Diffuse Large B-cell Lymphoma Presenting Research Articles

Lacrimal sac diffuse large B-cell lymphoma presenting as sudden-onset binocular diplopia

Introduction: Diffuse large B-cell lymphoma (DLBCL) is a prevalent subtype of non-Hodgkin lymphoma (NHL) affecting predominantly elderly individuals. Case description: A 68-year-old man with a history of hypertension, hyperlipidaemia and a small pituitary gland tumour presented with sudden-onset binocular diplopia and right-eye blurry vision. A magnetic resonance imaging (MRI) of the brain revealed enhancing soft tissue in the right superolateral orbit inseparable from the lacrimal gland, extending medially to the right superior rectus muscle and soft tissue. Further scanning showed widespread metastasis to the bilateral retroperitoneal lymph nodes, adrenal gland, spine and lymph nodes in the neck. A biopsy of the lacrimal gland confirmed DLBCL. Conclusion: Primary lacrimal gland DLBCL is a rare and delayed diagnosis that often stems from the resemblance of its clinical manifestations to more benign conditions such as dacryocystitis, dacryostenosis or mucocele. Timely recognition and accurate diagnosis are essential for initiating appropriate treatment and improving patient outcomes.

Diffuse Large B-cell Lymphoma Presenting as a Cardiac Mass

Diffuse Large B-cell Lymphoma Presenting as a Cardiac Mass

Diffuse Large B-cell Lymphoma Presenting as Bronchial Mass.

Diffuse Large B-cell Lymphoma Presenting as Bronchial Mass.

Primary Extranodal Diffuse Large B-cell Lymphoma Presenting in the Lips: A Case Report and Literature Review.

Approximately 30-40% of malignant lymphomas are classified as diffuse large B-cell lymphoma (DLBCL), with 30% of DLBCL cases manifesting as extranodal lymphomas. Among these extranodal DLBCLs, primary DLBCL in oral lesions, particularly in the lips, is rare. While the treatment methods, chemotherapy assessment, and prognosis for nodal and extranodal DLBCLs are generally similar, diagnostic challenges can lead to delayed therapeutic intervention. We herein present a recent case of primary extranodal DLBCL in the lips that was swiftly diagnosed and managed using rituximab-containing chemotherapies. Our experience underscores the important role that hematologists play in identifying the possibility of oral hematological tumors, thereby allowing for a rapid diagnosis and timely intervention.

Colonic polyposis with underlying diffuse large B-cell lymphoma presenting with ileocolic intussusception

Colonic polyposis with underlying diffuse large B-cell lymphoma presenting with ileocolic intussusception

Primary central nervous system diffuse large B-cell lymphoma presenting as homonymous hemianopia

Post-transplant lymphoproliferative disorder rarely affects the central nervous system although it can have visually significant consequences depending on the location of intracranial involvement.

Diffuse large B-cell lymphoma presenting as sternal mass in a patient with ankylosing spondylitis: a case report study.

The authors present a rare case of primary diffuse large B-cell lymphoma of the sternum in a 41-year-old Iranian woman with ankylosing spondylitis (AS). Physical examination revealed a 7×7.5cm firm swelling of the anterior midline chest wall above the breasts, and MRI showed a lesion within the sternal marrow with an associated soft-tissue mass in the anterior aspect of the sternum. Following core-needle biopsy under ultrasound guidance, a histopathological study demonstrated diffuse sheets of large noncleaved atypical cells with large multilobated prominent nuclei and fine chromatin compatible with diffuse large B-cell lymphoma. Primary and exclusive involvement of the sternum is an uncommon presentation of lymphoma. Radiological, histological, and clinical characteristics of primary bone lymphoma can resemble those of other medical disorders. Although infrequent, existing evidence shows that AS seems to be associated with a small but significant risk for malignancy. Even though inflammatory involvement of the anterior chest wall could be a common clinical finding in patients with AS, it is recommended that anterior chest wall pain or any mass almost always needs comprehensive assessment and imaging evaluation in such patients to avoid any delayed diagnosis, misdiagnosis, and ensuing morbidity or mortality.

Clinicopathological features of primary central nervous system diffuse large B-cell lymphoma presenting with diffuse white matter lesions

目的： 分析以弥漫性脑白质病变为表现的原发中枢神经系统弥漫性大B细胞淋巴瘤（又称大脑淋巴瘤病）的临床及病理学特征，探讨其鉴别诊断、治疗及预后。 方法： 选取2020年6月至2022年6月首都医科大学附属北京天坛医院病理科诊断的2例大脑淋巴瘤病患者资料，分析临床、磁共振成像（MRI）及病理学表现。 结果： 2例患者均为男性，年龄分别53岁（例1）、69岁（例2），临床表现为头晕乏力、记忆力减退，均伴有言语错乱；MRI均未见肿块形成，表现为弥漫性脑白质病变，呈T1稍低信号、T2及T2-FLAIR高信号、增强病灶未见明显强化，其中例2患者于2个月后复查MRI，病变范围较前扩大，病灶出现部分强化；送检穿刺组织镜下白质结构基本完整，可见弥漫浸润的异型淋巴细胞，核分裂象可见，核仁明显，免疫组织化学染色CD20、CD79α及PAX5强阳性，CD3弱阳性，Ki-67阳性指数高；例1进行以甲氨蝶呤为基础的化疗，就诊后5个月存活；例2未行特殊治疗，就诊后13个月死亡。 结论： 大脑淋巴瘤病临床罕见、预后不佳，临床表现为快速进展的认知功能障碍、影像学表现为弥漫性脑白质病变，没有明确肿块形成，没有外科手术指征，所以要尽快进行组织病理活检明确诊断，积极治疗以改善预后。.

Molecular and clinical diversity in primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is a rare and distinct entity within diffuse large B-cell lymphoma presenting with variable response rates probably to underlying molecular heterogeneity. To identify and characterize PCNSL heterogeneity and facilitate clinical translation, we carried out a comprehensive multi-omic analysis [whole-exome sequencing, RNA sequencing (RNA-seq), methylation sequencing, and clinical features] in a discovery cohort of 147 fresh-frozen (FF) immunocompetent PCNSLs and a validation cohort of formalin-fixed, paraffin-embedded (FFPE) 93 PCNSLs with RNA-seq and clinico-radiological data. Consensus clustering of multi-omic data uncovered concordant classification of four robust, non-overlapping, prognostically significant clusters (CS). The CS1 and CS2 groups presented an immune-cold hypermethylated profile but a distinct clinical behavior. The 'immune-hot' CS4 group, enriched with mutations increasing the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) and nuclear factor-κB activity, had the most favorable clinical outcome, while the heterogeneous-immune CS3 group had the worse prognosis probably due to its association with meningeal infiltration and enriched HIST1H1E mutations. CS1 was characterized by high Polycomb repressive complex 2 activity and CDKN2A/B loss leading to higher proliferation activity. Integrated analysis on proposed targets suggests potential use of immune checkpoint inhibitors/JAK1 inhibitors for CS4, cyclin D-Cdk4,6 plus phosphoinositide 3-kinase (PI3K) inhibitors for CS1, lenalidomide/demethylating drugs for CS2, and enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2) inhibitors for CS3. We developed an algorithm to identify the PCNSL subtypes using RNA-seq data from either FFPE or FF tissue. The integration of genome-wide data from multi-omic data revealed four molecular patterns in PCNSL with a distinctive prognostic impact that provides a basis for future clinical stratification and subtype-based targeted interventions.

Diffuse large B-cell lymphoma presenting as transverse myelitis

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin’s lymphoma. Although progressive lymphadenopathy is a typical feature, extranodal involvement may also occur, including the gastrointestinal tract, skin, bone, thyroid, and testes. Central nervous system invasion is rare, so differentiating it from diseases such as inflammatory demyelinating disorder or infection is essential. DLBCL is therefore a challenge to diagnose, especially when the first findings are neurological symptoms. We report an unusual case of DLBCL that presented as transverse myelitis.

Primary Testicular Diffuse Large B-cell Lymphoma Presenting in a Young Adult

Primary testicular lymphoma is a rare type of extranodal non-Hodgkin lymphoma (NHL), its positive diagnosis is based on histopathological findings. Treatment modalities consist of surgical excision, chemotherapy, and radiation therapy but the accurate procedures are not standardized. The authors report a new case of primary testicular lymphoma, and we discuss its diagnostic and therapeutic aspects. Sperm cryopreservation was carried out. The patient was started on chemotherapy with cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisone (CHOP) regime.

Primary diffuse large b-cell lymphoma presenting as a chest wall mass: A case report

Chest wall lymphoma is a rare entity and often confused with the more common sarcoma. We report a case of diffuse large B-cell non-Hodgkin lymphoma patient presented with a sole chest wall mass. Chest computed tomography revealed an abnormal mass with well-defined borders below the pectoralis major muscle with contrast enhancement. The excisional biopsy revealed diffuse large B-cell non-Hodgkin lymphoma, confirmed by immunohistochemistry. The patient was then treated with six cycles of R-CHOP and achieved complete response. She is currently free from malignancy for 12 months after treatment. This paper illustrates the rarity of this entity, the need for distinguishing it from sarcoma, and briefly reviews its current management.

Diffuse large B-cell lymphoma presenting with paraparesis.

The development of paraparesis in the setting of back pain and lassitude in an immunocompetent patient was diagnosed as the presenting feature of diffuse large B-cell lymphoma. MRI imaging and surgical biopsy were diagnostic, despite the absence of lymphadenopathy or splenomegaly, and near-normal laboratory workup. Different possible pathological mechanisms of paraparesis in large B-cell lymphoma are discussed.

Primary cardiac diffuse large B-cell lymphoma presenting with cardiac tamponade: a case report

BackgroundPrimary cardiac tumours are extremely rare with an autopsy incidence of 0.05%. They can present with a variety of symptoms, including life-threatening arrhythmia and cardiac tamponade. In this case report, we focus on the diagnostic process and management of a primary cardiac lymphoma (PCL) presenting with cardiac tamponade.Case summaryWe report on a 71-year-old male presenting with a large pericardial effusion, tamponade, and a mass in the right atrioventricular groove. Multimodality imaging was performed, including transthoracic echocardiography, computed tomography, magnetic resonance imaging, positron emission tomography, and computed tomography-guided transthoracic biopsy. The final diagnosis of a double-hit diffuse large-cell B-cell lymphoma was made, for which treatment consisting of a combination of chemotherapy and immunotherapy was initiated. Low-dose colchicine was also added to the treatment.DiscussionPrimary cardiac lymphoma remains a very rare diagnosis and this case highlights the need for multimodality imaging and imaging-guided biopsy to differentiate cardiac masses. First-line treatment for PCL remains a combination of chemotherapy with immunotherapy, with the addition of low-dose colchicine to prevent recurrence of malignant pericardial effusion.

Diffuse large B-cell lymphoma presenting as reversible intrapulmonary arteriovenous shunts with hypoxia, fever and progressive jaundice: a case report and literature review

BackgroundIntrapulmonary arteriovenous shunts is rare seen in a patient without lung involvement.Case presentationThis is the first report of reversible intrapulmonary arteriovenous shunts secondary to extrapulmonary lymphoma as one initial symptom. The patient presented as fever of unknown origin and dyspnea, and examinations of infection were negative. Diagnosis of DLBCL was finally confirmed through bone marrow and splenic biopsies. Intrapulmonary arteriovenous shunts were diagnosed through 100% oxygen inhalation test and transthoracic contrast echocardiography (TTCE). After the treatment of lymphoma, his respiratory failure was relieved. We rechecked the 100% oxygen inhalation test and TTCE, which both indicated that his intrapulmonary arteriovenous shunts had resolved.ConclusionsWe speculated the prominent inflammation from active DLBCL was the most possible mechanism associated with the reversible intrapulmonary shunt in this patient. These findings will assist us to better understand the mechanism of intrapulmonary shunts.

Two Cases of Pelvic Diffuse Large B-Cell Lymphoma.

Primary diffuse large B-cell lymphoma presenting as an extranodal site in the pelvis is rare and can mimic a gynecological malignancy. Although management for diffuse large B-cell lymphoma is standardized and curative, prognosis depends on timely diagnosis and therapy. Diagnosis can be challenging as patients lack classical symptoms of fever, night sweats, weight loss, and lymphadenopathy associated with lymphoma. A multidisciplinary approach is recommended to diagnose and treat judiciously. In this article, we present cases of 2 females who presented with pelvic masses with initial suspicion of a gynecological malignancy but were ultimately diagnosed as diffuse large B-cell lymphoma of the pelvis and managed accordingly.

Biallelic <i>BCL6</i> rearrangements by dual t(3;14)(q27;q32) and t(3;22)(q27;q11) translocations in diffuse large B-cell lymphoma

3q27 chromosomal translocation involving the BCL6 gene is one of the most frequent forms of cytogenetic abnormality observed in B-cell lymphoma. We report a case with diffuse large B-cell lymphoma (DLBCL) presenting dual 3q27 translocations. The patient was a 71-year-old man who presented with swelling of multiple abdominal lymph nodes (LNs) and obstructive jaundice. LN biopsy exhibited dense proliferation of atypical large cells expressing CD20, MUM1/IRF4, BCL2, BCL6, and MYC, but not CD10. He was diagnosed with non-GCB/ABC type DLBCL and showed an initially good response to R-CHOP chemotherapy, but relapsed soon after the completion of therapy. Chromosomal analysis of the biopsied LN exhibited multiple abnormalities including t(3;14)(q27;q32) and t(3;22)(q27;q11). Fluorescence in situ hybridization (FISH) using BCL6 break-apart probes confirmed chromosomal breaks occurring on both BCL6 alleles. Molecular analysis revealed two independent rearrangements of BCL6, either with the IGH or the IGL gene. 3q27 breakpoints were located 1.2kb apart from each other within the first intron of BCL6, while the IGH and IGL breaks occurred at the 5' of IGHG2 and within IGLV3-1, respectively. The results suggest that biallelic BCL6 rearrangements might be a rare but recurrent genetic event in B-cell lymphoma.

S2346 Bumpy Stomach: High-Grade Stage IV Diffuse Large B-cell Lymphoma Presenting as Numerous Ulcerated Bleeding Gastric Nodules

S2346 Bumpy Stomach: High-Grade Stage IV Diffuse Large B-cell Lymphoma Presenting as Numerous Ulcerated Bleeding Gastric Nodules

DIFFUSE LARGE B-CELL LYMPHOMA PRESENTING AS DIFFUSE BILATERAL INNUMERABLE PULMONARY NODULES

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) may rarely manifest as a primary pulmonary lymphoma or with secondary lung involvement. Typical radiologic presentations include chronic, indolent airspace consolidations, focal lung masses or perilymphatic lung nodules.(1) The objective of this report is to present rare secondary pulmonary involvement of DLBCL presenting as bilateral diffuse innumerable pulmonary nodules on chest computed tomographic (CT) imaging. This radiologic presentation has only previously been seen in the setting of acquired immunodeficiency syndrome (AIDS).(2) CASE PRESENTATION: A 67-year-old Caucasian woman with a history of stage IV DLBCL associated with a chest wall mass presented to the emergency department with chest pain and progressively worsening shortness of breath. Increasing oxygen requirements from baseline of 2L to 4L via nasal cannula, to maintain a pulse oximetry reading of 95% was noted. Physical examination was unremarkable with clear lung fields.Serology revealed bi-cytopenia, hemoglobin 11.0g/dL (normal 11.5-15.5g/dL) and platelets 81 k/uL (normal 150-400k/uL). LDH and CRP were elevated at 527U/L (normal 135-214U/L) and 6.4mg/dL (normal <0.9mg/dL) respectively. CT-chest with contrast showed no evidence of pulmonary embolism. However, innumerable bilateral diffuse lung nodules were noted (Figure 1). The left lower chest wall mass had increased in size. Broncho-alveolar lavage was negative for viral, bacterial and fungal etiologies. HIV serology, acid fast bacillus culture and stain were also negative. Transbronchial needle aspirate of enlarged lymph nodes was positive for lymphoma. Left lower lobe trans-bronchial biopsy revealed mild non-specific interstitial fibrosis but no granulomatous inflammation, neoplasm, or evidence of acute infection. Due to high suspicion of progression of her DLBCL as the underlying cause of her lung nodules, CT-guided biopsy of the lung nodules in the left lower lobe was performed. Diffuse sheets of large, CD5, 10 and 20 positive transformed lymphocytes were seen. Her diffuse bilateral innumerable pulmonary nodules were proven to be due to progression of her DLBCL disease. She received chemotherapy with bendamustine and rituximab. Her chest pain and oxygen requirements returned to her baseline, and she was discharged home one week later. DISCUSSION: This was a case of a 67-year-old Caucasian woman with stage IV DLBCL and secondary pulmonary involvement. Typical radiologic presentation of DLBCL with secondary pulmonary involvement is with a focal lung mass or perilymphatic lung nodules.(2) However, this patient presented with extensive bilateral diffuse innumerable pulmonary nodules unlike previous radiologic presentations of DLBCL described in immunocompetent patients. CONCLUSIONS: We suspect her pulmonary involvement was due to lymphatic spread of her DLBCL which may rarely occur in the setting of generalized disease.(3) REFERENCE #1: Lewis E, Caskey C, Fishman E. Lymphoma of the lung: CT Findings in 31 patients. AJR Am J Roentgenol. 1991 Apr;156(4):711-4. REFERENCE #2: Harbor N. Rapidly progressive diffuse large B-cell lymphoma presenting as innumerable pulmonary nodules in an Aids patient: A fatal case report. Journal of Hospital Medicine. 2015 March;abstract 604(10)supply 2. REFERENCE #3: Cheng C, Su Y, Chao T et al. Intralymphatic spread is a rare finding associated with poor prognosis in diffuse large B-cell lymphoma with extranodal involvements. Am J Surg Pathol. 2018 May;42(5):616-624. DISCLOSURES: No relevant relationships by Tanya Marshall, source=Web Response No relevant relationships by Atul Mehta, source=Web Response No relevant relationships by Prince Ntiamoah, source=Web Response No relevant relationships by Joseph Parambil, source=Web Response

S1849 A Rare Case of Diffuse Large B-cell Lymphoma Presenting as a Malignant Mass in Both Duodenum and Ascending Colon

S1849 A Rare Case of Diffuse Large B-cell Lymphoma Presenting as a Malignant Mass in Both Duodenum and Ascending Colon