Incidence Of Malignant Lymphoma Research Articles

Risks of malignant lymphoma in rheumatoid arthritis patients receiving methotrexate-alone and in combination therapy compared with the general population: A study based on a Japanese medical claims database.

The risk of malignancy in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) and biological disease-modifying antirheumatic drug (bDMARD) combination therapy is unknown. This study aimed to clarify the incidence of malignancy and the recommended monitoring period in patients receiving this combination therapy. A retrospective, observational study based on a large Japanese medical claims database was conducted between April 2013 and February 2020. Patients with RA were classified into MTX-alone and combination therapy groups, and the standardized incidence rates (SIR) of malignancy were calculated. The time of onset of malignancy in both groups was calculated. In total, 2,052 patients received MTX-alone and 782 received combination therapy. The incidence of malignant lymphoma was significantly higher with MTX-alone therapy (SIR: 6.09, 95% confidence interval (CI): 1.58-10.61) and combination therapy (SIR: 20.86, 95% CI: 8.53-33.19) than in the general Japanese population. Furthermore, the combination therapy had a significantly higher risk of malignant lymphoma than the MTX-alone therapy (adjusted odds ratio: 4.27, 95% CI: 1.64-11.12). The median time from MTX prescription to the onset of malignant lymphoma was 3.58 years (interquartile range (IQR): 2.00-5.34 years) for MTX-alone and 3.42 years (IQR: 1.25-4.92 years) for combination therapy. The incidence of malignant lymphoma in the combination therapy group was extensively higher than that in the general Japanese population. Special attention is required for early symptoms of malignant lymphoma, particularly in the 3rd - 4th year after initiating MTX therapy.

Life Span, Cause of Death and Neoplasia in B6C3F1 Mice Exposed In Utero to Low- and Medium-Dose-Rate Gamma Rays.

Previously, we reported that while low-dose-rate (LDR) gamma-ray exposure to 20 mGy/day for the entire gestation period (gestation days 0-18) did not result in any significant effect in B6C3F1 pups up to 10 weeks of age when compared to the non-irradiated controls, exposure to medium-dose-rates (MDR, 200 and 400 mGy/day) resulted in growth retardation and gonadal hypoplasia, in addition to delayed ossification (only at 400 mGy/day). In the present work, we investigated the late effects of continuous in utero exposure to gamma rays at LDRs (0.05, 1.0 and 20 mGy/day) and at an MDR of 400 mGy/day, on life span, causes of death, neoplastic and non-neoplastic disease incidences in B6C3F1 mice. Reproductive parameters such as litter size and weaning rates was not significantly different among the LDR groups, but was significantly decreased in the MDR group, when compared to the non-irradiated controls. Mean life spans were not significantly different among the LDR exposed groups compared to the non-irradiated controls, whereas the life spans of those exposed to the MDR were significantly shorter than the non-irradiated controls. There was no significant difference in tumor spectra between the non-irradiated and LDR nor MDR irradiated groups. In mice exposed to MDR in utero, the over-all incidence rates shifted with increased incidences in the number of neoplasms of liver (both sexes) and endocrine (adrenals, pituitary and ovaries in females) origin with corresponding decreases in the incidence of malignant lymphomas (both sexes) and lung neoplasms (males). Multiple primary neoplasms were significantly increased only in females exposed to MDR. Results show that B6C3F1 mice exposed to gamma-rays in utero at LDRs of 0.05, 1 and 20 mGy/day for the entire gestation period (18 days) does not significantly alter lifespan, cause of death, neoplasm incidence rates and tumor spectra.

Issue of predicting the risk of thromboembolic complications in patients with lymphoproliferative diseases

The incidence of malignant lymphomas has been increasing in recent years worldwide. These diseases are often accompanied by venous thromboembolic complications (VTEC). The development of VTEC leads to interrupting of therapy, increasing mortality and significant rising of treatment costs. Anticoagulants are effective in VTEC prophylaxis. Prescribing of anticoagulant therapy is based on VTEC different risk scales, which are far from perfect. The search of additional features for hemostasis assessment can increase the prognostic value of these scales. The optimization of VTEC risk scales can improve efficacy of anticoagulant therapy and decrease an incidence of thrombotic events in patient with malignant lymphomas. The article presents a literature review and own clinical observations regarding the VTEC risk assessment in patients with lymphoproliferative diseases.

Incidence of malignant lymphoma in adolescents and young adults in the 58 counties of California with varying synthetic turf field density

BackgroundCase reports of cancer among soccer players raised concerns that the crumb rubber infill in synthetic turf fields may cause malignant lymphoma. One prior epidemiologic study on the topic found no association. MethodsAn ecologic evaluation of county-level incidence of lymphomas by race/ethnicity and socioeconomic status for the state of California with data obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results Program. Synthetic turf field density by county was obtained from the Synthetic Turf Council. During 2000–2013, 7214 14- to 30-year-old Californians were diagnosed with malignant lymphoma. ResultsAnnual lymphoma county incidence trends were not associated with the county-level synthetic turf field density. None of 20 sub-analyses by race/ethnicity, sex and county median household income indicated a correlation of lymphoma incidence with synthetic turf field density. In California, there was no evidence at the county-level that synthetic turf fields are associated with an increased incidence of lymphoma in adolescents and young adults. ConclusionOur findings in the state with the greatest number of such fields and a large, diverse patient population are consistent with those of a prior study observing no association between individual-level exposures to turf fields and cancer incidence. Avoidance of synthetic turf fields for fear of increased cancer risk is not warranted.

소뇌교각의 악성 림프종 : 돌발성 난청의 드문 원인 1예

Cerebellopontine angle (CPA) tumor is a rare cause of sudden deafness, with the probability of 0.8-4.0%, and mostly acoustic neurinoma. Autoimmune inflammatory rheumatic diseases can increase the risk of malignant lymphoma. As a consequence of increasing life expectancy of immune-mediated disease patients and growing prevalence of those disease among average population, the incidence of malignant lymphoma is expected to increase. However, central nervous system (CNS) lymphoma either primary or secondary is very rare moreover when locating in the CPA. Therefore, it is very difficult to speculate malignant lymphoma in sudden deafness. We present a rare case that 45-year-old man, who has taken immunosuppressant for systemic lupus erythematosus and systemic sclerosis suffered sudden hearing loss in his right ear due to CPA malignant lymphoma. (J Clinical Otolaryngol 2016;27:316-321)

PTU-282 Dysplasia following stapled restorative procto-colectomy for ulcerative colitis: is there a correlation between pre-op colorectal dysplasia and development of post-op dysplasia in the rectal cuff mucosa?

Introduction Preserved rectal cuff mucosa following restorative proctocolectomy with ileal-pouch anal anastomosis (RPC-IPAA) in mucosal ulcerative colitis (MUC) carries the risk of malignant transformation and/or recurrent active inflammation (cuffitis). This study aimed to determine: any correlation between pre-op colorectal dysplasia or malignancy and post-op rectal cuff dysplasia; overall risk of post-op dysplasia development in MUC patients after stapled RPC-IPAA; patient compliance with annual rectal cuff biopsies; any potential post-op period during which rectal cuff dysplasia is more prevalent. Method After IRB approval, all MUC patients who underwent stapled RPC-IPAA were identified. Review of demographics, risk factors, operative details and pathology reports (pre- and post-op surveillance biopsies as well as operative specimens) was conducted. Results 611 MUC patients [mean age 46.7 (11–89 years), 368 (60%) males] underwent stapled RPC-IPAA from 1988–2011. Pathology reports were unavailable in 45 and 239 patients had no post-op surveillance biopsies. Among a cohort of 566 patients with obtainable perioperative reports, 16 (2.8%) were histologically diagnosed with “Crohn’s disease (CD)”, 104 (18.4%) with “dysplasia/indefinite for dysplasia without malignancy” and 44 (7.8%) with “adenocarcinoma with or without dysplasia”. Incidental small bowel carcinoid tumours were detected in operative specimens of 6 (1%) patients. 327 patients (58%) had a mean of 8.5 (1–16) identifiable annual post-op rectal cuff biopsies. 282/327 patients (86.2%) had ≤5 post-op surveillance years records available. Post-op rectal cuff dysplasia was identified in 5 patients (1.5%): 2 had no history of dysplasia, 1 had pre-op dysplasia by biopsy, 1 was diagnosed with CD without dysplasia and 1 with adenocarcinoma. One incidence of malignant lymphoma was identified in a post-op pouch surveillance biopsy of a patient who had a previous incidental appendiceal carcinoid. All histologically abnormal post-op surveillance specimens were detected in the first 5 postoperative years. Conclusion The incidence of dysplasia in the rectal cuff after stapled RPC-IPAA in MUC patients was very low (1.5%). There was no correlation between pre-op colorectal dysplasia/malignancy and post-op rectal cuff dysplasia. 327 patients (58%) had a mean of 8.5 (1–16) identifiable annual post-op rectal cuff biopsies. Although no histologically abnormal lesions were detected after 5 post-op surveillance years, 13.8% of patients continued follow up beyond 5 years. Disclosure of interest None Declared.

A Case of Carcinoma of the Mandibular Gingiva Complicated by Malignant Lymphoma

The incidence of malignant lymphoma has recently increased and it is becoming more common to encounter multiple primary carcinomas including the present case. In a case with multiple primary carcinomas with malignant lymphoma, it is necessary to determine the priority and treatment plan according to the clinical stage and the prognosis of the diseases. We therefore report a case with multiple primary carcinomas of the mandibular gingiva complicated by malignant lymphoma. Patient: 75-year-old male. Chief complaint: fecal occult blood. The patient visited the department of gastrointestinal medicine due to fecal occult blood in December 2006. A biopsy was conducted because the endoscopy revealed adenomatoid lesion. Consequently, the patient was diagnosed with diffuse large B-cell lymphoma and was transferred to the department of hematology to receive R-COP therapy. After two courses of the chemotherapy, an ulcerative lesion was detected on the buccal gingiva of the lower left molars in February 2007, which was diagnosed as squamous cell carcinoma of the mandibular gingiva (T2 N0 M0) by pathological examination, CT and MRI. Subsequently, marginal resection of the mandible was performed. Three months after the operation, four courses of R-COP therapy were conducted.

How oncologists adhere to evidence-based G-CSF-guidelines to prevent febrile neutropenia: A sample survey in hospitals and practices in Germany.

6591 Background: Primary G-CSF prophylaxis after chemotherapy is recommended in evidence based guidelines (GL), if the risk of febrile neutropenia (FN) is high (≥20%), or intermediate (≥ 10% - 20%) in case of risk factors. The aim was to evaluate, if G-CSF is used as proposed by GL, to identify determinants of GL implementation and adherence. Methods: The sample size was calculated at 2% of the incidence of malignant lymphoma, breast and lung cancer in Germany. Pts who had received 3-9 cycles of chemotherapy with a FN risk ≥10% between 5/2011 to 4/2012 were documented retrospectively. Results: 286 lymphoma, 666 lung cancer and 976 breast cancer pts were collected from 87 hospitals and 59 oncology practices with 195 physicians participating. Adherence to GL was higher in physicians up to 10 than over 10 years of experience. Conclusions: The adherence to and acceptance of GL for G-CSF may not be sufficient. Patient risk factors are underestimated therefore resulting in a possible underuse of G-CSF. Physicians may underestimate FN risk in pts who have an intermediate risk of FN and they overestimate their adherence to the GL. [Table: see text]

Epidemiologic overview of malignant lymphoma

Malignant lymphoma encompasses a wide variety of distinct disease entities. It is generally more common in developed countries and less common in developing countries. The East Asia region has one of the lowest incidence rates of malignant lymphoma. The incidence of malignant lymphoma around the world has been increasing at a rate of 3-4% over the last 4 decades, while some stabilization has been observed in developed countries in recent years. The reasons behind this lymphoma epidemic are poorly understood, although improving diagnostic accuracy, the recent AIDS epidemic, an aging world population and the increasing adoption of cancer-causing behaviors are suggested as contributing factors. Etiologies of malignant lymphoma include infectious agents, immunodeficiency, autoimmune disease, exposure to certain organic chemicals, and pharmaceuticals. The distribution of many subtypes exhibit marked geographic variations. Compared to the West, T/natural killer (NK) cell lymphomas (T/NK-cell lymphoma) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) are relatively more common, whereas other B-cell lymphomas, particularly follicular lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma, are less common in Asia. Some subtypes of T/NK-cell lymphomas defined by Epstein-Barr virus association are predominantly Asian diseases, if not exclusively so. Both ethnic and environmental factors play roles in such diversity. In this review, we discuss the geographic distribution and etiology of malignant lymphoma, as well as the trend.

Malignant lymphoma incidence and HIV-related lymphoma subtypes in the Western Cape of South Africa, 2002-2009

Background The incidence of malignant lymphomas (ML) in the Western Cape, a province of South Africa (SA), with a population of 5 million and an estimated HIV prevalence of 15% (census report 2002) has not been previously documented. Highly active antiretroviral therapy (HAART) was introduced into the public patient sector in 2004, with 28% estimated coverage by 2007 (UNAIDS/WHO 2008). People living with HIV (PLWH) have 60-200 times increased risk of developing HIVrelated lymphoma (HRL). Therefore, based on HIV prevalence, HRL would be expected to increase but is undocumented.

EBV, HHV8 and HIV in B cell non Hodgkin lymphoma in Kampala, Uganda.

BackgroundB cell non Hodgkin lymphomas account for the majority of lymphomas in Uganda. The commonest is endemic Burkitt lymphoma, followed by diffuse large-B-cell lymphoma (DLBCL). There has been an increase in incidence of malignant lymphoma since the onset of the HIV/AIDS pandemic. However, the possible linkages of HHV8 and EBV to the condition of impaired immunity present in AIDS are still not yet very clearly understood.Objectives1. To describe the prevalence of Epstein-Barr virus, Human Herpes virus 8 and Human Immunodeficiency Virus-1 in B cell non Hodgkin lymphoma biopsy specimens in Kampala, Uganda.2. To describe the histopathology of non Hodgkin lymphoma by HIV serology test result in Kampala, UgandaMethodTumour biopsies specimens from 119 patients with B cell non Hodgkin lymphoma were classified according to the WHO classification. Immunohistochemistry was used for detection of HHV8 and in situ hybridization with Epstein Barr virus encoded RNA (EBER) for EBV. Real time and nested PCR were used for the detection of HIV.The patients from whom the 1991-2000 NHL biopsies had been taken did not have HIV serology results therefore 145 patients biopsies where serology results were available were used to describe the association of HIV with non Hodgkin lymphoma type during 2008-2009.ResultsIn this study, the majority (92%) of the Burkitt lymphomas and only 34.8% of the diffuse large B cell lymphomas were EBV positive. None of the precursor B lymphoblastic lymphomas or the mantle cell lymphomas showed EBV integration in the lymphoma cells.None of the Burkitt lymphoma biopsies had HIV by PCR. Of the 121 non Hodgkin B cell lymphoma patients with HIV test results, 19% had HIV. However, only 1(0.04%) case of Burkitt lymphoma had HIV. All the tumours were HHV8 negative.ConclusionsThe majority of the Burkitt lymphomas and two fifths of the diffuse large B cell lymphomas had EBV. All the tumours were HHV8 negative. Generally, the relationship of NHL and HIV was weaker than what has been reported from the developed countries. We discuss the role of these viruses in lymphomagenesis in light of current knowledge.

Association of Anthropometric Characteristics with the Risk of Malignant Lymphoma and Plasma Cell Myeloma in a Japanese Population: A Population-Based Cohort Study

Although Asian and Western populations differ markedly in anthropometric characteristics and the incidence of malignant lymphoma and plasma cell myeloma, few studies have evaluated the associations between these variables among Asian populations. We conducted a large-scale, population-based prospective study in a Japanese cohort that included 45,007 men and 49,540 women ages 40 to 69 years at baseline. During an average follow-up period of 13 years, 257 cases of malignant lymphoma and 88 of plasma cell myeloma were identified. Hazard ratios (HR) and 95% confidence intervals (95% CI) were estimated with the use of a Cox regression model adjusted for potential confounders. Compared with the 1st quartile, categorization in the 4th quartile for height showed a positive association with lymphoid neoplasm risk (HR, 1.38; 95% CI, 1.00-1.91), and the association was significant among men (HR, 1.72; 95% CI, 1.11-2.66). A similar trend was observed for subcategories of malignant lymphoma, plasma cell myeloma, and non-Hodgkin lymphoma, albeit the associations were weak due to the small number of subjects in each category. In contrast, weight and body mass index were not associated with risk of lymphoid neoplasm. Height was positively associated with risk of lymphoid neoplasm in a Japanese population. Our data suggested that early life exposure to growth-related hormones, such as insulin-like growth factors and growth hormones, or genetic factors relating to height may affect the risk of lymphoid neoplasm.

Kombinierte adjuvante Chemo-/Immuntherapie eines diffus großzelligen Non-Hodgkin-Lymphoms bei einem 80-jährigen Patienten

The continuously aging population in the western nations has to be regarded as a new challenge that requires professional strategies concerning medical oncologic treatments of the elderly. The incidence of malignant lymphoma is increasing beyond the age of 65. The presented case report describes the innovative therapy protocol that combines the monoclonal antibody rituximab with the antineoplastic agent, bendamustine, in the adjuvant treatment of an aggressive non-hodgkin lymphoma.

Profile of Early Occurring Spontaneous Tumors in Han Wistar Rats

It is sometimes difficult to assess the relevance of tumors that occur in treated animals in short-term studies. This report is intended to establish a general profile of tumor occurrence in young Han Wistar rats. Data were collected and evaluated from 29 rat carcinogenicity studies and from a few 2-, 4-, 13-, and 26-week studies conducted between 1995 and 2009 at Huntingdon Life Sciences, UK. The route of administration was dietary, oral gavage, or inhalation, and the analysis was confined to sporadic deaths (decedents) in carcinogenicity studies. In Han Wistar rats, the most common and earliest occurring tumor was malignant lymphoma in both sexes, the earliest being seen in the 16th and 26th week in males and females, respectively. The incidence of malignant lymphoma was slightly higher in males than in females. The second most common type of tumor was brain tumors in males and mammary tumors in females. Compared with Sprague-Dawley rats, where the most common early tumor was pituitary tumor in females, the most common early tumor in Han Wistar rats was malignant lymphoma in both sexes. These early tumor profiles are consistent with the lifetime tumor occurrence in these strains.

Systemic and Local Interleukin-17 and Linked Cytokines Associated with Sjögren’s Syndrome Immunopathogenesis

Recently recognized as a distinct CD4(+) T helper (Th) lineage, Th17 cells have been implicated in host responses to infections and in pathogenesis associated with autoimmune diseases. This cytokine is implicated in primary Sjögren's syndrome (pSS) immunopathology because of the increased levels of circulating interleukin (IL)-17 in pSS. Plasma and minor salivary glands (MSGs) from patients with pSS were therefore evaluated for CD4(+) T cells, T regulatory cells, IL-17, and supporting cytokines by immunohistochemistry, RT-PCR, and microbead assays. MSGs from pSS patients contain IL-17-expressing cells as a dominant population within inflammatory lesions. IL-17 protein expression progressively increased with higher biopsy focus scores (P < 0.0001), in parallel with detection by RT-PCR. Transforming growth factor-beta, IL-6 and IL-23, which are requisite promoters of Th17 differentiation, were found in abundance compared with the amounts in control tissues. Although transforming growth factor-beta is also a pivotal differentiation factor for immunosuppressive Foxp3(+) T regulatory cells (Tregs), an increase in Foxp3(+) Tregs was evident in biopsy specimens with mild and moderate inflammation but this increase was disproportionate to escalating pro-inflammatory Th17 populations in advanced disease. Furthermore, the Th17-centric cytokines IL-17, IL-6, IL-23, and IL-12 were significantly elevated in pSS plasma. These data identify a profusion of IL-17-generating cells and supporting cytokines within diseased pSS MSGs without a compensatory increase in immunomodulatory Tregs; this imbalance seems to foster a pathogenic milieu that may be causative and predictive of infiltrative injury and amenable to therapeutic intervention.

Interferon treatment reduces incidence of malignant lymphoma in patients infected with HCV

Interferon treatment reduces incidence of malignant lymphoma in patients infected with HCV

Autoimmune Diseases and Sjögren's Syndrome

Autoimmune diseases include a diverse group of over 80 conditions. Sjögren's syndrome is the second most common autoimmune rheumatic disease, with an estimated prevalence in the United States of 2-4 million persons. There are prominent and consistent oral and dental findings in Sjögren's syndrome related to the autoimmune-mediated loss of normal salivary function. Additionally, nonoral clinical manifestations of Sjögren's syndrome include: dry eyes (with specific ocular surface changes termed keratoconjunctivitis sicca); other xeroses, such as dryness of the nose, throat, skin, and vagina; peripheral (and less frequently central) neuropathies; myalgias and arthralgias; thyroid disorders (particularly autoimmune thyroiditis); pulmonary disorders; renal disorders; and lymphoma. There is a significant (20- to 40-fold) increase in the incidence of malignant lymphoma, particularly in primary Sjögren's syndrome. Establishing the diagnosis of Sjögren's syndrome has been difficult in the light of its nonspecific symptoms (dry eyes and mouth), disagreement on diagnostic criteria, and a lack of both sensitive and specific laboratory markers. Many serum and salivary biomarkers for Sjögren's syndrome have been proposed although, to date, none has proven to be sufficiently specific for diagnostic purposes or has been well correlated with disease activity measures. Investigators have recently begun to apply modern genomic and proteomic approaches to identify candidate biomarkers in Sjögren's syndrome. The results of these investigations promise to provide a wealth of information on candidate biomarkers and possible etiopathological mechanisms underlying this disorder. Further, this information will improve clinical outcomes by fostering the design of new rational therapeutics and assisting in the monitoring of clinical disease.

Sick Leave due to Depressive Disease: Not a Risk Factor for the Development of Malignant Lymphoma

For unknown reasons the incidence of non-Hodgkin's Lymphomas (NHL) has increased during the last decades. Conditions with impaired immune functions have been associated with an increased risk of malignant lymphomas. Interactions between the central nervous, immune, and endocrine systems have been recently identified, and the potential physiological importance of these interactions is being explored. In this prospective cohort study the potential association between an increasing incidence of depressive disorders and the development of malignant lymphoma is being explored. The participants were part of the Swedish manpower on sick leave between 1988 and 2000 with depressive disease for more than two weeks were followed until a diagnosis of lymphoid malignancy, death, emigration, or end of follow-up period. The final cohort included 87,677 individuals with 373,135 years of follow-up. There were 80 cases of NHL, chronic lymphocytic leukemia (CLL), and Hodgkin lymphoma (HL) with 70 cases expected. The first year of follow-up showed a slightly increased risk of NHL, which most probably can be interpreted as initial symptoms of lymphoma. We conclude that the increase in the incidence of malignant lymphomas observed during the last decades seems not to be associated with a concurrent increase of depressive disorders.

Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas

The incidence of malignant lymphomas has been increasing rapidly, but the causes of these malignancies remain poorly understood. One hypothesis holds that exposure to ultraviolet (UV) radiation increases lymphoma risk. We tested this hypothesis in a population-based case-control study in Denmark and Sweden. A total of 3740 patients diagnosed between October 1, 1999, and August 30, 2002, with incident malignant lymphomas, including non-Hodgkin lymphoma, chronic lymphocytic leukemia, and Hodgkin lymphoma, and 3187 population controls provided detailed information on history of UV exposure and skin cancer and information on other possible risk factors for lymphomas. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by logistic regression. Statistical tests were two-sided. Multivariable-adjusted analyses revealed consistent, statistically significant negative associations between various measures of UV light exposure and risk of non-Hodgkin lymphoma. A high frequency of sun bathing and sunburns at age 20 years and 5-10 years before the interview and sun vacations abroad were associated with 30%-40% reduced risks of non-Hodgkin lymphoma (e.g., for sunbathing four times a week or more at age 20 versus never sunbathing, OR = 0.7, 95% CI = 0.6 to 0.9; for two or more sunburns a year at age 20 versus no sunburns, OR = 0.6, 95% CI = 0.5 to 0.8). These inverse associations increased in strength with increasing levels of exposure (all P(trend)< or =.01). Similar, albeit weaker, associations were observed for Hodgkin lymphoma. There were no clear differences among non-Hodgkin lymphoma subtypes, although associations were stronger for B-cell than for T-cell lymphomas. A history of skin cancer was associated with a doubling in risks of both non-Hodgkin and Hodgkin lymphoma. A history of high UV exposure was associated with reduced risk of non-Hodgkin lymphoma. The positive association between skin cancer and malignant lymphomas is, therefore, unlikely to be mediated by UV exposure.

Lymphoproliferative and Intestinal Malignancies in 214 Patients With Biopsy-defined Celiac Disease

Prior studies have suggested that the incidence of some neoplastic disorders, particularly malignant lymphoma, is increased in celiac disease. In the present study, lymphoproliferative and intestinal cancers in 214 consecutive biopsy-defined celiac disease patients, including 148 females (69.2%) and 66 males (30.8%), seen by a single clinician over more than 20 years were tabulated. Of the 214 patients, 151 were diagnosed with celiac disease before age 60 and 63 at or after age 60. In total, 18 malignant lymphomas and 3 small intestinal adenocarcinomas were detected. While the overall incidence of malignant lymphoma was 8.4%, similar to other European centers, the incidence in elderly celiacs in this study was 22.2%. Celiac disease was detected before or even after the diagnoses of lymphoma or small intestinal adenocarcinoma were established. In some, epithelial lymphocytosis was evident in gastric, colonic, or biliary ductal epithelium. In addition, other immune-mediated disorders, dermatitis herpetiformis, and autoimmune thyroid disease were common, suggesting a distinct clinical and pathologic phenotype in celiac disease that may predispose to malignant complications. Finally, except for a single hypopharyngeal carcinoma in a celiac disease patient with a malignant lymphoma, other malignant disorders of esophagus, stomach, and colon were not detected.