005 to 2014 when compared to 1995 to 2004. In addition, pretreatment nomograms to predict 5- and 10-year survival were established. CONCLUSION The findings of this study provide population-based estimates of the prognosis for patients with spinal bone lymphoma. Both sociodemographic and clinical factors may have an impact on the outcomes. LEVEL OF EVIDENCE 4.
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13
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Epiphyseal Primary Diffuse Large B-Cell Lymphoma of Bone. Case Rep Pathol 2019; 2018:4160925. [PMID: 30598851 PMCID: PMC6287168 DOI: 10.1155/2018/4160925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/15/2018] [Indexed: 11/17/2022] Open
Abstract
Primary lymphoma of bone (PLB) confined to the epiphysis has only been described in four other patients. Due to the rarity of this entity, diagnosis has often been delayed, leading to mismanagement with adverse clinical consequences. We report a fifth case of primary epiphyseal lymphoma of bone located in the left distal medial femoral epiphysis of a 13-year-old boy. Radiographic and histologic features of PLB are discussed, along with a review of the literature and pitfalls of misdiagnosis. The patient initially presented with six months of progressive left knee pain with an associated loss of passive range of motion. Imaging revealed a mixed radiolucent lesion within the left distal medial femoral epiphysis with cortical breakthrough. A core biopsy was performed revealing a blue round cell tumor. Thanks to modern immunohistochemistry techniques, a diagnosis of primary lymphoma of bone was quickly made. The patient thus avoided further surgical intervention and received the appropriate treatment of chemotherapy, with subsequent rapid resolution of the lesion. This case highlights the necessity of including primary lymphoma of bone in all epiphyseal lesion differential diagnoses, especially in the pediatric patient population when aggressive radiographic features are present.
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Extranodal Diffuse Large B Cell Lymphoma: Molecular Features, Prognosis, and Risk of Central Nervous System Recurrence. Curr Treat Options Oncol 2018; 19:38. [PMID: 29931605 DOI: 10.1007/s11864-018-0555-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OPINION STATEMENT Diffuse large B cell lymphoma (DLBCL) arises from extranodal organs in about 30% of cases. Its prognosis and risk of recurrence in the central nervous system (CNS) vary according to the primary site of origin. Recent studies begin to clarify these differences using molecular classification. Testicular, breast, and uterine DLBCL (as well as possibly primary cutaneous DLBCL, leg-type) share a high prevalence of the non-germinal center B cell (non-GCB) phenotype and the MYD88/CD79B-mutated (MCD) genotype. These biologic features, which resemble primary CNS lymphoma, may underlie their stage-independent propensity for CNS involvement. Management of these lymphomas should involve CNS prophylaxis, preferably using systemic high-dose methotrexate to prevent intraparenchymal recurrence. Involvement of the kidneys, adrenal glands, ovary, bone marrow, lung, or pleura usually indicates disseminated disease, conferring worse prognosis. Involvement of these sites is often associated with high CNS-International Prognostic Index (IPI), concurrent MYC and BCL2 or BCL6 rearrangements, or intravascular lymphoma-risk factors warranting CNS prophylaxis. In contrast, craniofacial, thyroid, localized bone, or gastric lymphomas have a variable prevalence of the non-GCB phenotype and lack MYD88 mutations. Their outcomes with standard immunochemotherapy are excellent, and the risk of CNS recurrence is low. We recommend individualized consideration of CNS prophylaxis based on the CNS-IPI score and anatomical proximity in cases of epidural, orbital, or skull involvement. Rituximab-containing immunochemotherapy is a standard approach for all extranodal DLBCLs. Surgery is no longer required for any primary site, but routine consolidative radiation therapy is recommended for testicular lymphoma. Radiation therapy also appears to be associated with better progression-free survival in primary bone DLBCL. Future studies should better distinguish primary from secondary sites of extranodal involvement, and investigate the association of newly identified genotypes with the risk of CNS or systemic recurrence.
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15
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Hu JY, Yu D, Wu YH. Primary non-Hodgkin lymphoma of the right femur and subsequent metastasis to the left femur: A case report and literature review. Oncol Lett 2018. [PMID: 29541210 DOI: 10.3892/ol.2018.7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Non-Hodgkin lymphoma of the bone is rare and typically causes an extensive bone lesion. The present study describes a case of diffuse large B-cell primary non-Hodgkin lymphoma of the bone, which occurred in the right femur, and was initially treated with surgery and chemotherapy. Following a 7-year period of complete remission, a new, similar lesion was identified in the left femur. With both lesions, there was no accompanying destruction of any other bones or organ involvement. Metastasis of PLB to the contralateral side is extremely rare and, to the best of our knowledge, this is the first report of this particular presentation in China or worldwide. We hypothesized that the present situation arose due to mechanisms involving the tumor microenvironment, circulating tumor cells, lymphocyte homing and self-seeding. The present report describes the case in detail, and discusses the possible underlying mechanisms and their potential contribution to the treatment of non-Hodgkin lymphoma, as well as the prevention of metastasis and recurrence, which may be of considerable clinical significance.
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Affiliation(s)
- Jing-Yu Hu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Dan Yu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China.,Department of Hematology, Wuhan First Hospital, Wuhan, Hubei 430030, P.R. China
| | - Yao-Hui Wu
- Department of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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17
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Primary Bone Lymphoma Exhibits a Favorable Prognosis and Distinct Gene Expression Signatures Resembling Diffuse Large B-Cell Lymphoma Derived From Centrocytes in the Germinal Center. Am J Surg Pathol 2017; 41:1309-1321. [DOI: 10.1097/pas.0000000000000923] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Xu Y, Li J, Ouyang J, Li J, Xu J, Zhang Q, Yang Y, Zhou M, Wang J, Zhang C, Xu Y, Li P, Zhou R, Chen B. Prognostic relevance of protein expression, clinical factors, and MYD88 mutation in primary bone lymphoma. Oncotarget 2017; 8:65609-65619. [PMID: 29029457 PMCID: PMC5630357 DOI: 10.18632/oncotarget.19936] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 07/25/2017] [Indexed: 12/27/2022] Open
Abstract
Primary bone lymphomas (PBLs) are composed of malignant lymphoid cells presenting in osseous sites, without supra-regional lymph node or extranodal involvement. We systematically characterized the immunophenotype and the myeloid differentiation factor 88 (MYD88)-L265P gene mutation status in PBL. Clinical data from 19 patients with PBL treated at Nanjing Drum Tower Hospital between 2009 and 2015 were analyzed retrospectively. Protein expression patterns were identified immunohistochemically, and MYD88 mutation was assessed using polymerase chain reaction and direct DNA sequencing. Fifteen patients presented with diffuse large B-cell lymphoma. Clinical factors favoring a good prognosis were an age < 60 years and rituximab treatment. B-cell lymphoma 2 expression was detected in 5/15 diffuse large B-cell lymphoma patients, and was associated with a poor prognosis in a univariate model. Janus kinase/signal transducer and activator of transcription 3 (JAK/STAT3) signaling factors were upregulated in PBLs. All eighteen evaluable PBL samples harbored wild-type MYD88. These data thus suggest that age and rituximab treatment are independent prognostic factors determining overall survival, and that activation of JAK/STAT3 signaling may promote the pathogenesis of PBL. Moreover, the absence of MYD88-L265P mutation in PBL indicate there are distinct pathogenetic backgrounds among extranodal lymphomas.
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Affiliation(s)
- Yong Xu
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jian Li
- Department of Hematology Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Ouyang
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Juan Li
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jingyan Xu
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Qiguo Zhang
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yonggong Yang
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Min Zhou
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Wang
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Cuiling Zhang
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yueyi Xu
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ping Li
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Rongfu Zhou
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Bing Chen
- Department of Hematology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Linfoma primario óseo multifocal: reporte de caso y revisión de la literatura. GACETA MEXICANA DE ONCOLOGÍA 2016. [DOI: 10.1016/j.gamo.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zhang X, Zhu J, Song Y, Ping L, Zheng W. Clinical characterization and outcome of primary bone lymphoma: a retrospective study of 61 Chinese patients. Sci Rep 2016; 6:28834. [PMID: 27357354 PMCID: PMC4928085 DOI: 10.1038/srep28834] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/31/2016] [Indexed: 11/11/2022] Open
Abstract
Primary bone lymphoma(PBL) is a rare disease. To assess the clinical characteristics, outcome, and prognostic factors of this entity in Chinese population, we retrospectively analyzed 61 PBL patients initially treated in our institution between 1997 and 2014. The median age was 45 years. The most common histological subtype was diffuse large B-cell lymphoma (DLBCL) (55.7%), followed by T-cell lymphoma (18.0%). All patients underwent systemic chemotherapy as initial treatment while 24 patients (39.3%) were additionally treated with radiotherapy. The 5-year overall survival (OS) and the 5-year progression-free survival (PFS) rates of 57 cases with completed follow-up were 52.3% and 40.1%, respectively. In further analysis of the primary bone DLBCL (PB-DLBCL) subgroup, the 5-year OS and PFS rates were 53.0% and 47.0%, and a multivariable analysis revealed that baseline Eastern Cooperative Oncology Group (ECOG) score and response to initial treatment (complete remission versus no complete remission) were independent prognostic factors for both OS and PFS. The proportion of T-cell lymphoma is higher in China than in western populations. High baseline ECOG scores (≥2) and unachieved CR in initial therapy were factors for poor PB-DLBCL prognosis. The role of radiotherapy and rituximab in PLB therapy remains to be confirmed in further investigation.
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Affiliation(s)
- XuanYe Zhang
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China.,Department of Medical Oncology, Sun Yat-Sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
| | - Jun Zhu
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - YuQin Song
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - LingYan Ping
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
| | - Wen Zheng
- Department of Lymphoma, Peking University Cancer Hospital &Institute, 52 Fucheng Road, Beijing 100142, China
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Pilorge S, Harel S, Ribrag V, Larousserie F, Willems L, Franchi P, Legoff M, Biau D, Anract P, Roux C, Blanc-Autran E, Delarue R, Gisselbrecht C, Ketterer N, Recher C, Bonnet C, Peyrade F, Haioun C, Tilly H, Salles G, Brice P, Bouscary D, Deau B, Tamburini J. Primary bone diffuse large B-cell lymphoma: a retrospective evaluation on 76 cases from French institutional and LYSA studies. Leuk Lymphoma 2016; 57:2820-2826. [PMID: 27118302 DOI: 10.1080/10428194.2016.1177180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Primary bone diffuse large B-cell lymphoma (PB-DLBCL) is a rare DLBCL location variant. We treated 76 PB-DLBCL patients by immuno-chemotherapy, resulting in an 84% sustained complete remission rate and a 78.9% survival over a 4.7-year median follow-up period. Ann Arbor stage IV and high age-adjusted international prognostic index were predictive of adverse outcome in univariate analysis. In multivariate analysis using a Cox model, only aa-IPI predicted long-term survival. While based on a limited number of cases, we suggested that radiotherapy may be useful as a consolidation modality in PB-DLBCL. We also suggested that positron emission tomography/CT scan should be interpreted with caution due to a persistent [18F]fluorodeoxyglucose [18FDG] uptake of bone lesions even after remission in some in PB-DLBCL patients. Our study based on a homogeneous cohort of PB-DLBCL patients confirmed the favorable outcome of this DLBCL variant and support the implementation of prospective clinical trials in this disease.
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Affiliation(s)
- Sylvain Pilorge
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Stephanie Harel
- c Lymphoid Malignancies Unit , Saint Louis Hospital , Paris , France
| | | | - Frédérique Larousserie
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,e Pathology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France
| | - Lise Willems
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Patricia Franchi
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Marielle Legoff
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - David Biau
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,f Orthopedic Surgery Department , Cochin Hospital, AP-HP , Paris, France
| | - Philippe Anract
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,f Orthopedic Surgery Department , Cochin Hospital, AP-HP , Paris, France
| | - Christian Roux
- b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France.,g Rhumatology Department , Cochin Hospital, AP-HP , Paris, France
| | - Estelle Blanc-Autran
- h Nuclear Medicine Department , Centre Medico-Chirurgical Marie-Lannelongue , Le Plessis-Robinson , France
| | | | | | | | - Christian Recher
- l Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole , Toulouse , France
| | - Christophe Bonnet
- m Département de Médecine, Service d'Hématologie Clinique , CHU Liège, Campus Universitaire du Sart-Tilman , Belgique
| | - Frederic Peyrade
- n Department of Oncology , Antoine-Lacassagne Center , Nice , France
| | - Corinne Haioun
- o Department of Hematology , Henri Mondor University Hospital , Créteil , France
| | - Hervé Tilly
- p Centre Henri-Becquerel , Université de Rouen , Rouen , France
| | - Gilles Salles
- q Centre Hospitalier Lyon Sud , Service d'Hématologie, Hospices Civils de Lyon , Lyon , France
| | - Pauline Brice
- c Lymphoid Malignancies Unit , Saint Louis Hospital , Paris , France
| | - Didier Bouscary
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Bénédicte Deau
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
| | - Jerome Tamburini
- a Hematology Department , Cochin Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP) , Paris, France.,b Faculté de Médecine Sorbonne Paris Cité , Université Paris Descartes , Paris, France
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Ishiguro K, Hayashi T, Aoki Y, Murakami R, Ikeda H, Ishida T. Other Iatrogenic Immunodeficiency-associated Lymphoproliferative Disorder Presenting as Primary Bone Lymphoma in a Patient with Rheumatoid Arthritis. Intern Med 2016; 55:2259-64. [PMID: 27523005 DOI: 10.2169/internalmedicine.55.6684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Primary bone lymphoma (PBL) is a rare disorder. We herein present a case of other iatrogenic immunodeficiency-associated lymphoproliferative disorder (OIIA-LPD) presenting as PBL. A 63-year-old woman was diagnosed with rheumatoid arthritis and had been treated with methotrexate for seven years. Two months before admission, she suffered from pain in the limbs. Magnetic resonance imaging revealed multiple irregular lesions in the bones of the limbs, which showed an uptake of (18)F-FDG on positron emission tomography. A biopsy of the right radius revealed diffuse large B-cell lymphoma, leading to the diagnosis of OIIA-LPD. She received rituximab-containing regimens resulting in a complete response.
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Affiliation(s)
- Kazuya Ishiguro
- Department of Gastroenterology, Rheumatology, and Clinical Immunology, Sapporo Medical University School of Medicine, Japan
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Clinical characteristics and prognostic factors of bone lymphomas: focus on the clinical significance of multifocal bone involvement by primary bone large B-cell lymphomas. BMC Cancer 2014; 14:900. [PMID: 25465716 PMCID: PMC4265495 DOI: 10.1186/1471-2407-14-900] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 11/27/2014] [Indexed: 12/25/2022] Open
Abstract
Background Malignant bone lymphoma can be classified as primary (PBL) or secondary (SBL) bone lymphoma. However, the clinico-pathological characteristics and prognostic factors of PBL versus SBL have not yet been well defined. Whether lymphoma with multifocal bone involvement should be considered as stage IV PBL or SBL still remain controversial throughout the literature. Methods In this study, we retrospectively reviewed 127 patients with bone lymphoma diagnosed from1998 to 2013 at the Moffitt Cancer Center. Patients were classified as PBL (81 cases) and SBL (46 cases) using the 2013 WHO Classification of Bone/Soft Tissue Tumors and PBL patients were further subdivided into: 1) PBL with unifocal bone disease (uPBL, 46 cases), 2) PBL with multifocal bone involvement (mPBL, 35 cases). Patient characteristics, survival, and prognostic factors were analyzed. Results Diffuse large B-cell lymphoma (DLBCL) was the most common histological subtype in all three groups (37/46 of uPBL, 23/35 of mPBL, 23/46 of SBL). B symptoms, lymph node involvement, and bone marrow involvement were found to be more common in mPB-DLBCL and SB-DLBCL groups than in the uPB-DLBCL group. Femur was found to be the most common affected site in uPB-DLBCL patients, while spine was most commonly involved in the other two groups. Survival analysis indicated that uPBL-DLBCL patients had a significantly better progression-free survival (PFS) and overall survival (OS) than those in the other two groups (P < 0.05). We also found by univariate analysis that multifocality, and stage IV were significantly poor prognostic factors for both PFS and OS in PBL patients. Using multivariate analysis, multifocality remained an independent prognostic factor for both PFS and OS (P = 0.0117, RR: 3.789, 95% CI: 1.275-11.256). Conclusion Overall, our results suggest that mPBL is more similar to SBL in characteristics and survival rather than uPBL, and thus should be better classified and treated as SBL. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-900) contains supplementary material, which is available to authorized users.
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