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Sardella L, Merlo E, Casutt A. Endobronchial High-Grade Non-Hodgkin B-Cell Lymphoma Mimicking Small Cell Lung Cancer. Arch Bronconeumol 2024; 60:306-307. [PMID: 38461110 DOI: 10.1016/j.arbres.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Luca Sardella
- Division of Pulmonology, Ospedale Regionale di Bellinzona, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Elisabetta Merlo
- Institute of Pathology, Ospedale di Locarno, Ente Ospedaliero Cantonale (EOC), Locarno, Switzerland
| | - Alessio Casutt
- Division of Pulmonology, Department of Medicine, Lausanne University Hospital (CHUV), and University of Lausanne (UNIL), Lausanne, Switzerland; Division of Pulmonology, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), and Università della Svizzera Italiana (USI), Lugano, Switzerland.
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Lin WH, Wu MN. Non-Hodgkin's Lymphoma with Intraspinal Involvement Mimics Bilateral Thoracolumbar Plexopath. Acta Neurol Taiwan 2023; 32(3):122-126. [PMID: 37674424] [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] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma, and its extranodal manifestation is rare. Skeletal muscle involvement is noted in only 1.1% of patients with NHL. Here, we present a case of high-grade B-cell lymphoma (HGBL); it infiltrated the left neural foramina from the left psoas muscle before encroaching on the whole spinal canal and subsequently invading the contralateral neural foramina from T12 to L3. CASE REPORT A 43-year-old man with HGBL who could function independently presented with numbness and weakness of the left thigh 2 months after a diagnosis of infiltrative lymphoma in the left psoas muscle. His symptoms were urine incontinence and unsteady gait. A neurological examination revealed weakness in the left psoas and quadriceps with hyporeflexia and hypesthesia. Lumbar spine magnetic resonance imaging (MRI) revealed intraspinal extradural invasion from T12 to L3 with multiple left-sided root compression despite the resolution of primary psoas lymphoma. At 6 weeks after symptom onset, his symptoms progressed to weakness, numbness, and hyporeflexia of the bilateral lower extremities with preserved anal sensation. Follow- up MRI revealed the progression of intraspinal invasion, which spread through the spinal canal and invaded the contralateral neural foramina from T12 to L3. The patient was finally bound to a wheelchair. CONCLUSION Clinicians must check for possible intraspinal involvement in patients with HGBL, particularly patients with known paraspinal soft-tissue involvement. The resolved infiltration of the soft tissue does not preclude the possibility of further neurological involvement. Additionally, MRI may provide higher resolution findings for clarifying the structure of the neural foramina and thecal sac. Keyword: Non-Hodgkin's Lymphoma, high-grade B-cell lymphoma, plexopathy.
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Affiliation(s)
- Wei-Hao Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Meng-Ni Wu
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Sesques P, Tordo J, Ferrant E, Safar V, Wallet F, Dhomps A, Brisou G, Bouafia F, Karlin L, Ghergus D, Golfier C, Lequeu H, Lazareth A, Vercasson M, Hospital-Gustem C, Schwiertz V, Choquet M, Sujobert P, Novelli S, Mialou V, Hequet O, Carras S, Fouillet L, Lebras L, Guillermin Y, Leyronnas C, Cavalieri D, Janier M, Ghesquières H, Salles G, Bachy E. Prognostic Impact of 18F-FDG PET/CT in Patients With Aggressive B-Cell Lymphoma Treated With Anti-CD19 Chimeric Antigen Receptor T Cells. Clin Nucl Med 2021; 46:627-634. [PMID: 34115706 DOI: 10.1097/rlu.0000000000003756] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 11/26/2022]
Abstract
PURPOSE OF THE REPORT We aimed to evaluate the role of 18F-FDG PET/CT in predicting patient outcome following chimeric antigen receptor T (CAR T) cells infusion in aggressive B-cell lymphoma. METHODS 18F-FDG PET/CT data before leukapheresis, before CAR T-cell infusion and 1 month (M1) after CAR T-cell infusion, from 72 patients were retrospectively analyzed. SUVmax, total lesion glycolysis (TLG), metabolic tumor volume (MTV), and parameters describing tumor kinetics were calculated for each 18F-FDG PET/CT performed. The aim was to evaluate the prognostic value of 18F-FDG PET/CT metabolic parameters for predicting progression-free survival (PFS) and overall survival (OS) following CAR T-cell therapy. RESULTS Regarding PFS, ∆MTVpre-CAR and ∆TLGpre-CAR were found to be more discriminating compared with metabolic parameters at preinfusion. Median PFS in patients with a ∆MTVpre-CAR of less than 300% was 6.8 months (95% confidence interval [CI], 2.8 months to not reached) compared with 2.8 months (95% CI, 0.9-3.0 months) for those with a value of 300% or greater (P = 0.004). Likewise, median PFS in patients with ∆TLGpre-CAR of less than 420% was 6.8 months (95% CI, 2.8 months to not reached) compared with 2.7 months (95% CI, 1.3-3.0 months) for those with a value of 420% or greater (P = 0.0148). Regarding OS, metabolic parameters at M1 were strongly associated with subsequent outcome. SUVmax at M1 with a cutoff value of 14 was the most predictive parameter in multivariate analysis, outweighing other clinicobiological variables (P < 0.0001). CONCLUSIONS Disease metabolic volume kinetics before infusion of CAR T cells seems to be superior to initial tumor bulk itself for predicting PFS. For OS, SUVmax at M1 might adequately segregate patients with different prognosis.
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Affiliation(s)
| | | | - Emmanuelle Ferrant
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | - Violaine Safar
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | | | | | | | - Fadhela Bouafia
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | | | | | | | - Helène Lequeu
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | - Anne Lazareth
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | - Marlène Vercasson
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | - Carole Hospital-Gustem
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | | | - Marion Choquet
- From the Department of Haematology, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite
| | | | - Silvana Novelli
- INSERM U1052 and CNRS UMR5286, Lyon Cancer Research Center, Lyon
| | - Valérie Mialou
- Department of Biology and Therapy, Etablissement Français du Sang Auvergne-Rhône-Alpes
| | - Olivier Hequet
- Department of Biology and Therapy, Etablissement Français du Sang Auvergne-Rhône-Alpes
| | - Sylvain Carras
- Department of Haematology, Grenoble University Hospital, Grenoble
| | - Ludovic Fouillet
- Department of Haematology, Institut de Cancérologie Lucien Neuwirth, Saint-Etienne
| | - Laure Lebras
- Department of Haematology, Centre Léon Bérard, Lyon
| | | | - Cécile Leyronnas
- Department of Haematology, Groupe Hospitalier Mutualiste, Institut Daniel Hollard, Grenoble
| | - Doriane Cavalieri
- Department of Haematology, Clermont Ferrand University Hospital, Clermont Ferrand, France
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Green K, Pavasovic V, Ghorashian S, Ancliff P, Bartram J, Rao A, Samarasinghe S, Vora A, Cheng D, O'Connor D. Clinical Utility of Radiologic Disease Reassessment in the Management of Pediatric B-Cell Non-Hodgkin Lymphoma. J Pediatr Hematol Oncol 2021; 43:e380-e384. [PMID: 32218099 DOI: 10.1097/mph.0000000000001781] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/16/2020] [Indexed: 11/26/2022]
Abstract
Although outcomes for children with B-cell non-Hodgkin lymphoma are excellent, between 20% and 40% demonstrate residual radiologic abnormalities at disease assessment during consolidation therapy, the significance of which remains uncertain. The authors report the outcomes for all children treated for B-cell non-Hodgkin lymphoma at our center over an 11-year period. Twenty-four of 64 (38%) children had residual radiologic abnormalities at disease remission assessment. Seven (29%) underwent histologic biopsies that were normal. No children with residual radiologic abnormalities experienced disease relapse or death, suggesting that imaging at this time point creates clinical uncertainty without indicating residual disease or predicting relapse.
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Affiliation(s)
- Katherine Green
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Li Q, Dong Y, Pan Y, Tang H, Li D. Case Report: Clinical Responses to Tislelizumab as a First-Line Therapy for Primary Hepatocellular Carcinoma With B-Cell Indolent Lymphoma. Front Immunol 2021; 12:634559. [PMID: 33868256 PMCID: PMC8044442 DOI: 10.3389/fimmu.2021.634559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/03/2021] [Indexed: 12/24/2022] Open
Abstract
Background As an emerging therapy with a promising efficacy, immunotherapy has been widely used in the treatment of solid tumors and hematologic malignancies. This clinical study compares the efficacy of tislelizumab, a domestic immune checkpoint inhibitor (ICI), to that of sorafenib when used as a first-line therapeutic option in hepatocellular carcinoma (HCC), and the concurrence of HCC and non-Hodgkin's lymphoma (NHL) is rare, especially in the treatment of ICIs. Case presentation A 61-year-old patient presenting with primary HCC and indolent B-cell lymphoma had a partial clinical response to tislelizumab for his primary HCC. Besides, we described a phenomenon of pseudo-progression and delayed diagnosis of his lymphoma during a long course of treatment. Conclusion Tislelizumab, an immunotherapeutic option with a favorable efficacy and toxicity, can be used to manage double primary tumors. However, studies should aim to elucidate the probable mechanisms of this therapy. Pseudo-progression and separation remission make the treatment of double primary tumors even more challenging, which calls for additional caution in patients undergoing immunotherapy to avoid misdiagnosis and, therefore, begin early appropriate interventions.
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MESH Headings
- Antibodies, Monoclonal, Humanized/therapeutic use
- Carcinoma, Hepatocellular/diagnostic imaging
- Carcinoma, Hepatocellular/drug therapy
- Carcinoma, Hepatocellular/immunology
- Carcinoma, Hepatocellular/metabolism
- Humans
- Immune Checkpoint Inhibitors/therapeutic use
- Liver Neoplasms/diagnostic imaging
- Liver Neoplasms/drug therapy
- Liver Neoplasms/immunology
- Liver Neoplasms/metabolism
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/metabolism
- Male
- Middle Aged
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/immunology
- Neoplasms, Multiple Primary/pathology
- Treatment Outcome
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Affiliation(s)
| | | | | | | | - Da Li
- Department of Medical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Wang L, Cai L, Chen X, Zheng Z. Paroxysmal supraventricular tachycardia as a major clinical presentation of the primary coronary sinus lymphoma: A case report. Medicine (Baltimore) 2021; 100:e24225. [PMID: 33429817 PMCID: PMC7793383 DOI: 10.1097/md.0000000000024225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/16/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Primary cardiac lymphoma is a rare tumor, especially a tumor located in coronary sinus (CS). The most common symptom of cardiac tumors is dyspnea, accounting for 64%, followed by chest pain, accounting for 26%. However, the cases with paroxysmal supraventricular tachycardia (SVT) as a major clinical presentation are extremely rare. PATIENT CONCERNS We report a 55-year-old female patient with primary CS lymphoma and paroxysmal SVT. DIAGNOSES After the surgical resection, pathology revealed the evidence of diffuse large B-cell lymphoma. INTERVENTIONS The patient underwent chemotherapy after CS tumor resection. OUTCOMES The patient was disease-free during the 6-month follow-up. LESSONS CS enlargement may be the cause of SVT. Echocardiography should focus on the CS section to arrive at the right diagnosis.
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Affiliation(s)
- Ling Wang
- Department of Ultrasound, Zhuji People's Hospital of Zhejiang Province, Zhuji
| | - Lixia Cai
- Department of Ultrasound, Zhuji People's Hospital of Zhejiang Province, Zhuji
| | - Xiangyu Chen
- Department of Ultrasound, Zhuji People's Hospital of Zhejiang Province, Zhuji Affiliated Hospital of Shaoxing University, Zhuji, China
| | - Zhelan Zheng
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, Zhejiang
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Abstract
F-FDG PET/CT is now an integral part of management of high-grade B-cell lymphoma. It is used for staging, response evaluation, restaging, and surveillance. Although high-grade B-cell lymphoma most commonly presents with involvement of the lymph nodes, spleen, liver, and bone marrow, chest wall involvement is very rare. We present the staging F-FDG PET/CT findings in a case of an 82-year-old woman with double expressor high-grade B-cell lymphoma of isolated presternal anterior chest wall mass.
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Affiliation(s)
- Punit Sharma
- From the Department of Nuclear Medicine and PET/CT, Apollo Gleneagles Hospitals, Kolkata, India
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Dawson LP, Pol D, Kranz S, Sivaratnam D. Pericardial constriction in double-hit lymphoma. J Nucl Cardiol 2020; 27:1398-1401. [PMID: 30972717 DOI: 10.1007/s12350-019-01711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Luke P Dawson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia.
| | - Derk Pol
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Sevastjan Kranz
- Deparment of Pathology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Dinesh Sivaratnam
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Nuclear Medicine, Royal Melbourne Hospital, Melbourne, VIC, Australia
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Feuerman H, Snast I, Amitay-Laish I, Bairey O, Barzilai A, Feinmesser M, Mimouni D, Even-Sapir E, Hodak E. The Utility of 18F-fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography in Cutaneous B-Cell Lymphoma. Isr Med Assoc J 2019; 21:580-584. [PMID: 31542900] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Whole-body integrated positron emission tomography / contrast-enhanced computed tomography (PET/CT) scan is increasingly used in cutaneous lymphomas. However, the value of PET/CT in the detection of cutaneous lesions in primary cutaneous B-cell lymphoma (PCBCL) has barely been investigated. OBJECTIVES To investigate the diagnostic accuracy of PET/CT in tracking cutaneous involvement in PCBCL. METHODS A retrospective study was conducted on 35 consecutive patients diagnosed with cutaneous B-cell lymphoma according to the World Health Organization classification who were evaluated with PET/CT as the initial staging procedure before treatment. RESULTS Thirty-five patients met the study criteria. In two patients extracutaneous disease was detected by PET/CT and CT and confirmed by biopsy. Of the 33 patients with PCBCL, 26 (79%) had small cell PCBCL (18 marginal-zone, 8 follicle-center lymphoma) and 7 (21%) had large cell PCBCL (3 follicle-center, 3 leg-type, 1 indeterminate). PET/CT detected skin lesions in 3 of 26 patients (12%) with small-cell PCBCL as compared to 6 of 7 patients with large-cell PCBLC (86%), a 7.4-fold detection risk (95% confidence interval, 2.4-22, P = 0.004). The PET-positive subgroup was characterized by larger lesion size (P < 0.001) and a higher Ki-67 proliferation index (P < 0.001). CONCLUSIONS The sensitivity of PET/CT for detecting cutaneous involvement of lymphomas is low for small-cell PCBCL but high for large-cell types, and thus may facilitate therapeutic strategies.
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Affiliation(s)
- Hana Feuerman
- Department of Dermatology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Snast
- Department of Dermatology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Amitay-Laish
- Department of Dermatology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Bairey
- Institute of Hematology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviv Barzilai
- Department of Dermatology, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maora Feinmesser
- Institute of Pathology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Mimouni
- Department of Dermatology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Department of Dermatology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Cheon M, Yoo J, Hyun SH, Lee KS, Kim H, Kim J, Zo JI, Shim YM, Choi JY. Diagnostic Performance of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/CT for Chronic Empyema-Associated Malignancy. Korean J Radiol 2019; 20:1293-1299. [PMID: 31339017 PMCID: PMC6658878 DOI: 10.3348/kjr.2018.0843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/02/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the diagnostic performance of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) for chronic empyema-associated malignancy (CEAM). MATERIALS AND METHODS We retrospectively reviewed the ¹⁸F-FDG PET/CT images of 33 patients with chronic empyema, and analyzed the following findings: 1) shape of the empyema cavity, 2) presence of fistula, 3) maximum standardized uptake value (SUV) of the empyema cavity, 4) uptake pattern of the empyema cavity, 5) presence of a protruding soft tissue mass within the empyema cavity, and 6) involvement of adjacent structures. Final diagnosis was determined based on histopathology or clinical follow-up for at least 6 months. The abovementioned findings were compared between the ¹⁸F-FDG PET/CT images of CEAM and chronic empyema. A receiver operating characteristic (ROC) analysis was also performed. RESULTS Six lesions were histopathologically proven as malignant; there were three cases of diffuse large B-cell lymphoma, two of squamous cell carcinoma, and one of poorly differentiated carcinoma. Maximum SUV within the empyema cavity (p < 0.001) presence of a protruding soft tissue mass (p = 0.002), and involvement of the adjacent structures (p < 0.001) were significantly different between the CEAM and chronic empyema images. The maximum SUV exhibited the highest diagnostic performance, with the highest specificity (96.3%, 26/27), positive predictive value (85.7%, 6/7), and accuracy (97.0%, 32/33) among all criteria. On ROC analysis, the area under the curve of maximum SUV was 0.994. CONCLUSION ¹⁸F-FDG PET/CT can be useful for diagnosing CEAM in patients with chronic empyema. The maximum SUV within the empyema cavity is the most accurate ¹⁸F-FDG PET/CT diagnostic criterion for CEAM.
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Affiliation(s)
- Miju Cheon
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Jang Yoo
- Department of Nuclear Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hojoong Kim
- Department of Medicine, Samsung Medical Center, Division of Pulmonary and Critical Care Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jhingook Kim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Il Zo
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Mog Shim
- Department of Thoracic Surgery and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Kitajima K, Okada M, Kashiwagi T, Yoshihara K, Tokugawa T, Sawada A, Yoshihara S, Fujimori Y, Yamakado K. Early evaluation of tumor response to 90Y-ibritumomab radioimmunotherapy in relapsed/refractory B cell non-Hodgkin lymphoma: what is the optimal timing for FDG-PET/CT? Eur Radiol 2019; 29:3935-3944. [PMID: 30899979 DOI: 10.1007/s00330-019-06134-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 02/14/2019] [Accepted: 03/06/2019] [Indexed: 01/13/2023]
Abstract
PURPOSE To determine the earliest optimal timing for assessment of early response following radioimmunotherapy in non-Hodgkin lymphoma patients using FDG-PET/CT. METHODS FDG-PET/CT was performed prior to treatment (PET1), at 2 (PET2) weeks, and at 6 (PET3) weeks after 90Y-ibritumomab radioimmunotherapy in 55 patients. Response was evaluated based on the Deauville 5-point scale and Lugano criteria as well as semiquantitative analysis and compared with progression-free survival (PFS). RESULTS PET 2 showed complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD) in 33, 13, 6, and 3 patients, respectively, while PET 3 in 41, 8, 3, and 3 patients, respectively. Mean SUVmax of 168 target lesions decreased over time (PET1, 2, 3; 5.58 ± 2.58, 1.87 ± 1.78, 1.75 ± 2.25, respectively). Progression or recurrence after a median of 12.6 months (range 2.6-72.0 months) was seen in 44 patients. Patients with CMR or metabolic response (CMR + PMR) on PET2 showed significantly longer PFS as compared to those who did not (p = 0.00028 and p = 0.029, respectively). A similar significant difference was observed based on PET3 (p = 0.00013 and p = 0.017, respectively). The same trend was observed when analyzing only the subgroup of patients with follicular lymphoma (N = 43/55) (p < 0.0001). CONCLUSION Use of FDG-PET/CT findings with Lugano criteria for assessing early response to radioimmunotherapy after 6 weeks allowed for accurate evaluation and prognostic stratification, though scanning after 2 weeks was too soon to precisely evaluate response. KEY POINTS • The optimal timing of FDG-PET/CT to obtain a suitable tool for assessment of response after 90 Y-ibritumomab radioimmunotherapy of lymphoma has not yet been defined. • Assessment after 6 weeks by FDG-PET/CT using the Lugano criteria accurately evaluates treatment response and prognosis. • FDG-PET/CT performed 2 weeks after radioimmunotherapy is too early as it significantly misses objective responses.
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Affiliation(s)
- Kazuhiro Kitajima
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Masaya Okada
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Toru Kashiwagi
- Department of Healthcare office, Daimaru Matsuzaka Department Store, Osaka, 530-8202, Japan
| | - Kyoko Yoshihara
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Tazuko Tokugawa
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Akihiro Sawada
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Satoshi Yoshihara
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Yoshihiro Fujimori
- Division of Hematology, Department of Internal Medicine Department of Transfusion Medicine and Cellular Therapy, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, 663-8501, Japan
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Pappolla A, Sosa-Albacete F, Rugiero M, Christiansen S, Garcia-Rivello H, Miquelini A. [Hypothalamic intravascular B-cell lymphoma in an immunocompetent patient]. Rev Neurol 2019; 68:131-132. [PMID: 30687922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- A Pappolla
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - M Rugiero
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - S Christiansen
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - A Miquelini
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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14
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Gallipani A, Cha A, Berkowitz L, Bakshi A. Concomitant Treatment of Hepatitis C Virus and Diffuse Large B-Cell Lymphoma with Direct-Acting Antivirals in HIV Coinfection: A Case Report. J Int Assoc Provid AIDS Care 2019; 18:2325958218822062. [PMID: 30798652 PMCID: PMC6748524 DOI: 10.1177/2325958218822062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This report describes a case of concomitant treatment of advanced diffuse large B-cell lymphoma with chemoimmunotherapy along with direct-acting antivirals for hepatitis C virus in a patient coinfected with HIV. The patient tolerated gemcitabine, dexamethasone, cisplatin, and rituximab and achieved sustained virologic response after treatment with ledipasvir/sofosbuvir.
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Affiliation(s)
| | - Agnes Cha
- Arnold & Marie Schwartz College of Pharmacy, Brooklyn, NY, USA
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15
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Vandekerckhove E, Vandopdenbosch L, Van Hoof A, De Wilde V. Recurrent pancreatitis : it can get on your nerves! A rare case of B-cell lymphoma presenting as recurrent pancreatitis and multiple cranial neuropathy. Acta Gastroenterol Belg 2018; 81:346-347. [PMID: 30024714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | | | | | - Vincent De Wilde
- Department of Gastroenterology and Hepatology, AZ Sint-Jan, Bruges, Belgium
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16
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Benecke L, Muller L, Storck C. [Not Available]. Praxis (Bern 1994) 2018; 107:170-172. [PMID: 29382266 DOI: 10.1024/1661-8157/a002896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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17
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Abstract
A 60-year-old female presented with abdominal pain and distension. Following computed tomography scans of the abdomen and pelvis, she was taken urgently to the operating room, with the belief that she had appendicitis with perforation. At laparotomy, the findings were consistent with an ovarian carcinoma; there was extensive infiltration of the ovary, bowel, and omental deposits. Cytoreductive surgery was performed including total abdominal hysterectomy and bilateral salpingo-oophorectomy. The final pathology, however, revealed infiltration with medium-sized atypical lymphoid cells positive for CD20, CD10, MYC, BLC2, and BCL6 by immunohistochemistry. MYC and BCL2 translocations were identified by fluorescence in situ hybridization consistent with a diagnosis of high-grade B-cell lymphoma with rearrangements of MYC and BCL2 With the current data available, what is the optimal treatment of this patient?
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Affiliation(s)
- Patrick M. Reagan
- Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY; and
| | - Andrew Davies
- Cancer Sciences Unit, Southampton General Hospital, Southampton, United Kingdom
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18
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Skala SL, Hristov AC, Gudjonsson JE, Chan MP. Unsuspected lymphomatoid granulomatosis in a patient with antisynthetase syndrome. Cutis 2017; 100:E22-E26. [PMID: 29136066] [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: 06/07/2023]
Abstract
Clinical diagnosis of lymphomatoid granulomatosis (LYG) often is difficult, especially in patients with multiple comorbidities. We present a 60-year-old woman with worsening fatigue, night sweats, unintentional weight loss, and dyspnea of 2 weeks' duration. Her medical history was remarkable for recent radiation therapy for recurrent breast cancer and antisynthetase syndrome complicated by interstitial lung disease and controlled with azathioprine. Computed tomography showed ground-glass opacities and nodular infiltrates in all lung lobes, raising concern for radiation pneumonitis and drug toxicity. Skin examination revealed erythematous and hemorrhagic papules, macules, and blisters on the lower leg. A diagnosis of LYG was made on a skin biopsy showing large angiocentric Epstein-Barr virus (EBV)-positive B cells. The patient soon progressed to develop nodal large B-cell lymphoma and died 6 weeks later. This rare report of LYG in a patient with antisynthetase syndrome highlights the diagnostic difficulty and aggressive course of LYG as well as the important role of skin biopsy in establishing the diagnosis.
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Affiliation(s)
| | - Alexandra C Hristov
- Department of Dermatology, Department of Pathology, University of Michigan, Ann Arbor, USA
| | | | - May P Chan
- Department of Dermatology, Department of Pathology, University of Michigan, Ann Arbor, USA
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19
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Mahdjoubi A, Salah S, Dendale R, Kuhnowski F, Brézin A, Farkhondeh F, Cassoux N. [Low-grade primary choroidal lymphoma: Case report]. J Fr Ophtalmol 2017; 40:e241-e243. [PMID: 28478015 DOI: 10.1016/j.jfo.2016.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/10/2016] [Accepted: 09/16/2016] [Indexed: 11/15/2022]
Affiliation(s)
- A Mahdjoubi
- Service ophtalmologie, institut Curie, 26, rue d'ULM, 75248 Paris, France.
| | - S Salah
- Service ophtalmologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - R Dendale
- Service radiothérapie, institut Curie, 26, rue d'ULM, 75248 Paris, France
| | - F Kuhnowski
- Service hématologie, institut Curie, 26, rue d'ULM, 75248 Paris, France
| | - A Brézin
- Service ophtalmologie, hôpital Cochin, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - F Farkhondeh
- Service d'anatomie pathologique, institut Curie, 26, rue d'ULM, 75248 Paris, France
| | - N Cassoux
- Service ophtalmologie, institut Curie, 26, rue d'ULM, 75248 Paris, France
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20
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Lee EJ, Kim M, Kim HS, Kang HJ, Kim HJ, Min SK, Lee YK. CD3 and CD20 Immunohistochemical Staining Patterns of Bone Marrow-Infiltrating Malignant Lymphoma Cells. Ann Clin Lab Sci 2017; 47:136-143. [PMID: 28442514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES It is known that CD3 and CD20 are homogenously expressed in T lineage and B lineage lymphoma, respectively; however, there are no standard guidelines to interpret immunohistochemistry findings. In this study, we investigated CD3 and CD20 immunohistochemical staining patterns of bone marrow (BM)-infiltrating lymphoma cells. METHODS Among 297 patients diagnosed with malignant lymphoma, the BM biopsy slides of all 39 cases found to have BM infiltration (T lineage: 11; B lineage: 28) were reviewed. We specifically investigated the immunohistochemical staining patterns of CD3 and CD20. RESULTS All 11 T lineage lymphoma cases showed homogenous immunohistochemical staining patterns. In the 28 B lineage lymphoma cases, 15 (53.6%) showed a homogenous pattern while 13 (46.4%) showed a heterogeneous pattern. Ten cases in the latter group showed additional evidence of BM infiltration by lymphoma cells in separate laboratory analyses or imaging studies. There were no differences in overall or progression-free survival rates in patients exhibiting homogeneous vs. heterogeneous staining patterns (P=0.81 and P=0.59, respectively). CONCLUSIONS A considerable number of B lineage cases showed heterogeneous patterns with evidence of BM infiltration. Thus, heterogeneous immunohistochemical staining patterns (particularly in B lineage lymphomas) may signify malignant lymphoma cell infiltration into the BM.
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Affiliation(s)
- Eun Jin Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Miyoung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Han-Sung Kim
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hee Jung Kang
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea
| | - Soo Kee Min
- Department of Pathology, Hallym University College of Medicine, Anyang, Korea
| | - Young Kyung Lee
- Department of Laboratory Medicine, Hallym University College of Medicine, Anyang, Korea
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21
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Ceriani L, Martelli M, Gospodarowicz MK, Ricardi U, Ferreri AJM, Chiappella A, Stelitano C, Balzarotti M, Cabrera ME, Cunningham D, Guarini A, Zinzani PL, Giovanella L, Johnson PWM, Zucca E. Positron Emission Tomography/Computed Tomography Assessment After Immunochemotherapy and Irradiation Using the Lugano Classification Criteria in the IELSG-26 Study of Primary Mediastinal B-Cell Lymphoma. Int J Radiat Oncol Biol Phys 2017; 97:42-49. [PMID: 27839910 DOI: 10.1016/j.ijrobp.2016.09.031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 09/10/2016] [Accepted: 09/21/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the predictive value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) for disease recurrence after immunochemotherapy (R-CHT) and mediastinal irradiation (RT), using the recently published criteria of the Lugano classification to predict outcomes for patients with primary mediastinal large B-cell lymphoma. METHODS AND MATERIALS Among 125 patients prospectively enrolled in the IELSG-26 study, 88 were eligible for central review of PET/CT scans after completion of RT. Responses were evaluated using the 5-point Deauville scale at the end of induction R-CHT and after consolidation RT. According to the Lugano classification, a complete metabolic response (CMR) was defined by a Deauville score (DS) ≤3. RESULTS The CMR (DS1, -2, or -3) rate increased from 74% (65 patients) after R-CHT to 89% (78 patients) after consolidation RT. Among the 10 patients (11%) with persistently positive scans, the residual uptake after RT was slightly higher than the liver uptake in 6 patients (DS4; 7%) and markedly higher in 4 patients (DS5; 4%): these patients had a significantly poorer 5-year progression-free survival and overall survival. At a median follow-up of 60 months (range, 35-107 months), no patients with a CMR after RT have relapsed. Among the 10 patients who did not reach a CMR, 3 of the 4 patients (positive predictive value, 75%) with DS5 after RT had subsequent disease progression (within the RT volume in all cases) and died. All patients with DS4 had good outcomes without recurrence. CONCLUSIONS All the patients obtaining a CMR defined as DS ≤3 remained progression-free at 5 years, confirming the excellent negative predictive value of the Lugano classification criteria in primary mediastinal large B-cell lymphoma patients. The few patients with DS4 also had an excellent outcome, suggesting that they do not necessarily require additional therapy, because the residual 18F-fluorodeoxyglucose uptake may not reflect persistent lymphoma.
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Affiliation(s)
- Luca Ceriani
- Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Maurizio Martelli
- Department of Cellular Biotechnologies and Hematology, Sapienza University, Rome, Italy
| | | | | | - Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milano, Italy
| | - Annalisa Chiappella
- Hematology, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Torino, Italy
| | - Caterina Stelitano
- Hematology, Azienda Ospedaliera Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | | | - Maria E Cabrera
- Hematology, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | - David Cunningham
- Department of Medicine, The Royal Marsden National Health Service Foundation Trust, London and Surrey, United Kingdom
| | - Attilio Guarini
- Hematology Unit, Istituto Nazionale Tumori Giovanni Paolo II IRCCS, Bari, Italy
| | - Pier Luigi Zinzani
- Institute of Hematology and Medical Oncology, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Luca Giovanella
- Nuclear Medicine and PET-CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Peter W M Johnson
- Cancer Research UK Centre, University of Southampton, Southampton, United Kingdom
| | - Emanuele Zucca
- Oncology Department, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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22
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Abstract
We herein report the case of a 52-year-old woman who consulted us because of a 2-month history of a fever, anorexia and weight loss. A physical examination was unremarkable. The blood count showed mild anemia and lymphopenia, and lactate dehydrogenase was elevated. Creatinine clearance was normal and proteinuria was undetectable. CT showed enlarged kidneys. A bone marrow biopsy was normal. PET-CT showed an intense uptake of 18fluorodeoxyglucose in both kidneys. A kidney biopsy provided the diagnosis of intravascular large B-cell lymphoma (IVLBCL). Kidney-limited IVLBCL without an impairment in the renal function or proteinuria has not been described. We analyzed the 38 published cases of IVLBCL involving the kidney to describe the main features of this entity.
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Affiliation(s)
- Arnaud Desclaux
- Internal Medicine and Infectious Diseases Unit, Haut-Leveque Hospital, France
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23
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Magalhães-Costa P, Brito MJ, Pinto-Marques P. A diffusely enlarged pancreas: the (un)usual suspect. Rev Esp Enferm Dig 2016; 108:809-811. [PMID: 27931107] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An 81-years-old female presented with obstructive jaundice and a non-specific clinical picture of nausea and appetite loss. Labs demonstrated a conjugated hyperbilirrubinemia (7.7 mg/dL), increased aspartate aminotransferase and alanine aminotransferase (10xULN and 8xULN, respectively), increased lactate dehydrogenase (10xULN) and serum lipase (3xULN). CA 19.9 was 342 U/mL (Ref value < 37 U/mL). There was no evidence of peripheral lymphadenopathy or hepatosplenomegaly. Imaging (Figure 1A and 1B) revealed a marked homogeneous enlargement of the pancreas (without any well-defined mass), dilation of the extra and intra-hepatic bile ducts and ascites. Endoscopic ultrasound (Figure 1C and 1D) identified an enlarged homogeneous hypoechoic pancreas, without any well-defined lesion, no dilation of the main pancreatic duct, no peripancreatic or celiac enlarged lymph nodes. A fine-needle biopsy was performed yielding, on cytological examination and cell-block technique (Figure 2A and 2B), numerous medium/large sized atypical lymphoid cells that displayed a B-cell lineage immunophenotype (Figure 2A-2F). Even though, further characterization (by flow cytometric immunophenotyping) could not be obtained, a final diagnosis of primary pancreatic lymphoma (PPL) was assumed. Primary pancreatic lymphoma is a remarkably rare tumor of the pancreas, representing approximately 0.5% of all pancreatic neoplasms and <2% of all lymphomas (1,2). A correct diagnosis is crucial because therapeutic management differs from other pancreatic malignancies (pancreatic ductal adenocarcinoma, neuroendocrine tumor and metastases) (2,3). Two morphologic patterns of PPL are recognized: a focal form (occurring in the pancreatic head in 80% of cases) and a rarer diffuse/infiltrative pattern, as depicted herein, emulating an acute/autoimmune pancreatitis (1).
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Affiliation(s)
- Pedro Magalhães-Costa
- Gastroenterology Department, Hospital Egas Moniz, Crt Hospitalar Lisboa Ocident, Portugal
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24
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Slavnova EN, Volchenko NN. [The application of automated system of evaluation of morphology of cells for diagnostic of Hodgkin's lymphoma in education process of course of clinical oncocytology]. Klin Lab Diagn 2016; 61:701-704. [PMID: 30615331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The analysis of cytological analysis data demonstrated that cytological diagnosis of Hodgkin's lymphoma was established properly in exact and estimated form in 92.8%. The cytological reports mentioned no alternatives. The cytological analysis system Vision Cyto® was applied to analyze cellular content by micro photos of cytological samples of 119 patients with established morphologic (histological and cytological) diagnosis of Hodgkin's lymphoma. On the basis of the received data training programs were developed concerning cytological diagnostic and detection of forms of disease. The gallery was organized concerning pictures of tumor and background cells playing key role in cytological diagnostic. The distinctive differential diagnostic indications of various forms of Hodgkin's lymphoma were established.
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25
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Ferreri AJM, Cwynarski K, Pulczynski E, Ponzoni M, Deckert M, Politi LS, Torri V, Fox CP, Rosée PL, Schorb E, Ambrosetti A, Roth A, Hemmaway C, Ferrari A, Linton KM, Rudà R, Binder M, Pukrop T, Balzarotti M, Fabbri A, Johnson P, Gørløv JS, Hess G, Panse J, Pisani F, Tucci A, Stilgenbauer S, Hertenstein B, Keller U, Krause SW, Levis A, Schmoll HJ, Cavalli F, Finke J, Reni M, Zucca E, Illerhaus G. Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol 2016; 3:e217-27. [PMID: 27132696 DOI: 10.1016/s2352-3026(16)00036-3] [Citation(s) in RCA: 364] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 02/24/2016] [Accepted: 03/03/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Standard treatment for patients with primary CNS lymphoma remains to be defined. Active therapies are often associated with increased risk of haematological or neurological toxicity. In this trial, we addressed the tolerability and efficacy of adding rituximab with or without thiotepa to methotrexate-cytarabine combination therapy (the MATRix regimen), followed by a second randomisation comparing consolidation with whole-brain radiotherapy or autologous stem cell transplantation in patients with primary CNS lymphoma. We report the results of the first randomisation in this Article. METHODS For the international randomised phase 2 International Extranodal Lymphoma Study Group-32 (IELSG32) trial, HIV-negative patients (aged 18-70 years) with newly diagnosed primary CNS lymphoma and measurable disease were enrolled from 53 cancer centres in five European countries (Denmark, Germany, Italy, Switzerland, and the UK) and randomly assigned (1:1:1) to receive four courses of methotrexate 3·5 g/m(2) on day 1 plus cytarabine 2 g/m(2) twice daily on days 2 and 3 (group A); or the same combination plus two doses of rituximab 375 mg/m(2) on days -5 and 0 (group B); or the same methotrexate-cytarabine-rituximab combination plus thiotepa 30 mg/m(2) on day 4 (group C), with the three groups repeating treatment every 3 weeks. Patients with responsive or stable disease after the first stage were then randomly allocated between whole-brain radiotherapy and autologous stem cell transplantation. A permuted blocks randomised design (block size four) was used for both randomisations, and a computer-generated randomisation list was used within each stratum to preserve allocation concealment. Randomisation was stratified by IELSG risk score (low vs intermediate vs high). No masking after assignment to intervention was used. The primary endpoint of the first randomisation was the complete remission rate, analysed by modified intention to treat. This study is registered with ClinicalTrials.gov, number NCT01011920. FINDINGS Between Feb 19, 2010, and Aug 27, 2014, 227 eligible patients were recruited. 219 of these 227 enrolled patients were assessable. At median follow-up of 30 months (IQR 22-38), patients treated with rituximab and thiotepa had a complete remission rate of 49% (95% CI 38-60), compared with 23% (14-31) of those treated with methotrexate-cytarabine alone (hazard ratio 0·46, 95% CI 0·28-0·74) and 30% (21-42) of those treated with methotrexate-cytarabine plus rituximab (0·61, 0·40-0·94). Grade 4 haematological toxicity was more frequent in patients treated with methotrexate-cytarabine plus rituximab and thiotepa, but infective complications were similar in the three groups. The most common grade 3-4 adverse events in all three groups were neutropenia, thrombocytopenia, anaemia, and febrile neutropenia or infections. 13 (6%) patients died of toxicity. INTERPRETATION With the limitations of a randomised phase 2 study design, the IELSG32 trial provides a high level of evidence supporting the use of MATRix combination as the new standard chemoimmunotherapy for patients aged up to 70 years with newly diagnosed primary CNS lymphoma and as the control group for future randomised trials. FUNDING Associazione Italiana del Farmaco, Cancer Research UK, Oncosuisse, and Swiss National Foundation.
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Affiliation(s)
- Andrés J M Ferreri
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Kate Cwynarski
- Royal Free Hospital/University College London Hospital, London, UK
| | | | - Maurilio Ponzoni
- Ateneo Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Deckert
- Institute of Neuropathology, University Hospital of Cologne, Cologne, Germany
| | - Letterio S Politi
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valter Torri
- IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | | | - Achille Ambrosetti
- Dipartimento di Medicina, Sezione di Ematologia, Università di Verona, Verona, Italy
| | | | | | - Angela Ferrari
- Azienda Ospedaliera Arcispedale Santa Maria Nuova IRCCS, Reggio Emilia, Italy
| | - Kim M Linton
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Roberta Rudà
- AOU Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - Mascha Binder
- Uke Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | - Peter Johnson
- Medical Oncology Unit, Southampton General Hospital, Southampton, UK
| | | | | | - Jens Panse
- Department of Oncology, Hematology, Hemostaseology and Stem Cell Transplantation, University Hospital Aachen, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Francesco Pisani
- Hematology and Stem Cell Transplantation Unit, Istituto Nazionale dei Tumori Regina Elena, Rome, Italy
| | | | | | | | | | | | | | | | - Franco Cavalli
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
| | | | - Michele Reni
- Department of Medical Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Zucca
- Istituto Oncologico Della Svizzera Italiana, Bellinzona, Switzerland
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Natarajan A, Arksey N, Iagaru A, Chin FT, Gambhir SS. Validation of 64Cu-DOTA-rituximab injection preparation under good manufacturing practices: a PET tracer for imaging of B-cell non-Hodgkin lymphoma. Mol Imaging 2016; 14. [PMID: 25762106 DOI: 10.2310/7290.2014.00055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Manufacturing of 64Cu-1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-rituximab injection under good manufacturing practices (GMP) was validated for imaging of patients with CD20+ B-cell non-Hodgkin lymphoma. Rituximab was purified by size exclusion high performance liquid chromatography (HPLC) and conjugated to DOTA-mono-(N-hydroxysuccinimidyl) ester. 64CuCl2, buffers, reagents, and other raw materials were obtained as high-grade quality. Following a semi-automated synthesis of 64Cu-DOTA-rituximab, a series of quality control tests was performed. The product was further tested in vivo using micro-positron emission tomography/computed tomography (PET/CT) to assess targeting ability towards human CD20 in transgenic mice. Three batches of 64Cu-DOTA-rituximab final product were prepared as per GMP specifications. The radiolabeling yield from these batches was 93.1 ± 5.8%; these provided final product with radiopharmaceutical yield, purity, and specific activity of 59.2 ± 5.1% (0.9 ± 0.1 GBq of 64Cu), > 95% (by HPLC and radio-thin layer chromatography), and 229.4 ± 43.3 GBq/µmol (or 1.5 ± 0.3 MBq/µg), respectively. The doses passed apyrogenicity and human serum stability specifications, were sterile up to 14 days, and retained > 60% immunoreactivity. In vivo micro-PET/CT mouse images at 24 hours postinjection showed that the tracer targeted the intended sites of human CD20 expression. Thus, we have validated the manufacturing of GMP grade 64Cu-DOTA-rituximab for injection in the clinical setting.
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27
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Rentas Torres Y, Rodríguez-López JL, Valentin M, Silva H. Difficult Diagnosis between B Cell Lymphoma and Classical Hodgkin's Lymphoma. Bol Asoc Med P R 2015; 107:98-101. [PMID: 26742206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Although primary mediastinal large B-cell lymphoma and classic Hodgkin lymphoma of nodular sclerosis type are distinct disease, they share several clinical characteristics and biologic features. However, there are mediastinal lymphomas that not fit in either category. These types of lymphomas are recognized as mediastinal gray zone lymphomas. Gray zone lymphomas are lymphatic tumors that cannot be assigned to a defined lymphoma entity due to morphological, clinical, or genetic reasons. In this report, we present a case of a 22 year-old-Hispanic-female diagnosed with B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Hodgkin lymphoma.
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MESH Headings
- Antigens, Differentiation, B-Lymphocyte/analysis
- Antigens, Neoplasm/analysis
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- B-Lymphocytes/chemistry
- B-Lymphocytes/pathology
- Bone Marrow/pathology
- Cough/etiology
- Cyclophosphamide/administration & dosage
- Delayed Diagnosis
- Diagnosis, Differential
- Disease Management
- Doxorubicin/administration & dosage
- Dyspnea/etiology
- Female
- Hodgkin Disease/diagnosis
- Humans
- Lymph Nodes/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Mediastinal Neoplasms/diagnosis
- Mediastinal Neoplasms/diagnostic imaging
- Mediastinal Neoplasms/drug therapy
- Mediastinal Neoplasms/pathology
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Puerperal Disorders/diagnosis
- Rituximab/therapeutic use
- Tomography, X-Ray Computed
- Vincristine/administration & dosage
- Young Adult
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Krol EM, Ogrodnik A, Sieber S, Chronakos J, Mahfoozi AP. Unusual Case of Isolated Pleural B-Cell Lymphoma. Conn Med 2015; 79:347-349. [PMID: 26263715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Pleural involvement in lymphoma is rare as the initial presentation of disease in the immunocompetent patient. We describe a rare case of primary, isolated pleural B-cell lymphoma in a 75-year-old female, previously treated for adenocarcinoma of the left lung with lobectomy and chemotherapy, who presented with shortness of breath. A CT scan of the chest revealed a right-sided pleural effusion and pleural thickening. She underwent multiple nondiagnostic thoracenteses. A subsequent surgical biopsy was diagnostic of large B-cell lymphoma.
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Novelli S, Briones J, Flotats A, Sierra J. PET/CT Assessment of Follicular Lymphoma and High Grade B Cell Lymphoma - Good Correlation with Clinical and Histological Features at Diagnosis. ADV CLIN EXP MED 2015; 24:325-30. [PMID: 25931367 DOI: 10.17219/acem/31804] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 12/23/2022]
Abstract
BACKGROUND Follicular lymphoma is a common type of non-Hodgkin's lymphoma observed in Western countries. The diagnosis of this disease is based primarily on morphological and immunohistochemical assessment. The proliferative index Ki67 correlates with histological grading and clinical aggressiveness. Currently, positron emission tomography/computed tomography scanning are not applied for standard staging at diagnosis of follicular lymphoma and its use is limited to those patients for whom the identification of residual disease is crucial for therapeutic decisions and only when transformation to a high-grade lymphoma is suspected. OBJECTIVES Our aim was to assess whether a correlation exists between the maximal standardized uptake value (SUVmax) at the biopsy site as detected via positron emission tomography/computed tomography and pathological (Ki67 and FL histological grade) and clinico-biological features (e.g. LDH, beta-2-microglobulin, Ann Arbor stage and FL International Prognostic Index--FLIPI) at diagnosis. MATERIAL AND METHODS We retrospectively identified 16 patients during the previous 3.5 years in whom node biopsies were guided, taking into account the SUVmax as detected upon PET/CT scan at diagnosis. The results of these biopsies were diagnostic of follicular lymphoma. We also included 6 patients with high grade B cell lymphoma: 5 diffuse large B cell lymphoma (DLBCL) and 1 FL 3b histological grade. A 2-tailed non-parametric Spearman's correlation analysis of the SUVmax with Ki67, histological grade, LDH and b-2-microglobuline was performed. RESULTS The Ki67 (r=0.73) and follicular lymphoma histological grade (r=0.75) at the biopsy displayed a significant correlation with the SUVmax at diagnosis (p<0.01). CONCLUSIONS Our results suggest that SUV detected by positron emission tomography/computed tomography correlates with histological grade in follicular lymphoma/high grade B cell lymphoma, Ki67 and LDH. Positron emission tomography/computed tomography should be considered for guiding lymph node biopsy when transformation to a high-grade B cell lymphoma is suspected.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy
- Female
- Humans
- Immunohistochemistry
- Ki-67 Antigen/analysis
- L-Lactate Dehydrogenase/analysis
- Lymph Nodes/chemistry
- Lymph Nodes/diagnostic imaging
- Lymph Nodes/pathology
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/chemistry
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/diagnostic imaging
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Multimodal Imaging
- Neoplasm Grading
- Positron-Emission Tomography
- Predictive Value of Tests
- Retrospective Studies
- Tomography, X-Ray Computed
- beta 2-Microglobulin/analysis
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Affiliation(s)
- Silvana Novelli
- Department of Hematology, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
| | - Javier Briones
- Department of Hematology, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
| | - Albert Flotats
- Nuclear Medicine, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
| | - Jorge Sierra
- Department of Hematology, Hospital of the Holy Cross and Saint Paul, Barcelona, Spain
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Zaibi H, Ourari-Dhahri B, Azzebi S, Ben Amar J, Baccar MA, El Gharbi L, Aouina H, Bouacha H. High-grade primary lymphoma of the lung and hypercalcaemia. A case report. Tunis Med 2015; 93:115-117. [PMID: 26337317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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31
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Poletti V, Gurioli C, Piciucchi S, Rossi A, Ravaglia C, Dubini A, Asioli S, Casoni GL. Intravascular large B cell lymphoma presenting in the lung: the diagnostic value of transbronchial cryobiopsy. Sarcoidosis Vasc Diffuse Lung Dis 2015; 31:354-358. [PMID: 25591148] [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] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/03/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND OBJECTIVE intravascular large B-cell lymphoma is a distinct subtype of mature B-cell neoplasms, with uncommon primary presentation in the lungs. Diagnosis could be very difficult due to the lack of detectable tumor masses and it is usually made by surgical lung biopsy or autopsy examination. METHODS two patients occurred primarily with interstitial lung disease and underwent a pulmonary biopsy using cryoprobes. RESULTS the pathological analysis of the lung biopsies revealed in both cases a conclusive diagnosis of intravascular large B-cell lymphoma with primary lung involvement and patients have been safely diagnosed using transbronchial cryobiopsy for the first time in the literature. CONCLUSIONS transbronchial cryobiopsy could be used as valid surrogate for surgical lung biopsy in lymphoprolipherative lung disorders (including intravascular lymphomas), as allows larger samples of tissue, greater diagnostic yield, no crush artifacts and much less complications than surgical biopsy.
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Affiliation(s)
- Venerino Poletti
- Department of Diseases of the Thorax Ospedale GB Morgagni, Forlì (I).
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Abstract
A 56-year-old woman with rheumatoid arthritis treated with methotrexate (MTX) was admitted to our hospital due to multiple liver tumors. Contrast-enhanced computed tomography (CT) revealed multiple hypovascular masses, and 18F-fluorodeoxyglucose positron emission tomography CT showed diffuse abnormal accumulation in the liver only. We therefore made a diagnosis of MTX-related primary hepatic lymphoma (MTX-PHL) exhibiting features of diffuse large B-cell lymphoma. Although MTX has been reported to increase the risk of lymphoproliferative disorders, MTX-PHL has not been reported previously. The present case is the first case in which MTX appears to have been involved in the development of PHL.
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Affiliation(s)
- Koichiro Miyagawa
- The Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
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33
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Dhull VS, Mukherjee A, Karunanithi S, Durgapal P, Bal C, Kumar R. Bilateral primary renal lymphoma in a pediatric patient: staging and response evaluation with ¹⁸F-FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2014; 34:49-52. [PMID: 25065972 DOI: 10.1016/j.remn.2014.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/14/2014] [Accepted: 05/18/2014] [Indexed: 11/19/2022]
Abstract
Primary renal lymphoma (PRL) is a rare disease. We here present the case of an 8-year-old child who presented with bilateral renal masses. On biopsy, it was confirmed to be B-cell non-Hodgkin's lymphoma. (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET/CT) for staging demonstrated (18)F-FDG avid bilateral renal masses, with no other abnormal focus. Follow up (18)F-FDG PET/CT showed complete resolution of the disease after six cycles of chemotherapy. Here we have highlighted the potential role of (18)F-FDG PET/CT in staging and response evaluation of a patient with PRL and presented a brief review.
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Affiliation(s)
- V S Dhull
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A Mukherjee
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - S Karunanithi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - P Durgapal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - C Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - R Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.
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34
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Affiliation(s)
- Jamil Hajj-Chahine
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Charles Uzan
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
| | - Pierre Corbi
- Department of Cardiothoracic Surgery, University Hospital of Poitiers, Poitiers, France
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35
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Xiao D, Fu C, Long X, Liu W, Chen C, Zhou J, Fan S. Lung intravascular large B-cell lymphoma with ground glass opacities on chest computed tomography: a case report. Int J Clin Exp Pathol 2014; 7:5285-90. [PMID: 25197411 PMCID: PMC4152101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/01/2014] [Indexed: 06/03/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumina of vessels, particularly within capillaries, with exception of larger arteries and veins. The authors reported a case of a 45-year-old woman who was admitted in hospital with refractory fever, cough and progressive dyspnea despite of receiving broad-spectrum antibiotics. Computed tomography (CT) of the lung showed bilateral patchy ground-glass opacities with some pleural effusion in the left lung. A CT-guided percutaneous lung biopsy was performed and primary pulmonary intravascular large B-cell lymphoma was diagnosed by histopathology, immunophenotype and fluorescence in situ hybridization. The patient's general status was improved after chemotherapy with R-CHOP. CT-guided percutaneous biopsy of lung is a safe and accurate diagnostic procedure in IVLBCL.
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Affiliation(s)
- Desheng Xiao
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Chunyan Fu
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Xueying Long
- Department of Radiology, Xiangya Hospital, Central South UniversityHunan, China
| | - Wei Liu
- Department of Oncology, Xiangya Hospital, Central South UniversityHunan, China
| | - Chen Chen
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Jianhua Zhou
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Songqing Fan
- Department of Pathology, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China
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36
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Affiliation(s)
- Edith Vassallo
- Department of Medical Imaging, Mater Dei Hospital, Msida, Malta
| | | | - Reuben Grech
- Department of Medical Imaging, Mater Dei Hospital, Msida, Malta
| | - Adrian Mizzi
- Department of Radiology, Mater Dei Hospital, Msida, Malta
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37
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38
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Marshall ADL, Miller DR, Smith LJ, Chetty M, Currie GP. A patient with concurrent primary lung cancer and lymphoma diagnosed using endobronchial ultrasound. QJM 2013; 106:389-90. [PMID: 23389432 DOI: 10.1093/qjmed/hct045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The use of sensitive and specific imaging techniques for accurate initial staging and evaluation of response to therapy in patients with lymphoma is essential for their optimal management. Fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) integrated with computed tomography (CT) has emerged as a powerful imaging tool and is being routinely used in staging, response evaluation, and posttreatment surveillance in patients with non-Hodgkin lymphoma and Hodgkin lymphoma. PET/CT is currently widely used in clinical practice, but the established clinical benefit is currently restricted to the posttreatment evaluation of Hodgkin lymphoma, diffuse large B-cell lymphoma, and follicular lymphoma. Although used in other histologic subtypes and in other clinical situations including response assessment, its impact on patient outcome remains to be demonstrated. We performed a literature search of PubMed from 1999 to 2011 using the following keywords: PET scan, FDG-PET, PET/CT, lymphoma. This review addresses the challenges and controversies in the use of PET/CT scans in the management of patients with lymphoma.
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Key Words
- abvd, doxorubicin, bleomycin, vinblastine, dacarbazine
- beacopp, bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone
- ct, computed tomography
- dlbcl, diffuse large b-cell lymphoma
- fdg, fluorine 18 fluorodeoxyglucose
- flt, fluoro-l-thymidine
- fuo, fever of unknown origin
- ifrt, involved-field radiotherapy
- ihp, international harmonization project
- pet, positron emission tomography
- r-chop, rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone
- rt, radiotherapy
- suv, standardized uptake value
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Affiliation(s)
| | - James O. Armitage
- Department of Internal Medicine, Division of Hematology/Oncology, University of Nebraska Medical Center, Omaha
- Correspondence: Address to James O. Armitage, MD, Department of Internal Medicine, Division of Hematology/Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198-7680
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40
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Shah RN, Simmons TW, Carr JJ, Entrikin DW. Primary cardiac lymphoma diagnosed by multiphase-gated cardiac CT and CT-guided percutaneous trans-sternal biopsy. J Cardiovasc Comput Tomogr 2012; 6:137-9. [PMID: 22398010 DOI: 10.1016/j.jcct.2011.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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] [Received: 10/03/2011] [Revised: 11/26/2011] [Accepted: 12/27/2011] [Indexed: 11/18/2022]
Abstract
We present a case of a primary cardiac B-cell lymphoma where a multiphase-gated cardiac CT exam helped to successfully guide trans-sternal needle biopsy to establish a tissue diagnosis.
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Affiliation(s)
- Ripal N Shah
- Department of Radiology, Section on Cardiology, Wake Forest University School of Medicine Medical Center Boulevard, Winston-Salem, NC 27157-1088, USA
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41
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Rizvi SNF, Visser OJ, Vosjan MJWD, van Lingen A, Hoekstra OS, Zijlstra JM, Huijgens PC, van Dongen GAMS, Lubberink M. Biodistribution, radiation dosimetry and scouting of 90Y-ibritumomab tiuxetan therapy in patients with relapsed B-cell non-Hodgkin's lymphoma using 89Zr-ibritumomab tiuxetan and PET. Eur J Nucl Med Mol Imaging 2012; 39:512-20. [PMID: 22218876 PMCID: PMC3276758 DOI: 10.1007/s00259-011-2008-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/15/2011] [Indexed: 11/26/2022]
Abstract
Purpose Positron emission tomography (PET) with 89Zr-ibritumomab tiuxetan can be used to monitor biodistribution of 90Y-ibritumomab tiuxetan as shown in mice. The aim of this study was to assess biodistribution and radiation dosimetry of 90Y-ibritumomab tiuxetan in humans on the basis of 89Zr-ibritumomab tiuxetan imaging, to evaluate whether co-injection of a therapeutic amount of 90Y-ibritumomab tiuxetan influences biodistribution of 89Zr-ibritumomab tiuxetan and whether pre-therapy scout scans with 89Zr-ibritumomab tiuxetan can be used to predict biodistribution of 90Y-ibritumomab tiuxetan and the dose-limiting organ during therapy. Methods Seven patients with relapsed B-cell non-Hodgkin’s lymphoma scheduled for autologous stem cell transplantation underwent PET scans at 1, 72 and 144 h after injection of ~70 MBq 89Zr-ibritumomab tiuxetan and again 2 weeks later after co-injection of 15 MBq/kg or 30 MBq/kg 90Y-ibritumomab tiuxetan. Volumes of interest were drawn over liver, kidneys, lungs, spleen and tumours. Ibritumomab tiuxetan organ absorbed doses were calculated using OLINDA. Red marrow dosimetry was based on blood samples. Absorbed doses to tumours were calculated using exponential fits to the measured data. Results The highest 90Y absorbed dose was observed in liver (3.2 ± 1.8 mGy/MBq) and spleen (2.9 ± 0.7 mGy/MBq) followed by kidneys and lungs. The red marrow dose was 0.52 ± 0.04 mGy/MBq, and the effective dose was 0.87 ± 0.14 mSv/MBq. Tumour absorbed doses ranged from 8.6 to 28.6 mGy/MBq. Correlation between predicted pre-therapy and therapy organ absorbed doses as based on 89Zr-ibritumomab tiuxetan images was high (Pearson correlation coefficient r = 0.97). No significant difference between pre-therapy and therapy tumour absorbed doses was found, but correlation was lower (r = 0.75). Conclusion Biodistribution of 89Zr-ibritumomab tiuxetan is not influenced by simultaneous therapy with 90Y-ibritumomab tiuxetan, and 89Zr-ibritumomab tiuxetan scout scans can thus be used to predict biodistribution and dose-limiting organ during therapy. Absorbed doses to spleen were lower than those previously estimated using 111In-ibritumomab tiuxetan. The dose-limiting organ in patients undergoing stem cell transplantation is the liver.
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Affiliation(s)
- Saiyada N F Rizvi
- Department of Nuclear Medicine and PET Research, VU University Medical Center, Amsterdam, The Netherlands.
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42
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Jedliński I, Jamrozek-Jedlińska M, Bugajski P, Pyda M, Poprawski K. [Massive infiltration of the right vetricular wall caused by large B-cell lymphoma]. Kardiol Pol 2012; 70:732-734. [PMID: 22825952] [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: 06/01/2023]
Abstract
We presented a case of symptomatic secondary cardiac B-cell lymphoma localised in the free wall of the right ventricle (RV). It was detected during transthoracic echocardiography and confirmed by nuclear magnetic resonance imaging. The RV free wall motion abnormalities, decreased dimensions of RV and small pericardial effusion were found. The tumour dimensions declined after the first cycle of chemiotherapy with antracyclins.
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43
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Zhang JJ, Zhang JS, Han ZH, Li Q, Zhang YP, Zhang GC. [Leucoma complicated by severe abdominal distension as first presentation in a child]. Zhongguo Dang Dai Er Ke Za Zhi 2011; 13:1001-1002. [PMID: 22172271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Jing-Jing Zhang
- Department of Pediatrics, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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44
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Sjögreen-Gleisner K, Dewaraja YK, Chiesa C, Tennvall J, Lindén O, Strand SE, Ljungberg M. Dosimetry in patients with B-cell lymphoma treated with [(90)Y]ibritumomab tiuxetan or [(131)I]tositumomab. Q J Nucl Med Mol Imaging 2011; 55:126-54. [PMID: 21386787] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Radioimmunotherapy involves the use of radiolabeled monoclonal antibodies (MAbs) to treat malignancy. The therapeutic effect is determined by the radiopharmaceutical, the radiation absorbed dose and previous treatments. There are currently two approved radiopharmaceuticals for the treatment of B-cell lymphoma - the (90)Y-labeled ibritumomab and the (131)I-labeled tositumomab. Both are directed against CD20, albeit not against the same epitope. This paper summarizes current results of dose-responses for normal tissues and tumours of [(131)I]tositumomab and [(90)Y]ibritumomab tiuxetan, discusses them in the context of dosimetry methods used and highlights the assumptions being made in the different dosimetry methodologies. Moreover, we wish to point at the possibility of performing low-cost therapy bremsstrahlung imaging for [(90)Y]ibritumomab tiuxetan to confirm biodistribution, and possibly also for dosimetric calculations.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/pharmacokinetics
- Antibodies, Monoclonal/therapeutic use
- Antigens, CD20/metabolism
- Bone Marrow/radiation effects
- Dose-Response Relationship, Radiation
- Female
- Humans
- Iodine Radioisotopes/administration & dosage
- Iodine Radioisotopes/therapeutic use
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/radiotherapy
- Male
- Radioimmunotherapy/methods
- Radiopharmaceuticals/administration & dosage
- Radiopharmaceuticals/pharmacokinetics
- Radiopharmaceuticals/therapeutic use
- Radiotherapy Planning, Computer-Assisted
- Tomography, Emission-Computed, Single-Photon
- Tomography, X-Ray Computed
- Yttrium Radioisotopes/administration & dosage
- Yttrium Radioisotopes/pharmacokinetics
- Yttrium Radioisotopes/therapeutic use
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45
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Tan S, Özcan AŞ, Akçay E, Süngü N. Sonographic appearance of primary lacrimal sac lymphoma. J Ultrasound Med 2011; 30:574-575. [PMID: 21460158 DOI: 10.7863/jum.2011.30.4.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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46
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Alsinnawi M, Quinlan M, Brady A, Khan N. An unusual pelvic mass: bladder lymphoma. JBR-BTR 2011; 94:40. [PMID: 21466068 DOI: 10.5334/jbr-btr.489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- M Alsinnawi
- Department of Urology, Mercy University Hospital, Cork, Ireland
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47
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Weng SC, Shu KH, Wen MC, Cheng CH, Wu MJ, Yu TM, Chuang YW, Chen CH. Malignant lymphoma of the kidney mimicking rapid progressive glomerulonephritis. Clin Nephrol 2010; 74:480-484. [PMID: 21084053] [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: 05/30/2023] Open
Abstract
Primary renal lymphoma (PRL) is rare and often presents as rapidly progressive renal failure. Most cases of PRL are large-cell lymphomas of B-cell lineage. Herein, we report a 75-year-old female patient with infiltrative CD20 (+) B-cell lymphoma who underwent 4 consecutive courses of chemotherapy with R-CVP (rituximab, cyclophosphamide, vincristine, and prednisone) and after 12 sessions became free from hemodialysis in good general condition. Her serum creatinine level gradually decreased to 4.1 mg/dl with adequate urine output. Unfortunately, a relapse of CD20 (-) lymphoma developed rapidly involving other organs. She died with severe hospital-acquired pneumonia and febrile neutropenia after the last chemotherapy with R-MINE almost 1 year after onset of symptoms. We conclude that renal biopsy enables prompt diagnosis in rapidly progressive renal failure and immunophenotyping and also staging workup of the lymphoma in case of positive biopsy. Though rituximab improved response rate of PRL, it reduced expression of CD20. This may relate to frequent relapse/resistance after rituximab therapy and poor long-term patient survival.
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Affiliation(s)
- S-C Weng
- Division of Nephrology, Department of Internal Medicine, Tunghai University, Taichung, Taiwan
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48
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Affiliation(s)
- Dahlia Elkadi
- Cancer Center, Montefiore Medical Center, North Division, Bronx, New York, USA
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49
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Ceylan Gunay E, Erdogan A, Apaydin D. Unusual extraosseous tumoral accumulation of 99mTc-MDP in non-Hodgkin's lymphoma in two cases. ACTA ACUST UNITED AC 2010; 30:162-4. [PMID: 20580467 DOI: 10.1016/j.remn.2010.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 02/12/2010] [Accepted: 04/03/2010] [Indexed: 11/19/2022]
Abstract
The authors describe a rare pattern of soft tissue uptake observed in a (99m)Tc-MDP bone scintigraphy of two patients with the diagnosis of non-Hodgkin's lymphoma. Both patients had abdominal masses and bone scintigraphy revealed unusual (99m)Tc-MDP uptake in the abdominal region. The possible mechanisms of soft tissue uptake of bone seeking agents are discussed.
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Affiliation(s)
- E Ceylan Gunay
- Mersin University, Faculty of Medicine, Department of Nuclear Medicine, Turkey.
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50
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Ribeiro A, Pereira D, Escalón MP, Goodman M, Byrne GE. EUS-guided biopsy for the diagnosis and classification of lymphoma. Gastrointest Endosc 2010; 71:851-5. [PMID: 20363431 DOI: 10.1016/j.gie.2009.12.033] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [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] [Received: 09/01/2009] [Accepted: 12/16/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND EUS-guided FNA and Tru-cut biopsy (TCB) is highly accurate in the diagnosis of lymphoma. Subclassification, however, may be difficult in low-grade non-Hodgkin lymphoma and Hodgkin lymphoma. OBJECTIVE To determine the yield of EUS-guided biopsy to classify lymphoma based on the World Health Organization classification of tumors of hematopoietic lymphoid tissues. DESIGN Retrospective study. SETTING Tertiary referral center. PATIENTS A total of 24 patients referred for EUS-guided biopsy who had a final diagnosis of lymphoma or "highly suspicious for lymphoma." INTERVENTIONS EUS-guided FNA and TCB combined with flow cytometry (FC) analysis. MAIN OUTCOMES MEASUREMENT: Lymphoma subclassification accuracy of EUS guided biopsy. RESULTS Twenty-four patients were included in this study. Twenty-three patients underwent EUS-FNA, and 1 patient had only TCB. Twenty-two underwent EUS-TCB combined with FNA. EUS correctly diagnosed lymphoma in 19 out of 24 patients (79%), and subclassification was determined in 16 patients (66.6%). Flow cytometry correctly identified B-cell monoclonality in 95% (18 out of 19). In 1 patient diagnosed as having marginal-zone lymphoma by EUS-FNA/FC only, the diagnosis was changed to hairy cell leukemia after a bone marrow biopsy was obtained. EUS had a lower yield in nonlarge B-cell lymphoma (only 9 out of 15 cases [60%]) compared with large B-cell lymphoma (78%; P = .3 [Fisher exact test]). LIMITATIONS Retrospective, small number of patients. CONCLUSION EUS-guided biopsy has a lower yield to correctly classify Hodgkin lymphoma and low-grade lymphoma compared with high-grade diffuse large B-cell lymphoma.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biopsy, Fine-Needle
- Bone Marrow/pathology
- Endosonography
- Female
- Flow Cytometry
- Hodgkin Disease/classification
- Hodgkin Disease/diagnostic imaging
- Hodgkin Disease/pathology
- Humans
- Leukemia, Hairy Cell/diagnostic imaging
- Leukemia, Hairy Cell/pathology
- Lymphoma/classification
- Lymphoma/diagnostic imaging
- Lymphoma/pathology
- Lymphoma, B-Cell/classification
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/classification
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Non-Hodgkin/classification
- Lymphoma, Non-Hodgkin/diagnostic imaging
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Retrospective Studies
- Sensitivity and Specificity
- Ultrasonography, Interventional
- Young Adult
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Affiliation(s)
- Afonso Ribeiro
- Division of Gastroenterology, Miller School of Medicine, University of Miami, Miami, Florida 33101, USA.
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