Lymphoma presenting as a parotid tumour: a population-based study of diagnosis, treatment and outcome on behalf of the Scotland and Newcastle Lymphoma Group

AIMS

Lymphoma presenting as a parotid tumour is rare. Previous published studies have been small and have not characterised fully the nature of lymphoma presenting this way. We studied the clinical features, diagnosis, prognosis and treatment in a patient group identified from the Scotland and Newcastle Lymphoma Registry, which is a prospectively collected population-based register of consecutive cases of lymphoma since 1979.

MATERIALS AND METHODS

The study includes all patients with a biopsy-proven lymphoma in the parotid gland as the first presentation of their disease.

RESULTS

Of 136 cases identified, 128 had non-Hodgkin's lymphoma (representing 1.5% of the 8499 non-Hodgkin's lymphomas in the registry) and eight had Hodgkin's disease (0.3% of the 2716 cases registered). Female to male ratio was 1.3:1, and median age was 69 years (range 19-94 years). Fifty-six per cent of patients had stage I, 16% had stage II, 11 % had stage III and 17% had stage IV disease. Diagnostic method was recorded in 81 cases; 47 of these were by parotidectomy. Overall median survival was 90 months, with a 5-year survival of 54%, but there was substantial variation according to age, grade, stage and International Prognostic Index (IPI). Diagnosis was often made by unnecessary major facial surgery, which could be avoided in many cases.

CONCLUSION

Treatment should be directed by standard practice for lymphoma according to stage and histological classification.

Massive haemolysis in a group A recipient of a group O peripheral blood stem cell allogeneic transplant

A 28-year-old man with lymphoblastic lymphoma received G-CSF mobilized stem cells from his HLA identical sister, who had been taking methotrexate for psoriasis until 1 month prior to harvest. The recipient's blood group was A Rh D positive and donor's group O Rh D positive. Engraftment and major haemolysis were evident by day 9. From day 9 to day 13 he received 17 units of blood (approximately 3 L of red cells) at a time when his calculated red cell volume was 1 L. This massive transfusion requirement was not explained by his clinical condition and led us to consider factors that may have influenced the degree of haemolysis. The stem cell graft contained 2.85 x 10(6) CD34+ cells kg(-1) and we speculate there was B cell hyperactivity following the withdrawal of methotrexate in the donor and this went unchecked by the omission of methotrexate in the GVHD prophylaxis of the recipient. We have also considered the phenomenon of bystander haemolysis, previously unreported in this situation, as haemolysis of transfused group O blood must have also occurred. The case also illustrates the importance of transfusing donor type red cells and recipient type fresh frozen plasma (FFP) and platelets into minor mismatched transplant patients. The decision to revert to donor type FFP and platelets should only be made when the direct antiglobulin test is negative and the appropriate isohaemagglutinins are no longer demonstrable.

Acquired haemophilia complicating the remission of a patient with high grade non-Hodgkin's lymphoma treated by fludarabine

We report the development of a high titre antibody to factor VIII in a patient with previous high grade B cell non-Hodgkin's lymphoma treated with fludarabine. Unlike previous reports of factor VIII inhibitors and lymphoproliferative disease this patient's lymphoma was in remission. We speculate that the occurrence of the inhibitor is another manifestation of the increasingly recognized autoimmune side-effects of fludarabine.