Prostate Lymphoma Research Articles

A Rare Case of Incidental Primary Follicular Lymphoma Co-Existing With Grade Group 5 Prostatic Adenocarcinoma

Abstract Introduction/Objective Primary lymphoma of the prostate is an exceedingly rare entity comprising less than 0.1% of all prostatic cancers with follicular lymphoma making up only 12% of primary prostatic lymphomas. There is very limited literature owing to their rarity and underdiagnosis. To the best of our knowledge, prostatic adenocarcinoma with an incidental follicular lymphoma presenting as a prostate imaging reporting and data system 4 (PI-RADS 4) lesion on multiparametric magnetic resonance imaging (mpMRI) with mildly elevated serum prostate specific antigen (PSA) has not been previously described. Methods/Case Report A 73 year old male presented to Danbury Hospital for follow up on benign prostatic hyperplasia (BPH) diagnosed in 2020. The patient was experiencing nocturia and had a serum PSA of 4.8. Multiparametric MRI revealed an enlarged, 5.5 x 4.1 x 3.3 cm, prostate gland (estimate weight of 45.5 grams) with a 1.2 cm PI-RADS 4 lesion in the right anterior mid gland. There was no evidence of metastatic disease on his most recent body imaging. He was subsequently scheduled for prostate needle biopsy. Histopathology showed a high grade prostatic adenocarcinoma, with a Gleason score 4 + 5=9, along with a focally prominent dense lymphoid infiltrate in four of four cores from the same area of abnormality that was detected on mpMRI. The latter comprised of ill defined follicles and sheets of small cleaved atypical lymphoid cells consistent with centrocytes and very few centroblasts. By immunohistochemical staining, the atypical cells in lymphoid follicles and interfollicular areas were positive for CD20, CD10 and BCL2 and negative for cyclin D1. CD21 stain highlighted the follicular dendritic cell meshwork in the germinal centers with a low Ki67 proliferation index. A final diagnosis of low grade follicular lymphoma (grade1-2) coexisting with the prostatic adenocarcinoma was rendered. The patient is currently undergoing lymphoma staging as the treatment for adenocarcinoma is planned. Results (if a Case Study enter NA) NA Conclusion Primary lymphoma of the prostate usually presents with non specific obstructive voiding symptoms and normal or near normal PSA levels which makes it challenging for physicians to suspect lymphomas. The lymphocytic infiltrate, originally thought to be prostatitis, underwent further evaluation with immunohistochemistry due to its monotonous appearance, which clinched the final diagnosis. Careful evaluation of prostate core needle biopsies is necessary even after spotting carcinoma in order to rule out low grade lymphomas.

Primary Prostatic Lymphoma Presenting with Prostatomegaly

Primary Prostatic Lymphoma Presenting with Prostatomegaly

18F-Prostate-Specific Membrane Antigen and 18F-Fluorodeoxyglucose PET/CT Unmasked the Characteristics of Prostate Lymphoma: A Case Report and Literature Review

Prostate lymphoma (PL) is rarely observed and may be concurrently presented with prostate adenocarcinoma. Moreover, the appearance of PL on conventional imaging is similar with prostate adenocarcinoma. Thus, most of PL is diagnosed through prostate biopsy, or accidentally found in the specimens of surgery. Prostate-specific membrane antigen (PSMA) PET/CT has improved the management of prostate adenocarcinoma. While, the question regarding whether it benefits the discovery of the characteristics of PL is unknown. A 32-year-old man presented with worsening dysuria for 1 month, and the prostate-specific antigen (PSA) concentration was normal. While the pelvic MRI showed a mass in the prostate and multiple enlarged lymph nodes in the bilateral inguinal area. Then, the diagnosis of prostate adenocarcinoma was considered, but the serum PSA was normal and he was younger than most patients. So, 18F-PSMA PET/CT was then performed to further reveal the characteristics of the lesion and guide biopsy. However, there was no abnormal PSMA uptake in the lesion of the prostate and lymph nodes of the pelvic cavity and bilateral inguinal area. These lesions presented with increased glucose metabolism on fluorodeoxyglucose (FDG) PET/CT, and the prostate biopsy was then performed. PL was confirmed based on the results of the histopathologic examination, and the patient subsequently received systemic chemotherapy plus radiotherapy. Fortunately, the symptoms and the lesions completely disappeared after radiotherapy. The clinical symptoms of PL are atypical, and PL and adenocarcinoma may be concurrently presented. Moreover, distinguishing PL from prostate adenocarcinoma based on the appearance of conventional imaging is difficult. As opposed to prostate adenocarcinoma, a high FDG-avidity and low PSMA uptake by lymphoma either in the prostate or metastases are seen. So, PSMA PET/CT combined with FDG PET/CT can non-invasively identify the characteristics and origin of PL.

Primary lymphoma of the prostate: A report of two cases

The primary lymphoma of prostate is rare, representing 0.2–0.8% of extranodal lymphomas and 0.1% of all prostate neoplasias.

Lymphome prostatique: une cause rare de rétention urinaire: à propos d'un cas

Prostate lymphomas (LP) are rare, fewer than 300 cases have been reported in the literature. Each time they are a diagnostic surprise as is the case with our study that is typical, didactic and reports the thirteenth case of prostatic lymphoma in the marginal zone. The study involved a 65-year-old patient, with no particular previous history who presented with signs of prostatism lasting for 4 months, aggravated by the occurrence of acute urinary retention. The diagnosis of benign prostatic hyperplasia with normal prostate-specific antigen (PSA) level was easily made and the patient underwent transurethral resection. To our surprise, the histological study revealed a massive infiltration of prostatic tissue by a non-Hodgkin lymphoma (NHL), marginal zone lymphoma (MZL) subtype. According to Steuter, it was classified as prostatic lymphoma stage IVB with leukemic transformation. The patient has experienced remission for 18 months with normalization of LDH after R-chop therapy. Although rare, these sites of occurrence should be suspected, LDH assay should be systematic in patients with prostatic signs and normal PSA levels. Prognosis is variable, according to age, histologic type and evolutionary stage, however, the median overall survival is identical for primary and secondary forms.

Prostatic Burkitt Lymphoma, a Rare Secondary Location

Introduction: Non-Hodgkin’s malignant lymphoma is found primarily in African children. Prostate localization is a rare entity. We report the case of a secondary prostatic localization of Burkitt lymphoma in a 14-year-old child. Observation: the 14-year-old child NNJ was followed at the Libreville Cancer Institute (ICL) for Burkitt maxillo-facial stage II bilateral Murphy lymphoma. The clinical examination noted an alteration of the general state, total hematuria, a voluminous prostatic mass filling the rectal ampoule. The paraclinical assessment noted renal insufficiency, a prostatic mass on ultrasound. Anatomo-pathological examination of the prostatic biopsy diagnosed Burkitt type non-Hodgkin’s malignant lymphoma. He died a week later. Conclusion: Primary or secondary prostatic lymphoma is rare. Obstructive renal insufficiency is an additional complication that darkens its prognosis by delaying etiological treatment based on polychemotherapy.

Exclusive B-cell phenotype of primary prostatic lymphomas: a potential role of chronic prostatitis.

Primary prostatic lymphomas (PPL) is exceedingly rare. The aim of this study was to investigate the largest series of PPL obtained from a nationwide expert pathologist network, and thus try to understand the pathophysiology of these tumours. Up to 66000 lymphoma cases have been collected and submitted for central expert review by the French Lymphopath network. We confirm the low frequency of PPL (n=77; 0.12%), all cases being of B-cell origin. Diffuse large B-cell lymphoma and small lymphocytic lymphoma were the most frequent subtypes, comprising 31% and 26% of cases respectively, followed by mucosa-associated lymphoid tissue (MALT)/lymphoplasmacytic lymphoma (19%), follicular lymphoma (12%), mantle cell lymphoma (6%), Burkitt lymphoma (4%), and unclassified lymphoma (1%). Clinical data obtained in 25 cases suggests that PPLs are rather indolent tumours. Our hypothesis for B-cell recruitment in the prostatic tissue was derived from the observation in chronic inflammation (prostatitis) of frequent heterotopic proliferation of high endothelial venules (HEVs). The latter are dedicated to lymphocyte entry into secondary lymphoid organs, here putatively driving circulating clonal B-lymphocytes from the blood into the inflamed prostate. This may account for the relatively high incidence of small lymphocytic lymphoma consistently reported in series of primary or secondary prostatic lymphoma. As in other organs or glands, chronic inflammation may promote antigen-dependent intraprostatic MALT lymphoma and diffuse large B-cell lymphoma development. PPLs are exclusively of B-cell origin, and chronic inflammation resulting from the proliferation of high endothelial venules could play some role in their development.

Primary Prostatic Lymphoma Presenting with Features of Prostatism Developed Central Nervous System (CNS) Symptoms During Chemotherapy: A Case Report

Primary lymphoma of prostate is rare representing approximately 0.1% of all non-Hogdk in lymphomas. This type of lymphoma is more common in men with an average age of 60 years old. Dysuria is the most common symptom of prostatic lymphoma, which can lead to misdiagnosis of benign prostatic hyperplasia and adenocarcinoma easily. Besides, PSA was widely considered in the normal range in most patients with prostatic lymphoma, only a few patients showed elevated. We report a case of a 72-year-old primary prostatic diffuse large B-cell lymphoma patient with a significant increasing of PSA, developed Central Nervous System (CNS) symptoms after completing a cycle of R-CHOP therapy. Unfortunately, the patients received R-CHP in combination with high dose immunoglobulin, after a brief relief of CNS symptoms, the similar CNS symptoms returning again later. Involvement of CNS symptoms during therapy represents a serious complication of aggressive lymphoma, which is rare occurring nearly 5% of non-Hodgkin lymphoma and is considered as a high-risk model In conclusions, primary prostatic lymphoma with an increasing of prostatic-specific antigen is a rare case that is easily misdiagnosed. R-CHOP is till the recommended regimen, but other safe and effective alternatives are urgently needed when obvious CNS symptoms occurred during treatment.

Primary lymphomas of the genitourinary tract: A population-based study

ObjectiveWe performed a population-based analysis focusing on primary extranodal lymphoma of either testis, kidney, bladder or prostate (PGUL). MethodsWe identified all cases of localized testis, renal, bladder and prostate primary lymphomas (PL) versus primary testis, kidney, bladder and prostate cancers within the Surveillance, Epidemiology, and End Results database (1998–2015). Estimated annual proportion change methodology (EAPC), multivariable logistic regression models, cumulative incidence plots and multivariable competing risks regression models were used. ResultsThe rates of testis-PL, renal-PL, bladder-PL and prostate-PL were 3.04%, 0.22%, 0.18% and 0.01%, respectively. Patients with PGUL were older and more frequently Caucasian. Annual rates significantly decreased for renal-PL (EAPC: −5.6%; p=0.004) and prostate-PL (EAPC: −3.6%; p=0.03). In multivariable logistic regression models, older ager independently predicted testis-PL (odds ratio [OR]: 16.4; p<0.001) and renal-PL (OR: 3.5; p<0.001), while female gender independently predicted bladder-PL (OR: 5.5; p<0.001). In surgically treated patients, cumulative incidence plots showed significantly higher 10-year cancer-specific mortality (CSM) rates for testis-PL, renal-PL and prostate-PL versus their primary genitourinary tumors. In multivariable competing risks regression models, only testis-PL (hazard ratio [HR]: 16.7; p<0.001) and renal-PL (HR: 2.52; p<0.001) independently predicted higher CSM rates. ConclusionPGUL rates are extremely low and on the decrease in kidney and prostate but stable in testis and bladder. Relative to primary genitourinary tumors, PGUL are associated with worse CSM for testis-PL and renal-PL but not for bladder-PL and prostate-PL, even after adjustment for other-cause mortality.

Incidental Lymphoplasmacytic Lymphoma Diagnosed Following Robotic-Assisted Laparoscopic Prostatectomy for Prostate Cancer

We report a case of prostatic lymphoma of the Walden-ström's macroglobulinemia subtype in a 64-year-old gentleman who underwent a robotic-assisted laparoscopic prostatectomy following lower urinary tract symptoms and high grade adenocarcinoma on transperineal prostate biopsy's. Histopathological and immunohistochemistry analysis at the time of surgery was consistent with a CD5-negative small B-cell lymphoma. To our knowledge this is the first reported prostatic lymphoma identified following robotic-assisted laparoscopic prostatectomy and the first documented case of lymphoplasmacytic lymphoma involving prostate. Lymphoma of the prostate is an uncommon entity in surgical practice and their diagnosis often poses considerable difficulty as they often mimic carcinoma. We discuss this rare diagnosis and review the literature for current considerations and prognosis.

Vitamin D deficiency in patients with newly diagnosed cancer.

e13117 Background: Vitamin D deficiency (VDD) is pandemic in modern society. There has been increasing interest in vitamin D and its impact on cancer. A number of studies have been published on a possible link between VDD and cancer. However, because of inconsistent results, controversy remains in various aspects of vitamin D. In this study, we assessed the association of VDD with various cancers. Methods: A retrospective study was conducted in a tertiary care hospital network in western Pennsylvania. Electronic health record database was used to extract the data from patients seen in outpatient office with newly diagnosed cancer who had a measured 25-hydroxy vitamin D level at diagnosis between 02/2016 and 02/2018. VDD was defined as level less than 30 ng/dl. Patient demographics, smoking, and vitamin D status were used for multivariate logistic regression analysis in order to determine odds ratio (OR) of certain cancer type in our cohort. We used SPSS version 23 for statistical analysis. Results: A total of 934 patients (59.2% female) with cancer were included. Most patients, 86.4%, were Caucasian, and 10.8% African American (AA). VDD was found in 433 patients (46.4%) and more prevalent in men (n = 203, 53.3%), and AA (n = 65, 64.4%) in our cohort. The most common cancer type was breast cancer (30.9%), followed by prostate cancer (11.3%), lymphoma (11.1%), and lung cancer (7.8%). After adjusting to demographic characteristics and smoking status, VDD was significantly associated with pancreatic cancer (OR = 2.28, p = 0.02), and reversely associated with breast cancer (OR = 0.56, p = 0.001). VDD was also prevalent in colorectal cancer, but not statistically significant, (OR = 1.71, p = 0.064). Conclusions: Our study demonstrated that VDD is prevalent among cancer patients, especially in men and AA patients. There is a strong association between VDD and the malignancies of digestive system, particularly pancreatic cancer. Further studies are needed to assess the effect of VDD on disease-specific risk and cancer mortality as well as the impact of vitamin D supplement.

Predominance of hypoechoic tissue changes in nine dogs with malignant prostatic lymphoma.

Neoplasia of the prostate is relatively uncommon in dogs with adenocarcinoma being the most common type. Non-epithelial tumors are rare and only individual cases of malignant lymphoma affecting the prostate have been reported. The purpose of this multi-institutional, retrospective, descriptive study was to characterize the ultrasonographic features of canine prostatic lymphoma. Inclusion criteria wereanabdominal ultrasound and cytological/histological diagnosis of malignant prostatic lymphoma. Ultrasonographic features were recorded based on the original ultrasonographic reports and consensus opinion of two readers on the available image sets retrospectively.Nine dogs met the inclusion criteria with a mean age of 6.5 years. Seven dogs were intact and two neutered. Subjective prostatomegaly was noted in all patients however not reproducible by objective measurements. Altered shape with rounded/irregular margins was detected in 78% of the cases. All prostates presented either diffuse (three dogs) or focal/periurethral (four dogs) and/or multifocal areas of hypoechogenicity (three dogs). In one dog, focal and multifocal hypoechoic changes co-occurred. Prostatic mineralization was not present in any of the cases. Ultrasonographic features of infiltrative disease of multiple organs and/or lymphadenopathy was found in all cases.Even though malignant lymphoma is rare in the prostate, it should be included in the list of differentials in patients with hypoechoic lesions/areas, altered shape, lack of mineralization of the prostatic parenchyma andevidence of multiorgan involvement.

Urinary tract lymphoma: a clinical analysis of 16 cases and review of literature

Objective To analyze the clinical features, treatment outcomes and prognosis of patients with urinary tract lymphoma. Methods The clinical data of 16 patients in Tongji Hospital of Tongji University from January 2009 to April 2016 were collected and retrospectively analyzed. Results The median age of these patients was 68 years. The onset symptoms of 14 cases were related to urinary system and imaging studies of 10 cases showed masses in the urinary system. The onset regions of lymphoma included: 4 cases were renal lymphoma, 5 cases were adrenal lymphoma, 5 cases were testicular lymphoma, 1 case was prostate lymphoma and 1 case was from urethral mouth. The histological type of 12 cases was diffuse large B-cell lymphoma and 10 patients were non-germinal center B cell-like (non-GCB) molecular profiling. Twelve cases belonged to Ann Arbor stages ⅢE-ⅣE, 10 cases had international prognostic index scores ≥3, and 7 cases had B symptoms. 10 patients were confirmed by surgery. Fourteen cases accepted rituximab-containing regimen chemotherapy. Five cases achieved complete response and 3 were partial response. Conclusions The clinical manifestations and imagine examination of patients with urinary tract lymphoma are lack of specificity. The clinical features are highly aggressive and most of the patients are diagnosed at advanced stage. The main histological type is diffuse large B-cell lymphoma and non-GCB molecular profiling. Treatment regimens include surgery combined with chemotherapy and radiotherapy. Earlier diagnosis and treatment may improve the survival of patients. Key words: Urologic neoplasms; Lymphoma; Treatment

Comparison of cancer incidence in Australian farm residents 45 years and over, compared to rural non-farm and urban residents - a data linkage study

BackgroundIt is not known if the incidence of common cancers in Australian farm residents is different to rural non-farm or urban residents.MethodsData from farm, rural non-farm and urban participants of the 45 and Up Study cohort in New South Wales, Australia, were linked with state cancer registry data for the years 2006–2009. Directly standardised rate ratios for cancer incidence were compared for all-cancer, prostate, breast, colorectal cancer, melanoma and non-Hodgkin Lymphoma (NHL). Proportional hazards regression was used to generate incidence hazard ratios for each cancer type adjusted for relevant confounders.ResultsFarm women had a significantly lower all-cancer hazard ratio than rural non-farm women (1.14, 1.01–1.29). However, the lower all-cancer risk observed in farm men, was not significant when compared to rural non-farm and urban counterparts. The all-cancer adjusted hazard ratio for combined rural non-farm and urban groups compared to farm referents, was significant for men (1.08,1.01–1.17) and women (1.13, 1.04–1.23). Confidence intervals did not exclude unity for differences in risk for prostate, breast, colorectal or lung cancers, NHL or melanoma. Whilst non-significant, farm residents had considerably lower risk of lung cancer than other residents after controlling for smoking and other factors.ConclusionsAll-cancer risk was significantly lower in farm residents compared to combined rural non-farm and urban groups. Farm women had a significantly lower all-cancer adjusted hazard ratio than rural non-farm women. These differences appeared to be mainly due to lower lung cancer incidence in farm residents.

Primary prostatic intravascular large B-cell lymphoma: report of one case and review of literature

目的 探讨原发于前列腺的血管内大B细胞淋巴瘤（IVLBCL）的临床病理特征、诊断、鉴别诊断、治疗及预后。 方法 回顾性分析1例前列腺的IVLBCL患者的临床资料、组织病理学形态和免疫组织化学结果，并复习相关文献。 结果 患者以头晕为首发症状，伴随排尿费力，体检有前列腺肥大，病理活组织检查发现前列腺间质小血管内见成簇异形淋巴样细胞。免疫组织化学示肿瘤细胞CD20+、LCA+、CD79a+、PAX5+、Ki-67阳性率90%，血管内皮CD34+。病理学诊断：前列腺的IVLBCL（活化B细胞起源）。患者拒绝治疗，于诊断后5个月死亡。 结论 原发于前列腺的IVLBCL罕见，临床表现缺乏特异性，病理学检查及免疫组织化学对IVLBCL的诊断和鉴别诊断具有重要意义。

Highlights lecture EANM 2015: the search for nuclear medicine's superheroes.

The EANM 2015 Annual Congress, held from October 10th to 14th in Hamburg, Germany, was outstanding in many respects. With 5550 participants, this was by far the largest European congress concerning nuclear medicine. More than 1750 scientific presentations were submitted, with more than 250 abstracts from young scientists, indicating that the future success of our discipline is fuelled by a high number of young individuals becoming involved in a multitude of scientific activities. Significant improvements have been made in molecular imaging of cancer, particularly in prostate cancer. PSMA-directed PET/CT appears to become a new gold standard for staging and restaging purposes. Novel tumour specific compounds have shown their potential for target identification also in other solid neoplasms and further our understanding of tumour biology and heterogeneity. In addition, a variety of nuclear imaging techniques guiding surgical interventions have been introduced. A particular focus of the congress was put on targeted, radionuclide based therapies. Novel theranostic concepts addressing also tumour entities with high incidence rates such as prostate cancer, melanoma, and lymphoma, have shown effective anti-tumour activity. Strategies have been presented to improve further already established therapeutic regimens such as somatostatin receptor based radio receptor therapy for treating advanced neuroendocrine tumours. Significant contributions were presented also in the neurosciences track. An increasing number of target structures of high interest in neurology and psychiatry are now available for PET and SPECT imaging, facilitating specific imaging of different subtypes of dementia and movement disorders as well as neuroinflammation. Major contributions in the cardiovascular track focused on further optimization of cardiac perfusion imaging by reducing radiation exposure, reducing scanning time, and improving motion correction. Besides coronary artery disease, many contributions focused on cardiac inflammation, cardiac sarcoidosis, and specific imaging of large vessel vasculitis. The physics and instrumentation track included many highlights such as novel, high resolution scanners. The most noteworthy news and developments of this meeting were summarized in the highlights lecture. Only 55 scientific contributions were mentioned, and hence they represent only a brief summary, which is outlined in this article. For a more detailed view, all presentations can be accessed by the online version of the European Journal of Nuclear Medicine and Molecular Imaging (Volume 42, Supplement 1).

Abstract B39: Trends in 5-year and 10-year crude survival rates among American Indians and Alaskan Natives diagnosed with cancer, 1997-2012

Abstract Background: Cancer is the second leading cause of death among American Indians and Alaskan Natives (AIANs) in the United States. However, information on cancer survival among AIANs, especially those living in urban areas, is limited. California is home to the largest AIAN population, comprised of over 700,000 individuals. To address this gap, we present data on cancer diagnoses and survival after cancer diagnoses among AIANs and non-Hispanic whites (NHWs) from the Kaiser Permanente Northern California (KPNC) tumor registry. Purpose: To examine cancer diagnoses and overall survival rates among AIAN individuals diagnosed with primary invasive cancer and compare to NHWs. Methods: This prospective cohort study uses data on 1,022 AIANs and 139,725 NHWs diagnosed with primary invasive cancer between 1997 and 2012, from the KPNC tumor registry and other electronic health records. Information on race, cancer site, tumor size, tumor grade, stage, year and age at diagnosis, type of treatment (e.g. surgery, radiation, chemotherapy, and hormone), comorbidities, follow-up time and sociodemographics were extracted. Follow-up time was defined as number of days from date of diagnosis through either death from any cause, disenrollment or end of study period (March 31, 2014), whichever came first. Descriptive statistics were calculated for tumor, and clinical characteristics. Sociodemographic characteristics, including race, were extracted from the electronic health record. We identified the top 5 cancer sites, by sex, and estimated 5- and 10-year Kaplan-Meier survival rates for AIANs and NHWs. Charlson comorbidity scores and top 5 comorbidities were also compared between these populations. Results: Among AIANs, the 5 most common cancers diagnosed were prostate (16.4%), breast (16.4%), lung (13.3%), colorectal (12.5%), and non-Hodgkin lymphoma (4.0%). Among NHWs, the most commonly diagnosed cancer was prostate (17.3%), followed by breast (16.8%), lung (11.7%), colorectal (9.3%) and melanoma (6.6%) cancers, respectively. Overall 5- and 10-year survival estimates among AIANs with any cancer were statistically significantly lower than for NHWs (51.9 vs. 58.2, p&amp;lt;0.001 and 37.4 vs. 43.8, p&amp;lt;0.001, respectively). When examining the most common individual cancer sites, 5- and 10-year overall survival estimates were consistently lower among AIANs compared to NHWs, although only the 5-year survival following breast cancer was statistically significant. AIANs with any cancer had a significantly higher rate of comorbidity compared to NHWs (p&amp;lt;0.003). The most common non-malignancy comorbidities among AIANs were chronic pulmonary disease (25.5%), diabetes (with and without end-organ damage), (18.7%), and congestive heart disease (7.0%); the most common for NHWs were chronic pulmonary disease (21.4%), diabetes (14.3%) and congestive heart (6.0%). Conclusions: This study adds valuable information to the literature, identifying the most commonly diagnosed cancers and overall survival among AIANs outside of the Indian Health Service (IHS). Despite equal access to health care in the study population, our results show a lower survival for AIANs than NHWs, following invasive cancer, and a greater proportion of AIAN cancer patients with multiple comorbid conditions. Given that over two-thirds of AIANs live in urban settings, research efforts to identify potentially unique drivers of cancer health disparities are warranted to improve outcomes for urban dwelling AIANs within non-IHS health care systems. Citation Format: Marc A. Emerson, Matthew P. Banegas, Neetu Chawla, Ninah Achacoso, Alyce Adams, Laurel A. Habel. Trends in 5-year and 10-year crude survival rates among American Indians and Alaskan Natives diagnosed with cancer, 1997-2012. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B39.

Abstract 3604: Targeting the PIM kinases in combination with BTK inhibition is synergistic in preclinical models of B-cell malignancies

Abstract BTK inhibitors (e.g. ibrutinib) have significantly impacted the treatment of B-cell malignancies in a positive way. Single agent response rates with ibrutinib are 65% or higher in B-cell lymphomas and chronic lymphocytic leukaemia with the majority of patients enjoying a prolonged duration of response. Continued clinical development is needed, however, as most patients achieve only a partial response from their treatment and ultimately patients become refractory to ibrutinib leading to relapse and disease progression. Targeted combinations with ibrutinib could potentially increase the number of patients undergoing complete remission and combat emergent resistant mechanisms. The PIM family (1, 2, and 3) are serine/threonine kinases that have proven to be oncogenic in-part due to their ability to suppress c-Myc induced apoptosis. The PIM kinases have emerged as important regulators of drug resistance in multiple cancer types. Tolero Pharmaceutical's second generation PIM Kinase inhibitor, TP-3654 has exhibited favorable activity in preclinical models of prostate cancer, AML, and lymphoma. Due to the signaling crosstalk between BTK and PIM through the STAT transcription factors, we hypothesized that synergies may arise through the simultaneous targeting of both kinases. Here, we report a significant increase in drug activity when a BTK inhibitor (ibrutinib) was combined with TP-3654 in various lymphoma cell lines. In Granta-519 cells, the IC50 of ibrutinib decreased 3.5-fold, from 0.7 μM to 0.2 μM, when cultured in combination with a subtoxic concentration of TP-3654 (300 nM). Similarly, the IC50 of TP-3654 decreased 6-fold, from 2.4 μM to 0.4 μM, when cells were cultured in combination with a subtoxic concentration of ibrutinib (100 nM). BTK is known to attenuate the activity of the transcription factor STAT3, a major regulator of PIM kinase levels in cells. Due to this, mechanistic studies focused on analyzing the STAT3 pathway are ongoing to determine the downstream effects of using ibrutinib and TP-3654 in combination. Several lymphoma xenograft studies are also ongoing to further explore this combination in vivo. These results provide a strong rationale that inhibitors of PIM and BTK could be used in combination for the treatment of B-cell malignancies and other B-cell mediated diseases. Citation Format: Jeremiah J. Bearss, Brigham L. Bahr, Katie K. Soh, Peter W. Peterson, Clifford J. Whatcott, Adam Siddiqui-Jain, David J. Bearss, Steven L. Warner. Targeting the PIM kinases in combination with BTK inhibition is synergistic in preclinical models of B-cell malignancies. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3604. doi:10.1158/1538-7445.AM2015-3604

Primary prostatic diffuse large B-cell lymphoma

Fig. 1. Computed tomography reveals a picture favoring prostate cancer with invasion of the seminal vesicles and bladder. A 52-year-old man suffered from urinary frequency and urge incontinence for 2 years. Intermittent gross hematuria was noted in the previous month. He denied other systemic diseases or surgical history. A firm mass in the anterior rectum was revealed on digital rectal examination, favoring external compression from an indurated prostate. Cystoscopy showed an enlarged prostate and no urinary bladder tumor. The serum prostate-specific antigen level was 0.747 ng/mL. Other laboratory data were within reference levels. Computed tomography revealed a picture favoring prostate cancer with invasion of the seminal vesicles and bladder (Fig. 1). Transurethral resection of the prostate was performed. Histopathology features revealed infiltration of discohesive, large tumor cells in the stroma (Fig. 2A). Immunohistochemically, the tumor cells were positive for CD20 (Fig. 2B). There was no history of lymphoma or systemic enlarged lymphadenopathy. Primary prostatic diffuse large B-cell lymphoma was diagnosed. The patient received chemotherapy. Post-therapy positron emission tomographyecomputed tomography revealed metabolic remission of the prostatic lesion. The patient achieved complete remission with regular follow-up. Prostatic lymphomas are uncommon, and are mostly secondary involvement from systemic lymphoma. Primary prostatic diffuse large B-cell lymphoma is rare. The criteria for primary prostatic

Concurrence of prostatic adenocarcinoma and lymphoma: Clinical and pathological characteristics–Single institutional experience.

e16101 Background: Prostatic adenocarcinoma (PA) is the most common cancer in men. Majority of non-Hodgkin lymphoma (NHL) and PA occur in the elderly, age > 65 years. Per latest SEER data incidence...