Different Types Of Lymphoma Research Articles

Immunohistochemical Profile of Hodgkin and Non-Hodgkin Lymphoma.

To analyze the frequencies of histological types of lymphoma, diagnosed with complete immunohistochemical profile in younger and older age group. Cross-sectional analytical study. Dow Diagnostic Research and Reference Laboratory, Dow University of Health Sciences, Karachi, from January 2009 to September 2013. Consecutive cases of lymphomas, which were diagnosed using immunohistochemistry, were analyzed according to WHO classification. Frequency and percentages for different types of lymphomas were calculated. Hodgkin and non-Hodgkin lymphomas characteristics in two age groups of less than and more than 40 years were compared, applying chi-square test. Out of the 318 cases, 79 (25%) were Hodgkin Lymphomas (HL) and 239 (75%) were Non-Hodgkin Lymphomas (NHL). Mixed Cellularity Hodgkin Lymphoma (MCHL) was the commonest (n=48). Amongst the NHL, 215 (89.95%) were B cell lymphomas and 24 (10.05%) were T-cell lymphomas. Diffuse Large B-Cell Lymphoma (DLBCL) was the commonest lymphoma (n=165, 69.95% of NHL). Anaplastic T-Cell Lymphoma (ALCL, n=10) was the commonest T-cell lymphoma. The frequency of HLwas significantly higher in the younger age group and that of NHLwas higher in the older age group (p < 0.001). Primary lymph node involvement was reported in 175 (55%) and cervical lymph node was the most frequent site. Extra nodal involvement was seen in 93 (29%) of all cases and was reported in 87 (36.4%) of NHLand 6 (7.5%) of HL. The most common extra nodal site was the gastrointestinal tract. Hodgkin lymphoma comprises 25% and non-Hodgkin lymphoma comprises 75% of all lymphomas. Both occur in younger age groups than reported in the West. B-cell NHLis three times more common than T-cell lymphoma. DLBCLis the most frequent lymphoma. ALCLis the most common T-cell, and mixed cellularity is the most common Hodgkin lymphoma.

Malignant lymphoma in Hadhramout Sector, Yemen: a retrospective study of 170 cases classified according to the WHO classification

Introduction Malignant lymphoma is a primary neoplasm of lymphoid tissue. It is the third most common cancer in children worldwide. There are two broad categories of malignant lymphomas: non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL). Both have different microscopic features, follow different treatment modalities, and have different prognoses. Aim of the work The aim of the study was to determine the different types of lymphoma in all age groups, and find its relation to sex and site of lymph node involvement in Hadhramout Governorate. Materials and methods This is a retrospective descriptive study of 170 cases of lymphomas retrieved from the archives of the National Oncology Center, Hadhramout, during the period between 2008 and 2013. The diagnosis was assessed with immunohistochemical results and categorized according to the WHO classification of lymphoid neoplasms. Results Out of 170 patients, 116 (68.2%) had NHL and 54 (31.8%) had HL. A male predominance was observed (103/170, 60.6%). B-cell lymphomas were the most frequent type of NHL (95/116, 81.9%) and diffuse large B-cell lymphoma was the most common pattern of NHL (58/95, 61.1%), followed by Burkitt's lymphoma (20/95, 21.1%). The distribution of HL showed predominance of nodular sclerosis classical HL (38/54, 70.4%). The proportion of lymph node involvement of lymphomas was higher than extranodal involvement, being seen in 91/116 cases (78.5%) of all NHLs and 49/54 cases (90.8%) of all HLs. Conclusion NHL is the most common type of malignant lymphoma, and diffuse large B-cell lymphoma is the most common pattern among all NHL types, whereas nodular sclerosis classical HL is the most common type of HL. The nodal involvement of malignant lymphoma is higher than extranodal involvement.

Hepatitis C virus - associated B cell non-Hodgkin's lymphoma.

The hepatitis C virus (HCV) infected patients are prone to develop bone marrow or various tissue infiltrates with monoclonal B cells, monoclonal B lymphocytosis or different types of B cell non-Hodgkin's lymphoma (BCNHL), of which the most common are splenic marginal zone BCNHL, diffuse large BCNHL and follicular lymphoma. The association between chronic HCV infection and non Hodgkin's lymphoma has been observed especially in areas with high prevalence of this viral infection. Outside the limitations of some studies that have been conducted, there are also geographic, environmental, and genetic factors that contribute to the epidemiological differences. Various microenvironmental signals, such as cytokines, viral antigenic external stimulation of lymphocyte receptors by HCV antigens, and intercellular interactions contribute to B cell proliferation. HCV lymphotropism and chronic antigenic stimulation are involved in B-lymphocyte expansion, as mixted cryoglobulinemia or monoclonal gammopathy of undetermined significance, which can progress to BCNHL. HCV replication in B lymphocytes has oncogenic effect mediated by intracellular HCV proteins. It is also involved in an important induction of reactive oxygen species that can lead to permanent B lymphocyte damage, as DNA mutations, after binding to surface B-cell receptors. Post-transplant lymphoproliferative disorder could appear and it has a multiclonal potentiality that may develop into different types of lymphomas. The hematopoietic stem cell transplant made for lymphoma in HCV-infected patients can increase the risk of earlier progression to liver fibrosis and cirrhosis. HCV infected patients with indolent BCNHL who receive antiviral therapy can be potentially cured. Viral clearance was related to lymphoma response, fact that highlights the probable involvement of HCV in lymphomagenesis. Direct acting antiviral drugs could be a solution for the patients who did not tolerate or respond to interferon, as they seem to be safe and highly effective. The use of chemotherapy in combination with rituximab for the treatment of BCNHL in patients infected with HCV can produce liver dysfunction. The addition of immunotherapy with rituximab can increase the viral replication, and severe complications can occure especially in patients co-infected with hepatitis B virus or immune immunodeficiency virus, in those with hepatocarcinoma, cirrhosis, or liver cytolysis. But the final result of standard immunochemotherapy applied to diffuse large BCNHL patients with HCV infection is not notably worse than in those without this viral infection. The treatment of patients chronically infected with HCV and having BCNHL is complex and requires a multidisciplinary approach and the risk / benefit ratio of rituximab treatment must be evaluated especially in those with liver cytolysis.

Correlation Between Tumor-Associated Macrophage and Inflammatory Factors in Lymphoma Patients

IntroductionTo study the expression of tumor associated macrophage (TAMs), inflammatory cytokines IL-1β (interleukin-lβ), TNF-α (tumor necrosis factor-α), IL-6 (interleukin 6) and IL-10 (interleukin 10) and its significance in different types of lymphoma in lymph node pathological tissue.Methods106 cases of clinical pathology specimens of patients were collected from different types and different staging classifications. The expressions of tumor-associated macrophage and interleukin-1β (IL-1β), tumor nec.rosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-10 (IL-10) in lymphoma tissues were detected by immunohistochemical staining;ResultsBoth CD68 and CSF-1R showed high expression in lymphoma tumor tissues. The positive rates of CD68 and CSF-1R in Ⅳ period patients was higher than Ⅱperiod (P <0.05), and the level of CSF-1R in high-risk group was higher than low-risk group (P <0.05). The expression of CD68 was positively correlated with CSF-1R. The inflammatory cytokines such as IL-1β, TNF-α, IL-6, IL-10 were highly expressed in tumor tissues; the positive rate of IL-1β in lymphoma IV period was higher than periodⅡ(P <0.05) and the level of IL- 6 in high-risk group were significantly higher than the low-risk group (P <0.05).The expression of tumor-associated macrophage phenotype CD68 in lymphoma tissues was positively correlated with inflammatory cytokines IL-1β, TNF-α, and IL-6 (P <0.05).Conclusion1.CD68, tumor-associated macrophage phenotype, and CSF-1R were highly expressed in lymphoma tissues2.The expression of CD68 was positively correlated with inflammatory cytokines.3.TAMs were involved in tumor inflammatory microenvironment.Funded by Jiangsu Provincial Special Program of Medical Science (BL2012005) DisclosuresNo relevant conflicts of interest to declare.

Immuno-PET Imaging of CD30-Positive Lymphoma Using 89Zr-Desferrioxamine-Labeled CD30-Specific AC-10 Antibody.

The CD30-specific antibody-drug conjugate, brentuximab vedotin, is approved for the treatment of relapsed, refractory Hodgkin lymphomas and systemic anaplastic large T-cell lymphomas. Multiple ongoing clinical trials are investigating brentuximab vedotin efficacy in other CD30-positive hematologic malignancies. Because CD30 expression varies among different types of lymphoma and can also change during the course of treatment, companion diagnostic imaging of CD30 could be a valuable tool in optimizing patient-specific brentuximab vedotin treatment regimens. The mouse antihuman CD30 antibody AC-10 was radiolabeled with the positron-emitting radionuclide (89)Zr. The stability and specificity of (89)Zr-desferrioxamine (DFO)-labeled CD30-specific AC-10 antibody ((89)Zr-DFO-AC-10) was evaluated in vitro. The pharmacokinetics of (89)Zr-DFO-AC-10 was studied in BALB/c nude mice bearing subcutaneous human Karpas 299 tumors (CD30-positive model) or A-431 tumors (CD30-negative model) using PET/CT imaging, biodistribution studies, and autoradiography. AC-10 was conjugated with a DFO B chelator and radiolabeled with (89)Zr to give formulated (89)Zr-DFO-AC-10 with a radiochemical yield of 80%, radiochemical purity greater than 99%, and specific activity of 111-148 MBq/mg. (89)Zr-DFO-AC-10 was stable in mouse and human sera and preserved the immunoreactivity toward CD30. Biodistribution data showed the highest tissue accumulation of (89)Zr-DFO-AC-10 in CD30-positive tumors, with 37.9% ± 8.2% injected activity per gram of tissue at 72 h after injection, whereas uptake in CD30-negative tumors was 11.0% ± 0.4%. The specificity of (89)Zr-DFO-AC-10 binding to CD30 in vivo was confirmed by blocking studies. Time-activity curves showed that between 24 and 144 h after injection, tumor-to-muscle ratios increased from 18.9 to 51.8 in the CD30-positive model and from 4.8 to 8.7 in the CD30-negative model. Tumor-to-blood ratios also increased, from 3.2 to 13.6 and from 1 to 2 in the CD30-positive and -negative models, respectively. Our results demonstrate that for measuring CD30 expression, (89)Zr-DFO-AC-10 is a sensitive PET agent with high tumor-to-normal-tissue contrast. (89)Zr-DFO-AC-10 is a promising CD30-imaging radiotracer for clinical translation in patients with various lymphomas and other diseases.

Composite Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma and Follicular Lymphoma

Introduction: Composite lymphoma is defined as the co-occurrence of two or, rarely, more than two morphologically and/or immunophenotypically different types of lymphoma in the same anatomic site. These lymphomas can arise synchronously or metachronously, and can be clonally related or unrelated. Different combinations of lymphomas have been reported, of which chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and follicular lymphoma …

VI. FDG-PET as a biomarker in lymphoma: from qualitative to quantitative analysis.

VI. FDG-PET as a biomarker in lymphoma: from qualitative to quantitative analysis.

Classical Hodgkin's lymphoma of the thyroid

Abstract Hodgkin's lymphoma is characterized by the presence of Reed–Sternberg cells. The majority of cases originate at nodal sites and only rarely does it occur in extranodal locations. Here we report a case of a woman with a classical Hodgkin's lymphoma of the thyroid developed from a Hashimoto thyroiditis. She presented with a mass in her thyroid which was surgically removed. Biopsy showed a nodular sclerosis classical Hodgkin's lymphoma. Our results were similar to previously reported cases. It would appear that the lesions grew over a MALT tissue created by the lymphoid proliferation of the thyroiditis. Differential diagnosis was made between the different types of lymphomas considering those most commonly occurring in extranodal lymphoid tissues. A final diagnosis was reached after consideration of the histopathology, immunophenotyping and molecular biology.

Distribution of nodal lymphomas in a referral hospital of Mangalore city.

The distribution of different types of lymphoma varies across geographic regions. The present study was done to understand the occurrence of nodal lymphomas in a referral hospital of Mangalore city. Descriptive study. The present study was conducted on 95 lymph node biopsy specimens, received in a referral hospital of Mangalore city. All cases of nodal lymphoma diagnosed between January 2007 and June 2010 in a referral hospital of Mangalore were selected for the study. The patients age and clinical details were obtained. Immunophenotyping was done for all cases of NHL and selected cases of HL. IPI score for NHL was noted and correlated with the outcome. Chi square test was used. Out of the total 95 cases of nodal lymphoma 37 (39%) were HL while 58 (61%) were NHL. Classical HL was diagnosed in 35 cases (37%) while 2 cases (2%) were diagnosed NLPHL. B cell lymphoma formed 72% of NHL. Follicular lymphoma accounted for 28% of all NHL. T cell lymphoma formed 28% of NHL. In conclusion the following points are significant about the distribution of lymphomas in a referral hospital of Mangalore city. The incidence of NSHL is higher while national data suggests MCHL as the most common subtype. The incidence of FL as well as T cell NHL is much higher when compared to national incidence. The epidemiological factors for this high frequency (either genetic or environmental) needs to be studied further.

BETA-2 MICROGLOBULIN: A NOVEL BIO-MARKER ASSISTING IN THE DIAGNOSIS OF LYMPHOMA: A STUDY OF 669 NEWLY DIAGNOSED LYMPHOMA CASES IN THE SOUTH OF IRAQ

Beta 2 microglobulin is a known marker used in the follow up and monitoring therapy of patients with hematological malignancies. However, its assistant role in the diagnosis of some of them, like lymphomas is less highlighted. Thus, this study was designed as a part of a larger, wide scale study, to clarify the help of B2MG in the support of the diagnosis of different types of lymphoma. A total of 669 newly diagnosed, pre-treated lymphoma cases were investigated for B2MG using the ELFA/mini VIDAS system and the results showed an elevated level of B2MG among both Hodgkin & non-Hodgkin, adults and childhood and nodal and extranodal lymphomas, with a significant increase among non-Hodgkin and extranodal type of lymphomas, a finding that may make its use as a diagnostic marker is helpful. Those results were comparable to some and contradicting to other studies. Further future studies are in need to consolidate this.

Diagnostic Value of protocadherin 15 on NK/T Cell Lymphoma

Objective: NK/T cell lymphoma is a unique subtype of non-Hodgkin’s lymphoma, accounting for 5% to 15% of lymphomas, and shows a prediction for the crowd of Asia, central and South America. Nasal, nasopharynx and oropharynx regions are commonly involved. Lesions may also occur in the upper respiratory tract, gastrointestinal tract, testis and other parts. Diagnosis of NK/T cell lymphoma is dependent on the pathological study of lesion biopsy specimens. Nevertheless, poor quantity or quality of specimens, such as tissue extensive necrosis often become an obstacle to the early diagnosis. Therefore, investigating an easy sampling, accurate and stable experimental marker has profound clinical significance for the diagnosis of NK / T-cell lymphoma.Protocadherin15 (PCDH15) is a member of the cadherin family, which encoding gene located on chromosome 10q21-22. Rouget-Quermalet found a secreted isoform PCDH15 in the cracking sediment of human YT-type NK/T-cell lymphoma cell lines 8 years ago. PCDH15 was found not expressed in fresh or activated normal peripheral blood cells, CD4/CD8 positive lymphocytes, NK cells, normal spleen, lymph nodes, tonsils reactivity and CD34 + cord blood cells, only specifically expressed in three kinds of NK cell lymphoma cell lines. PCDH15 was not expressed in the biopsies of diffuse large B-cell lymphoma, mantle cell lymphoma and other types of lymphoma, but specifically expressed in NK/T lymphoma biopsy tissues.Since PCDH15-SI was found in the human NK/T-cell lymphoma cell lines, its relationship with NK / T-cell lymphoma as well as other types of lymphoma was rarely reported, and studies of clinical specimens are still blank. The purpose of this study is to investigate what whether the PCDH15 is specifically expressed in NK/T-cell lymphoma biopsies, and whether the PCDH15-SI, as a secreted isoform, is specifically present in peripheral serum of newly diagnosed NK/T-cell lymphoma or not.Materials and methods: 1. Screening biopsy paraffin blocks of NK/T-cell lymphoma(2010.1～2013.10) and non-NK/T-cell lymphoma(2012.10～2013.11) in West China Hospital of Sichuan University, which have 45cases and 33 cases stained by immunohistochemistry respectively and blank controls were set.2. Collecting peripheral blood of NK/T-cell lymphoma, non-NK/T-cell lymphoma and normal population in the same Hospita. PCDH15 content of serum samples were detected by enzyme-linked immunosorbent content analysis (ELISA) method.Results: 1. Results of immunohistochemistry showed that PCDH15 were expressed both in the experimental group NK/T-cell lymphoma and the control group with non-NK/T cell lymphoma. High expression rate in the NK/T-cell lymphoma group was higher than in non-NK/T cell lymphoma. The differences of PCDH15 expression levels between the two groups, or among the different anatomical structures were not statistically significant (P > 0.05).2. PCDH15-SI can be detected in peripheral blood in the normal population, the experimental group of NK/T-cell lymphoma as well as in the control group of non-NK/T-cell lymphoma, which the level of PCDH15-SI in those patients with newly diagnosed disease was higher than that of the normal population and the serum level in the non-NK/T-cell lymphoma patients was higher than that in the NK/T-cell lymphoma patients(P < 0.05).Conclusions: 1. PCDH15 was expressed in biopsies of different types of lymphoma, and the degree of expression in NK/T-cell lymphoma was significantly higher.2. PCDH15 can’t be used to diagnose NK/T cell lymphoma as a marker. DisclosuresNo relevant conflicts of interest to declare.

Clinical implications of tumor necrosis factor-α in lymphomas

To investigate the levels of tumor necrosis factor-α (TNF-α) in tissue or plasma and its clinical implications in different types of lymphoma. The levels of TNF-α in paraffin tissue or plasma samples were detected by immunohistochemistry or ELISA assay in 88 lymphoma patients and 88 healthy controls. Univariate and multivariate Cox regression analysis were used to identify the correlation between Ann Ardor stage, blood cells count, bone marrow abnormalities, erythrocyte sedimentation rate (ESR), serum ferritin and TNF-α expression. The levels of TNF-α had significant difference in different types of lymphoma (P<0.05). High positive and levels in Hodgkin lymphoma [HL, 72.72% and (43.12±15.28) ng/L], aggressive non-HL [NHL, 67.86% and (40.73±16.65) ng/L], and indolent NHL [57.14% and (53.18±20.47) ng/L]. Cox regression analysis showed that Ann Ardor stage, bone marrow abnormalities, ESR, and the levels of TNF-α were independent risk factors for lymphoma with poor prognosis. As an independent factor, TNF-α may play a role in the development of lymphoma and is an important prognostic factor.

Bruton's tyrosine kinase (Btk) is a useful marker for Hodgkin and B cell non-Hodgkin lymphoma.

Bruton's tyrosine kinase (Btk) is a member of the Tec family of protein tyrosine kinases involved in B cell development and proliferation in neoplastic human lymphoid tissues. We used immunohistochemistry to evaluate a polyclonal anti-Btk antibody on formalin-fixed paraffin-embedded tissue blocks. The tested samples included normal lymphoid tissues, tissue samples of 395 different lymphomas and 14 malignant lymphoid cell lines. Btk was expressed more often in B cell lymphomas than in T cell lymphomas. This correlated well with the results obtained on B cell lymphoma cell lines, which strongly expressed Btk, in contrast to T cell lymphoma cell lines. More than 60% of myelomas expressed Btk. Among Hodgkin lymphomas, the nodular lymphocyte predominant variant was more often positive (14/16) than the classical variant (6/27). Only one out of three Hodgkin lymphoma-derived cell lines showed a few atypical large cells expressing Btk. Btk represents a useful marker to identify B cell non-Hodgkin lymphomas. Furthermore, Btk might help to distinguish the nodular lymphocyte predominant variant of Hodgkin lymphomas from the classical form. Finally, in view of the recently discovered therapeutic potential of Btk inhibitors in lymphoma, we report the pattern of expression of Btk in a large collection of different types of lymphoma.

Precision therapy for lymphoma--current state and future directions.

Modern advances in genomics and cancer biology have produced an unprecedented body of knowledge regarding the molecular pathogenesis of lymphoma. The diverse histological subtypes of lymphoma are molecularly heterogeneous, and most likely arise from distinct oncogenic mechanisms. In parallel to these advances in lymphoma biology, several new classes of molecularly targeted agents have been developed with varying degrees of efficacy across the different types of lymphoma. In general, the development of new drugs for treating lymphoma has been mostly empiric, with a limited knowledge of the molecular target, its involvement in the disease, and the effect of the drug on the target. Thus, the variability observed in clinical responses likely results from underlying molecular heterogeneity. In the era of personalized medicine, the challenge for the treatment of patients with lymphoma will involve correctly matching a molecularly targeted therapy to the unique genetic and molecular composition of each individual lymphoma. In this Review, we discuss current and emerging biomarkers that can guide treatment decisions for patients with lymphoma, and explore the potential challenges and strategies for making biomarker-driven personalized medicine a reality in the cure and management of this disease.

Clonal heterogeneity of lymphoid malignancies correlates with poor prognosis.

Clonal heterogeneity in lymphoid malignancies has been recently reported in adult T-cell lymphoma/leukemia, peripheral T-cell lymphoma, not otherwise specified, and mantle cell lymphoma. Our analysis was extended to other types of lymphoma including marginal zone lymphoma, follicular lymphoma and diffuse large B-cell lymphoma. To determine the presence of clonal heterogeneity, 332 cases were examined using array comparative genomic hybridization analysis. Results showed that incidence of clonal heterogeneity varied from 25% to 69% among different types of lymphoma. Survival analysis revealed that mantle cell lymphoma and diffuse large B-cell lymphoma with clonal heterogeneity showed significantly poorer prognosis, and that clonal heterogeneity was confirmed as an independent predictor of poor prognosis for both types of lymphoma. Interestingly, 8q24.1 (MYC) gain, 9p21.3 (CDKN2A/2B) loss and 17p13 (TP53, ATP1B2, SAT2, SHBG) loss were recurrent genomic lesions among various types of lymphoma with clonal heterogeneity, suggesting at least in part that alterations of these genes may play a role in clonal heterogeneity.

Diagnosis and management of lymphomas and other cancers in HIV-infected patients.

Despite the introduction of highly active antiretroviral therapy or combination antiretroviral therapy (HAART and cART, respectively) patients infected with HIV might develop certain types of cancer more frequently than uninfected people. Lymphomas represent the most frequent malignancy among patients with HIV. Other cancer types that have increased in these patients include Kaposi sarcoma, cancer of the cervix, anus, lung and liver. In the post-HAART era, however, patients with HIV have experienced a significant improvement in their morbidity, mortality and life expectancy. This Review focuses on the different types of lymphomas that generally occur in patients with HIV. The combination of cART and antineoplastic treatment has resulted in remarkable prolongation of disease-free survival and overall survival among patients with HIV who develop lymphoma. However, the survival in these patients still lags behind that of patients with lymphoma who are not infected with HIV. We also provide an update of epidemiological data, diagnostic issues, and strategies regarding the most-appropriate management of patients with both HIV and lymphomas.

The Utility Of 18f-FDG PET/CT In Assessing Bone Marrow Involvement In Lymphoma

BackgroundDetermining bone marrow involvement (BMI) is a crucial element for staging of lymphoma. While the standard procedure to evaluate BMI has traditionally been bone marrow biopsy, biopsies are subject to sampling error, particularly if the involvement is focal and outside the pelvis. 18F-FDG PET/CT scans have become an increasingly popular component of the pretreatment evaluation to assess nodal and extramedullary disease. Their ability to accurately detect BMI has been suggested in Hodgkin's lymphoma, but is less well established in other histologies. This retrospective study evaluated whether 18F-FDG PET/CT scans are useful in detecting BMI in different types of lymphoma and, thus, may replace trephine biopsies as part of staging. MethodsBetween 2005 and 2013, 222 patients (pts) seen at our center underwent coinciding bone marrow biopsies and whole body 18F-FDG PET/CT scans. The most common lymphoma subtypes represented were diffuse large B-cell (DLBCL), follicular, and Hodgkin's lymphoma. Ninety-two pts were referred to our center for a new diagnosis and retrospectively enrolled on study. Unilateral bone marrow biopsy of the iliac crest was used as the standard for detecting BMI. 18F-FDG PET/CT scan was interpreted as positive for BMI when bone marrow 18F-FDG uptake was not otherwise explained by CT findings. ResultsOf the 92 newly diagnosed pts, there were 44 DLBCL, 28 follicular, and 20 Hodgkin's lymphoma. Most pts underwent 18F-FDG PET/CT scan prior to biopsy (47), as opposed to the same day (13) or after (32). The median age at diagnosis was 48 years (Range 22-89). Fifty-one of the patients were male and 41 were female.Seven of the 44 DLBCL patients had BMI documented by biopsy; 5 DLBCL, 2 follicular. When evaluating for only DLBCL marrow involvement, the sensitivity, specificity, and accuracy (concordance) of 18F-FDG PET/CT scan was 80% (CI 0.28, 0.99), 97% (CI 0.86, 1.00), and 95% (CI 0.84, 0.99) respectively. 18F-FDG PET/CT scan failed to identify 1 patient with focal DLBCL involvement. This pt already had advanced stage disease based on imaging, and would have received the same treatment regimen regardless of the extra information provided by bone marrow biopsy. When accounting for any kind of lymphomatous involvement, the sensitivity dropped to 57% (CI 0.18, 0.90) as 18F-FDG PET/CT scan failed to identify the 2 pts with follicular lymphoma of the marrow. Specificity and accuracy, however, remained high at 97% and 91%. When evaluating pts with relapsed disease, all DLBCL pts in our cohort had negative BMI by both biopsy and 18F-FDG PET/CT.In follicular lymphoma, however, the sensitivity of 18F-FDG PET/CT was 43% (CI 0.21, 0.73), specificity 93% (CI 0.64, 1.00), and accuracy 68% (CI 0.48, 0.84). Of the 9 pts with discordant results, 18F-FDG PET/CT failed to identify 8 pts with marrow involvement, 6 of whom had focal involvement. In the remaining pt, 18F-FDG PET/CT scan indicated appendicular skeletal and vertebral involvement. The bone marrow biopsy was negative in this pt, presumably due to the lack of iliac involvement. Information provided by bone marrow biopsy upstaged one of the 9 pts from limited to advanced stage disease. In the 12 pts with relapsed disease, the sensitivity was 47%, specificity 93%, and accuracy 68% based on 22 coinciding studies.In Hodgkin's lymphoma, the sensitivity, specificity, and accuracy of 18F-FDG PET/CT at diagnosis was 67% (CI 0.09, 0.99), 71% (CI 0.44, 0.90), and 70% (CI 0.46, 0.88) respectively. Of the 5 Hodgkin's pts with discordant results, 18F-FDG PET/CT scans detected marrow involvement in 4 pts with negative bone marrow biopsies. One pt had evidence of marrow involvement by biopsy but not by 18F-FDG PET/CT. As the pt was already stage III by 18F-FDG PET/CT, this information did not impact the treatment regimen. ConclusionsIn our cohort, 18F-FDG PET/CT was a highly accurate tool for detecting BMI in DLBCL and Hodgkin's lymphoma. As most pts underwent imaging first, the subsequent biopsy was unnecessary. In Hodgkin's, 18F-FDG PET/CT demonstrated the ability to detect BMI in pts who would have otherwise been considered to be negative by biopsy alone. 18F-FDG PET/CT was not as accurate in follicular lymphoma, presumably due to the low-grade nature of the disease. Further evaluation in a prospective manner is warranted, and may eliminate the need for a costly and painful procedure in many pts with lymphoma. Disclosures:No relevant conflicts of interest to declare.

Pathology of lymphoma in HIV

HIV-infected individuals have a greatly increased risk of developing malignancies, even when HIV infection is successfully controlled with antiretrovirals. Non-Hodgkin's lymphoma is considered an AIDS-defining entity, and this disease is currently the most common type of cancer in HIV-infected individuals in the USA and Europe. Here, we describe the different types of lymphomas occurring in individuals with AIDS, and the most relevant pathologic features helpful for histologic and immunohistochemical diagnosis. The incidence of some AIDS-related lymphoma subtypes has changed since the introduction of combined antiretroviral therapy, and some of the diagnostic methodologies have evolved. New biomarkers of disease have been identified, which may be useful for diagnosis. Better pathological classification strategies and deeper molecular understanding of the different lymphoma subtypes that occur in people with AIDS will begin to allow the transition to more precise diagnosis and targeted treatments.

Primary intestinal B-cell lymphoma: A prospective multicentre clinical study of 91 cases

Clinical presentation, diagnosis and prognosis of different primary intestinal lymphomas have not been well described and compared so far. Our aim was to prospectively analyse a series of consecutive patients presenting different types of B-cell primary intestinal lymphomas. Adult patients with primary intestinal lymphoma, collected between 1991 and 2000 within the multicenter national study in France were evaluated and followed up prospectively. Clinical features and treatment outcomes were analyzed and compared among different groups of lymphomas. Among 91 cases of B-cell primary intestinal lymphomas identified, 38 (41%) were diffuse large B cell lymphomas, 34 (37%) mantle cell lymphomas, 12 (13%) follicular lymphomas, 5 (5%) marginal zone MALT-lymphomas, and 2 (3%) Burkitt's lymphomas. A differential diagnosis could be made on the basis of tumour cell morphology and phenotype assessed by immunohistochemistry. Clinical presentation of the different types of lymphomas varied with respect to age, symptoms, circumstances of diagnosis, and stage. Overall survival was the poorest for mantle cell lymphomas while diffuse large B cell lymphomas could be cured if in complete remission after first line treatment. This study underlines the existence, within the B-cell primary intestinal lymphomas, of several distinct entities with different clinico-pathological features and prognosis, whose identification is important for choosing appropriate therapeutic strategy.

XIV. The rationale for combining targeted and biological anti‐lymphoma drugs

XIV. The rationale for combining targeted and biological anti‐lymphoma drugs