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Kazan E, Maertens J, Herbrecht R, Weisser M, Gachot B, Vekhoff A, Caillot D, Raffoux E, Fagot T, Reman O, Isnard F, Thiebaut A, Bretagne S, Cordonnier C. A retrospective series of gut aspergillosis in haematology patients. Clin Microbiol Infect 2011; 17:588-94. [PMID: 20636423 DOI: 10.1111/j.1469-0691.2010.03310.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Gut invasive aspergillosis is an extremely rare infection in immunocompromised patients. The goal of this retrospective multicentre study is to report on cases of gut aspergillosis in haematology patients, including clinical presentation, risk factors, and outcome. Twenty-one patients from nine centres were identified. Eight had isolated gut aspergillosis, with no evidence of other infected sites, and 13 had disseminated aspergillosis. Thirteen patients had acute leukaemia. Nine were allogeneic stem cell transplant recipients. Clinical symptoms and imaging were poorly specific. The galactomannan antigenaemia test result was positive in 16/25 (64%) patients, including in four of the eight cases of isolated gut aspergillosis. Five of 21 patients had a dietary regimen rich in spices, suggesting that, in these cases, food could have been the source of gut colonization, and then of a primary gut Aspergillus lesion. The diagnosis was made post-mortem in six patients. The mortality rate in the remaining patients at 12 weeks was 7/15 (47%). Gut aspergillosis is probably misdiagnosed and underestimated in haematology patients, owing to the poor specificity of symptoms and imaging. Patients with a persistently positive galactomannan antigenaemia finding that is unexplained by respiratory lesions should be suspected of having gut aspergillosis in the presence of abdominal symptoms, and be quickly investigated. In the absence of severe abdominal complications leading to surgery and resection of the lesions, the optimal treatment is not yet defined.
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Affiliation(s)
- E Kazan
- Haematology Department, Henri Mondor Teaching Hospital, Assistance Publique-Hôpitaux de Paris and Paris 12 University, Créteil, France.
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Ukkola-Pons E, Weber-Donat G, Potet J, Fagot T, Kossowski M, Minvielle F, Baccialone J, Teriitehau C. [Rhinocerebral infections in immunosuppressed patients with hematological disorders]. ACTA ACUST UNITED AC 2010; 91:713-6. [PMID: 20808273 DOI: 10.1016/s0221-0363(10)70102-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Invasive rhinosinusitis, occurring almost exclusively in immunosuppressed patients, is defined by the presence of local inflammation with vascular and osseous necrosis with extensive soft tissue extension. Imaging and bacteriological and even histological (mycelial filaments) criteria have been established. Because it can evolve to death in patients with hematological disorders, accurate diagnosis is important but difficult to achieve due to the non-specific nature of signs and symptoms. Imaging plays an important role with CT of the paranasal sinuses and MR imaging of the brain for early diagnosis and treatment in order to improve prognosis. We will present the imaging features of three cases of rhinocerebral infections, with two cases of fungal infection and one case of invasive bacterial sinus infection.
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Affiliation(s)
- E Ukkola-Pons
- Service d'Imagerie médicale, Hôpital d'Instruction des Armées Percy, avenue Henri Barbusse, Clamart cedex.
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Malfuson JV, Margery J, Bonnichon A, Fagot T, Souleau B, Samson T, de Revel T. [Acute respiratory distress revealing acute myeloblastic leukaemia: case report]. Rev Pneumol Clin 2010; 66:276-280. [PMID: 20933171 DOI: 10.1016/j.pneumo.2010.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 06/24/2010] [Indexed: 05/30/2023]
Abstract
We report on the case of a patient diagnosed with acute leukaemic transformation of chronic myelomonocytic leukaemia. Its development was characterised by blastic pulmonary localisation and response to corticosteroids. We discuss the etiologies of respiratory distress in acute myeloblastic leukaemia and the corticosteroid sensitivity of this myeloid disease.
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Affiliation(s)
- J-V Malfuson
- Service d'hématologie clinique, hôpital d'instruction des Armées Percy, 92140 Clamart, France.
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Malfuson JV, Fagot T, Konopacki J, Souleau B, Cremades S, de Revel T. Which role for rituximab in hairy cell leukemia? Reflections on six cases. Acta Haematol 2009; 123:110-6. [PMID: 20051682 DOI: 10.1159/000270903] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 10/15/2009] [Indexed: 11/19/2022]
Abstract
Hairy cell leukemia (HCL) is a rare, chronic, B-cell, lymphoproliferative disorder. Treatment has been revolutionized by the advent of interferon (IFN)-alpha and purine analogs (PA). First-line therapy with PA yields complete response rates of 75-100%, with many long-lasting remissions. In the event of profound neutropenia and/or infectious complications, a short sequence of IFN-alpha may precede PA treatment. Because of the excellent results achieved with PA therapy, the potential role of rituximab (an anti-CD20 monoclonal antibody that is highly effective against most B-cell lymphomas) in HCL has yet to be elucidated. Six HCL cases treated with rituximab are reported herein with a view to elucidating the potential role of the drug in HCL. The indications essentially consist of relapsing or refractory disease, avoiding the cumulative toxicity of PA, consolidation therapy in order to eradicate minimal residual disease, and first-line therapy for patients with contraindications to PA and IFN-alpha.
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Affiliation(s)
- J V Malfuson
- Service d'hematologie, HIA Percy, BP 406 , 101 Av Henri Barbusse, FR-2141 Clamart, France. jvmalf @ free.fr
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Malfuson JV, Fagot T, Konopacki J, Mangouka L, Souleau B, de Revel T. [Hematological disorders and hypereosinophilias]. Rev Med Interne 2009; 30:322-30. [PMID: 19201511 DOI: 10.1016/j.revmed.2008.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 09/20/2008] [Accepted: 10/08/2008] [Indexed: 01/21/2023]
Abstract
Hematological disorders are the third cause of hypereosinophilia, after allergic and parasitic diseases. Hematological disorders associated with hypereosinophilias can be classified as clonal, reactive or idiopathic, and recently the improvements of cytogenetic, molecular biology and immunology have allowed to revisit numerous cases previously diagnosed as idiopathic hypereosinophilic syndrome. Reactive eosinophilias are mainly associated with lymphoma or abnormal, often clonal T lymphoid population. Clonal eosinophilia is related either to various myeloid malignancies or to a genuine myeloproliferative disorder from the eosinophile lineage, the so-called chronic eosinophilic leukaemia. Chronic eosinophilic leukaemia can be associated with recurrent genes rearrangements involving PDGFRA, PDGFRB and FGFR1 or with clonal abnormalities not yet categorized. Idiopathic hypereosinophilic syndrome remains an exclusive diagnosis in presence of moderate or severe unexplained eosinophilia with target organ damage. The purpose of the diagnostic work-up of hypereosinophilic syndrome is to evidence either an abnormal T cell population or a clonal haematopoiesis. Imatinib mesylate dramatically improves chronic eosinophilic leukaemias associated with PDGFR abnormalities, while corticosteroids are still the main treatment for the other patients. In a near future, advances could arise from identification of new genes involved in clonal eosinophilia or in alternative therapy such as the anti-IL-5 antibodies.
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Affiliation(s)
- J-V Malfuson
- Service d'hématologie clinique, hôpital d'instruction des Armées Percy, 101, avenue Henri-Barbusse, BP406, 92141 Clamart, France.
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Bertho JM, Roy L, Souidi M, Benderitter M, Gueguen Y, Lataillade JJ, Prat M, Fagot T, De Revel T, Gourmelon P. New Biological Indicators to Evaluate and Monitor Radiation-Induced Damage: An Accident Case Report. Radiat Res 2008; 169:543-50. [DOI: 10.1667/rr1259.1] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Accepted: 12/19/2007] [Indexed: 11/03/2022]
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Garcia-Hejl C, Fagot T, Foissaud V, Samson T, Defuentes G, Clavier B, Perez JP, de Revel T. [Thrombotic thrombocytopenic purpura: a case report]. Ann Biol Clin (Paris) 2008; 66:327-331. [PMID: 18558572 DOI: 10.1684/abc.2008.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 12/31/2007] [Indexed: 05/26/2023]
Abstract
We report a case of thrombotic thrombocytopenic purpura (TTP) in a 60 years-old woman with Sjogren's syndrome. Symptomatology on admission leads to evoke the diagnosis of TTP. Biological results allow to set the diagnosis. Actually, association of haemolytic anaemia, schizocytes and thrombocytopenia are in favour of TTP. Undetectable ADAMTS 13 activity (below 5%) confirms the diagnosis. In congenital TTP, plasma ADAMTS 13 is absent or severely reduced as a consequence of mutations in the two ADAMTS 13 gene. In acquired TTP, circulating antibodies inhibit plasma ADAMTS 13 activity. In those cases, further biological studies are needed to find a cause of TTP. Follow-up implies standard laboratory tests. Plasma exchanges are progressively tapered after normalization of platelets count.
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Giraud J, Froussart-Maille F, Fagot T, Blavier B, Maille M. 679 Œdème papillaire infiltratif et occusion de l’artère centrale de la rétine au cours d’une leucémie aiguë lymphoblastique. J Fr Ophtalmol 2008. [DOI: 10.1016/s0181-5512(08)71278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Elouennass M, Doghmi K, Fagot T, Soler C, Mac Nab C, Foissaud V, De Revel T, Hervé V. [Hepatosplenic and kidneys candidasis complicating an acute myeloblastic leukemia. A case treated with voriconazole and caspofungin]. Ann Biol Clin (Paris) 2005; 63:423-7. [PMID: 16061441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2004] [Accepted: 04/08/2005] [Indexed: 05/03/2023]
Abstract
We report the observation of hepato-splenic and kidneys candidiasis complicating the chemotherapy of a myeloblastic leukemia (LAM5b). Following the lack of effectiveness of a first line treatement, using amphotericine B liposomale and 5-fluorocytosine, implementation of an association of new molecules, a triazole of second generation (voriconazole) and an echinocandine (caspofungine) has allowed a successful result.
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Affiliation(s)
- M Elouennass
- Service de biologie médicale, hôpital d'instruction des armées Percy, Clamart.
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Froussart-Maille F, Dariel R, Lemaitre C, Crepy P, Fagot T, Maslin J, Maille M. 696 Uvéo-méningite aiguë à HHV-6. J Fr Ophtalmol 2005. [DOI: 10.1016/s0181-5512(05)73813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Doghmi K, Malfuson JV, El Ouennass M, Fagot T, Forel A, Branquet D, Foissaud V, Samson T, de Revel T, Nedellec G. [Hodgkin's disease with bone marrow involvement. The role of positron tomography]. Presse Med 2005; 34:227-9. [PMID: 15798535 DOI: 10.1016/s0755-4982(05)88253-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hodgkin's disease with initially predominant bone marrow involvement is observed in 1% of cases. OBSERVATION A case of Hodgkin's disease with massive bone marrow invasion, manifested by pancytopenia in the context of fever and alteration in general status of health, with little or non superficial peripheral lymph nodes. The bone marrow biopsy revealed extensive myelofibrosis with rare Reed-Sternberg cells. DISCUSSION This case report is inscribed within the framework of the exceptional massive bone marrow forms of Hodgkin's disease, described by Duhamel et al. in 1979. We believe that metabolic imaging with 18F-FDG positron emission tomography (PET) is a valid examination in orienting diagnosis and post-therapy assessment.
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Affiliation(s)
- K Doghmi
- Service d'hématologie clinique, Hôpital d'Instruction des Armées Percy, 101 avenue Henri Barbusse, 92141 Clamart, France.
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Elouennass M, Foissaud V, Trueba F, Doghmi K, Malfuson JV, Fagot T, Mac Nab C, Samson T, Souleau B, de Revel T, Nedellec G, Hervé V. Étude sur sept ans des isolats d’hémocultures dans un service d’hématologie clinique. Med Mal Infect 2004; 34:62-9. [PMID: 15620016 DOI: 10.1016/j.medmal.2003.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
GOAL This study had for aim to analyze the epidemiology of strains identified in blood cultures (hôpital d'instruction des armées Percy, Clamart, France, hematology unit) to compare the rate of identified micro-organisms with literature data, and to search for a possible correlation between antibiotherapy management and evolution of resistance profiles. MATERIAL AND METHODS All the micro-organisms (N = 690) collected over seven years (January 1996 to December 2002), from blood cultures of hospitalized patients in conventional and sterile sector were studied. RESULTS Gram positive cocci rate (GPC) was 62.6% and Gram negative bacilli (GNB) 31.3%. Evolution in time showed a decrease of GPC and an increase of GNB, notably the non fermenting Gram negative bacilli, leading to an equal rate by 2001-2002. The most frequently identified species were Staphylococcus epidermidis (36.4%), Escherichia coli (8.7%), Pseudomonas aeruginosa (6.8%), and Staphylococcus aureus (4.9%). The rate of methicillin-resistant staphylococci was 63.6%. Fifty-five percent of E. coli strains had a penicillinase phenotype. Pseudomonas aeruginosa resistance was 8.5, 8.5, 6.4 and 8.5%, respectively for ceftazidime, piperacillin-tazobactam, imipenem, and amikacin. CONCLUSION This study showed a tendency to inversion of former bacteremia epidemiology with increasing negative Gram bacilli. It justifies the antibiotherapy protocols adopted in the hematology unit.
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Affiliation(s)
- M Elouennass
- Service de biologie médicale, hôpital d'instruction des armées Percy, 101, avenue Henrie-Barbusse, BP 406, 92141 Clamart, France.
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Doghmi K, Branquet D, Fagot T, Souleau B, De Revel T, Nedellec G. Formes médullaires pures de maladie de Hodgkin:deux observations. Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80598-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Malfuson J, Dogmi K, Fagot T, Souleau B, de Revel T, Nedellec G. Rémission complète d'une maladie de Vaquez après une aplasie médullaire? Rev Med Interne 2003. [DOI: 10.1016/s0248-8663(03)80575-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Samson T, Mossafa H, Lusina D, Fagot T, Souleau B, de Revel T, Troussard X, Nedellec G. Dicentric chromosome 3 associated with binucleated lymphocytes in atypical B-cell chronic lymphoproliferative disorder. Leuk Lymphoma 2002; 43:1749-54. [PMID: 12685827 DOI: 10.1080/1042819021000006501] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Binucleated lymphocytes on blood smear are known in PPBL characterized by stable and polyclonal lymphocytosis, polyclonal increase of serum IgM, HLA DR7 and strong correlation with additional i(3q) and premature chromosome condensation. In this disorder some reports of clonal Ig rearrangement suggest a follow up of these patients with immunological and genetic studies. Binucleated lymphocytes are rarely described in other clonal B-CLPD as B-CLL or marginal zone B-cell lymphoma (MZL). Chromosome 3 abnormality is never described in B-CLL but trisomy 3 represents the most consistent abnormality characterizing the MZL. We report in a man without previous medical history an unusual B-CLPD with monoclonal lymphocytosis CD5-, characteristic cytology (particularly binucleated lymphocytes) and chromosomic abnormality as dicentric chromosome 3 never previously described in B-CLPD. In this case lymphocytosis is persistent and stable over 24 months, cytologic immunologic and chromosomic abnormalities are unchanged. We discuss the nosologic place of this atypical B-CLPD closely related to PPBL and MZL with at the moment, after 24 months, a quiet evolution that imply nevertheless a careful follow up with regular cytologic, immunological and genetic studies to clarify the issue.
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MESH Headings
- B-Lymphocytes
- Biotinylation
- Chromosomes, Human, Pair 3
- Cytogenetics
- Gene Rearrangement
- Humans
- Immunophenotyping
- In Situ Hybridization, Fluorescence
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Lymphocytes/metabolism
- Lymphocytosis/metabolism
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoproliferative Disorders/genetics
- Lymphoproliferative Disorders/metabolism
- Male
- Middle Aged
- Prognosis
- Time Factors
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Affiliation(s)
- T Samson
- Service de Biologic Médicale, Hôpital Percy, 101 Avenue Henri Barbusse, BP 406, 92141 Clamart Cedex, France.
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de Revel T, Fagot T, Souleau B, Dormont D, Nedellec G. [Secondary medullary aplasia from accidental radiation:therapeutic options and evolution of the concept]. Can J Physiol Pharmacol 2002; 80:694-9. [PMID: 12184321 DOI: 10.1139/y02-095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Bone marrow grafting following accidental irradiation exposure should be viewed in the perspective of a severe myeloablative syndrome linked to high medullary damage for a dose range higher than 6-8 Gy, resulting in very late or no recovery. Prognosis will depend on the presence or absence of radio-combined injuries, the toxicity of the transplant procedure, and the risk of rejection induced by insufficient percritical immunosuppression. It is in this context that new cell therapy modalities, which combine enhanced peripheral hematopoietic cell engraftment and high immunosuppressive conditioning regimen with low extrahematological toxicity, inducing early and stable mixed lymphomyeloid chimerism with minimal morbidity, can be considered. Such an approach is being evaluated in the treatment of patients with hematological malignancies at high risk of transplant-related mortality using conventional bone marrow methods.
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Affiliation(s)
- T de Revel
- Service d'Hématologie, HIA Percy, Fontenay-aux-Roses, France.
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Dufau JP, Patte JH, Ceccaldi B, Fagot T, Sylvestre A, Le Vagueresse R. [Non-Hodgkin lymphoma mimicking renal carcinoma: apropos of 1 case of follicular lymphoma]. Ann Pathol 2000; 20:253-7. [PMID: 10891725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Primary renal non-Hodgkin's lymphoma (NHL) is unusual, in contrast to the frequent renal involvement in disseminated NHL. We report a case of follicular lymphoma presenting initially as a renal mass. In the literature, twenty-seven similar cases have been described since 1980. The median age at diagnosis is 64 years with a male predominance. Clinical and radiological findings generally evoke renal carcinoma. Histologically, tumors are usually large B-cell lymphomas. The existence of renal non-Hodgkin lymphoma mimicking renal carcinoma must be recognized. Such lymphomas can either be primitive or be nodal with a renal presentation. Nephrectomy followed by chemotherapy permits long disease free survival.
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Affiliation(s)
- J P Dufau
- Service d'Anatomie Pathologique, Hôpital Percy, Clamart.
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Nedellec G, de Revel T, Fagot T, Souleau B, Merrer J. Traitement des lymphomes cérébraux primitifs par chimio- et radiothérapie. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80026-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Debourdeau P, Cartry C, Fagot T, Couteau C, Farge D, Lotz JP, Housset M. Tumeurs malignes associées au VIH: étude rétrospective de 38 cas. Rev Med Interne 1998. [DOI: 10.1016/s0248-8663(98)80053-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Johnson GO, Thorland WG, Crabbe JM, Dienstbier R, Fagot T. Effects of a 16-week marathon training program on normal college males. J Sports Med Phys Fitness 1982; 22:224-30. [PMID: 7162179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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