Lymphoma Of Cervix Research Articles

Head and neck lymphoma

Head and neck lymphoma

頸部Castlemanリンパ腫の一症例

頸部Castlemanリンパ腫の一症例

Altered p53 expression in Epstein Barr virus positive T cell lymphomas.

Recent studies have suggested a probable association between Epstein-Barr virus (EBV) and nasal/nasopharyngeal T cell lymphomas but the role of oncogenes or tumor suppressor genes is poorly understood. We have studied the frequency of p53 expression and its relation to the EBV infection in 33 Korean patients with head and neck (H&N) lymphomas. All cases (23 B cell & 10 T cell) were immunostained for p53 protein using the mAb D07 (Novocastra) and the avidin biotin peroxidase method. EBER in situ hybridization was performed using a fluorescein conjugated EBV oligonucleotide probe (Dako). Among 33 lymphomas, 16 cases stained positively for p53 protein. P53 expression was frequent both in higher grade lymphomas and in advanced stage. Nine cases were EBER positive, EBER was more commonly found in T cell lymphomas than in B cell lymphomas (70% vs 8.7%). EBER positive lymphomas showed a higher frequency of p53 positivity than EBER negative lymphomas (78% vs 38%), although the difference was not statistically significant (p = 0.095). These findings indicate altered expression of p53 protein occurs in H&N lymphomas, especially in late event lymphoma progression and appears to play a role in the development of EBER positive T cell lymphomas.

CT Findings of Neck Lymphoma:Significance of Central Low Attenuation and Differentiation of Non-Hodgkin's Lymphoma from Hodgkin's Disease

CT Findings of Neck Lymphoma:Significance of Central Low Attenuation and Differentiation of Non-Hodgkin's Lymphoma from Hodgkin's Disease

Palpation und Sonographie in der Nachsorge von Kopf-Hals-Tumorpatienten: Vergleich sonographischer Dignitätsparameter

The ranking of postoperative palpation and sonography is examined in respect of imaging of neck lymph node enlargement and neck lymph node metastases or lymphomas, using a prospective study involving 127 patients whose head and neck tumours had already undergone treatment. These patients had been subjected to tumour aftercare for an average period of 26 months. Sonography is well suited for detecting the presence of enlarged neck lymph nodes, the accuracy being 97.5%. In this study palpation was clearly less safely defined, the accuracy being only 85%. The following results were obtained in respect of the specific imaging of metastases: sensitivity of palpation (75%) is below that of sonography (M/Q ratio) (93%). In respect of specificity palpation also yielded poorer results than sonography (M/Q ratio 94%) because of the relatively high proportion of false positive palpations (17%). The reason for this is non-differentiation between reactively enlarged lymph nodes and lymph nodes metastases. The advantage of sonography vs palpation by using the M/Q ratio is therefore the accuracy of the findings (94% sonography, 81% palpation) and hence the clear reduction in false positive and false negative findings. Furthermore, sonography can image the exact relationship to surrounding tissue and especially the vessels. The drawback of sonography is that lymph nodes < 9 mm maximal diameter cannot be assessed with the safety and accuracy mentioned above. Sonomorphological criteria such as the central marrow reflex and a widened lymphatic node cortex enhance diagnostic safety of the sonographic expansion parameters to yield an assessment of tumour status.

Incidence of ‘unsuspected’ extranodal head and neck lymphoma : R Morton, HA Sillars, CS Benjamin. Clin Otolaryngol 17:373–375, 1992

Incidence of ‘unsuspected’ extranodal head and neck lymphoma : R Morton, HA Sillars, CS Benjamin. Clin Otolaryngol 17:373–375, 1992

CT of head and neck lymphoma

CT of head and neck lymphoma

The prognostic value of Ki-67 antigen in non-Hodgkin lymphoma of Waldeyer ring and the nasal cavity.

A monoclonal antibody, Ki-67, recognizes an antigen expressed in all phases of the cell cycle, except G0, and can be used as a simple histologic marker of cell proliferation. To assess the prognostic value of the growth fraction in non-Hodgkin lymphoma of Waldeyer ring (W-NHL) and the nasal cavity (N-NHL), the authors applied Ki-67 immunostaining combined with image analysis on such lymphomas. The authors studied 29 patients (18 with W-NHL and 11 with N-NHL), applying Ki-67 to frozen sections. The number of Ki-67-positive cells in a unit area (0.044 mm2), as an indicator of proliferative activity, and the mean area per Ki-67-positive cell (microns2), as an indicator of DNA content, were measured by the image processing system. High-grade lymphomas showed a significantly larger number of Ki-67-positive cells than intermediate-grade lymphomas (102.5 +/- 21.6 in high-grade and 46.8 +/- 8.92 in intermediate-grade lymphomas, P = 0.03), even when analyzed separately by immunophenotypes. A large mean area per Ki-67-positive cell was associated significantly with a T-cell phenotype (36.3 +/- 7.69 microns2 in T-cell lymphomas and 19.4 +/- 2.33 microns2 in B-cell lymphomas, P = 0.034) and an unfavorable clinical outcome. High proliferative activity, defined as nuclear Ki-67 expression in 2000 or more B-cell lymphoma cells and 1000 or more T-cell lymphoma cells in a 1-mm2 area, was found to be a strong predictor of poor survival among these patients (P = 0.048 and P = 0.009, respectively). Ki-67 immunostaining, combined with image analysis, is a novel method for determining a tumor proliferative index that provides useful clinical data regarding head and neck lymphomas.

Incidence of 'unsuspected' extranodal head and neck lymphoma.

A series of 100 consecutive patients presenting with non-Hodgkin's lymphoma in the head and neck region was reviewed. An examination of the contribution made to the staging classification by an otolaryngological examination showed that one-third of patients presenting with cervical nodes had unsuspected extranodal disease in Waldeyer's ring. Overall 14% of patients undergoing an otolaryngological examination had their disease upstaged because of that examination.

Head and neck lymphoma in patients with the acquired immune deficiency syndrome.

A marked increase has recently been noted in the incidence of lymphoma in patients with AIDS. These lymphomas are generally high-grade, of B-cell origin, and often involve extranodal sites. Reported here are twenty patients with AIDS in whom symptoms and physical findings developed related to the head and neck region as a result of lymphoma. The tumor was observed in a variety of sites, including the nasopharynx, orbit, submandibular triangle, anterior and posterior cervical triangles, supraclavicular fossa, and the hypopharynx. Sixteen tumors were large cell nonHodgkin's B-cell lymphomas, three were small cell nonHodgkin's B-cell lymphomas, and one was Hodgkin's disease, mixed cellularity. All were treated with combination chemotherapy. A high degree of suspicion for lymphoma is required in treating any patient with AIDS who has a rapidly enlarging mass in the head and neck. If needle aspiration is nondiagnostic, excisional biopsy should be performed after a complete head and neck evaluation. Although the development of lymphoma associated with AIDS portends a grave prognosis, prompt diagnosis will allow an improved chance of remission of the lymphoma.

Localized head and neck lymphomas — Analysis of prognostic factors and treatment outcome

Localized head and neck lymphomas — Analysis of prognostic factors and treatment outcome

Cervical lymph nodes from an unknown primary tumor in 190 patients

Over 10 years, 475 patients with isolated lateral neck masses were evaluated: 190 with lymph nodes from an unknown primary tumor (LNUP), 188 with neck lymphomas, 78 with benign tumors, 10 with sarcomas, and 9 with chemodectomas. This study focused on the patients with LNUP. Only 86 patients were treated with surgery (plus radiotherapy). Other patients were treated with radiotherapy (84) or chemotherapy (13) or had no treatment (7). For the overall population, failures in the neck occurred in 51% of the patients and distant metastases in 27%, while primary tumors appeared in 16%. Survival rates at 3, 5, and 10 years were 27%, 19%, and 7%, respectively, for the overall population and 45%, 35%, and 19%, respectively, for the surgical group. The diagnosis and therapeutic approach had a direct effect on neck control; failure in the neck occurred in 7 of 47 patients (15%) when fine needle aspiration and radical neck dissection with radiotherapy were performed, in 5 of 12 patients (42%) when fine needle aspiration and modified neck dissection with radiotherapy were used, in 5 of 12 patients (42%) when adenectomy diagnosis and radiotherapy treatment were performed, and in 6 of 11 patients (54%) when diagnosis by incisional biopsy was performed prior to admission, despite subsequent radical neck dissection and radiotherapy treatment. In our opinion, panendoscopy and fine needle aspiration should be the first-line diagnostic approach. When cytologic diagnosis proves impossible, the second-line approach must consist of cervical exploration with frozen section examination and excisional biopsy, followed by immediate appropriate treatment. In cases of LNUP, radical neck dissection seems to be preferable.

Uterine cervix lymphoma can be pharmacologically treated with fertility perservation

Uterine cervix lymphoma can be pharmacologically treated with fertility perservation

Head, neck, and Maxillofacial childhood Burkitt's lymphoma: A retrospective analysis of 31 patients

Thirty-one children with Burkitt's lymphoma of the head, neck, and maxillofacial region diagnosed between 1976 and 1988 were reviewed. The age range was 2 to 17 years (median, 7.2 years), and 77.4% were males. The most common presenting symptoms were detectable masses, floating and/or painful teeth, enlarged cervical lymph nodes, sore throat, and neurologic signs. The predominant primary tumor sites were the jaws and tonsils. All patients were staged by a clinical staging system, 17 of them having stage I–II, and 14 stage III–IV. Levels of lactate dehydrogenase and ferritin were the only significant laboratory parameters correlating with initial staging and disease-free survival. Radiologic features in the jaws were poorly circumscribed destructive lytic lesions with migration and crypt destruction of unerupted teeth buds. Complete disappearance of these findings was noted after successful chemotherapy and clinical regression of the tumor. Eighteen (58.1%) patients attained complete remission with a follow-up of 5 to 100 months. Stage was the most significant variable affecting outcome, with 90.2% disease-free survival of stage I patients, 72.4% of stage II, and 18.2% of stage III–IV. Based on these results, it is concluded that localized (stage I and II) Burkitt's lymphoma is responsive to chemotherapy and thus has a favorable prognosis.

Extranodal Head and Neck Lymphoma: Prognosis and Patterns of Recurrence

Stages I and II extranodal head and neck lymphomas treated between 1969 and 1986 were reviewed to determine prognosis and recurrence patterns. Forty-four patients had low-grade lymphoma, with 57% remaining disease free (median survival, 7.2 years). Radiotherapy provided long-term disease-free survival and palliation in the majority of patients. Relapse did not adversely affect survival. Eighty-eight patients had intermediate- or high-grade lymphoma, with 42% remaining disease free (median survival, 2.4 years). Treatment with radiotherapy alone was inadequate. Combined radiotherapy and anthracycline-containing chemotherapy appeared to be superior. Extranodal sites of first relapse were common. Central nervous system relapse was common with primary tumors located above the pterygopalatine line. Central nervous system staging and prophylactic therapy is warranted in patients with tumors above the pterygopalatine line.

Therapeutic plasmapheresis and protein A immunoadsorption in Malignancy: A brief review

Plasmapheresis is being used with considerable frequency in the management of malignant and non-malignant disorders. More recently, staphylococcal Protein A immunoadsorption has been employed in similar clinical situations. In patients with malignancy, plasmapheresis has been shown to produce alterations in plasma proteins, decrease circulating immune complexes, remove "specific" and "non-specific" blocking factors, change immune reactivity, and affect monocyte function. Partial responses have been reported in a small number of patients with carcinoma of lung, colon, and breast following plasmapheresis. In addition, there are reports of favorable responses in patients with melanoma, head and neck tumors, lymphomas, leukemias, and Kaposi's sarcoma in acquired immune deficiency. All these responses were partial and brief, and the treatment did not alter the course of the disease. Plasmapheresis has been useful in the management of hyperviscosity and occasionally of paraneoplastic syndromes. It may also have a role in the treatment of thrombotic thrombocytopenic purpura associated with mitomycin-C therapy. Protein A immunoadsorption, by which circulating immune complexes are selectively removed, can activate the complement system, increase blastogenic responses, and increase the natural killer cell activity. It has been shown to produce partial responses in breast and colon cancer, as well as Kaposi's sarcoma in acquired immune deficiency. It may have a useful role to play in the management of mitomycin-C-associated thrombotic thrombocytopenic purpura. Both plasmapheresis and Protein A immunoadsorption should be considered investigational interventions at this time. Toxicity of plasmapheresis, though uncommon, can be serious and may rarely be fatal. Toxicity of Protein A immunoadsorption is mild, consisting mainly of influenza-like symptoms and rash.

Lymphomas of the head and neck: CT findings at initial presentation.

CT findings were reviewed in 68 patients with untreated head and neck lymphoma. More than half of the patients with either Hodgkin's disease or non-Hodgkin's lymphoma were detected in the earlier stages (stage I or II). Four types of abnormalities were identified with CT: nodal involvement alone (type 1), extranodal involvement alone (type 2), a combination of extranodal and nodal disease (type 3), and multifocal extranodal disease with or without nodal involvement (type 4). In the 18 patients with Hodgkin's disease, a subgroup of mixed cellularity was most common; type 1 was the prevailing CT presentation, and no type 2 or 4 lesions were observed. In the 50 patients with non-Hodgkin's lymphoma, diffuse large-cell lymphoma was the most common histologic subtype, and the most common CT presentation was type 2, followed by type 3. Lymphomatous nodes may be extensive and confluent, but often they are smaller than 2 cm and rarely are necrotized. The most frequent extranodal sites of head and neck lymphomas are Waldeyer's ring, paranasal sinuses, and nasal cavity. Extranodal lymphoma cannot be differentiated reliably from the more commonly occurring carcinoma, although it is less often associated with invasion and destruction of adjacent bony structures. Multiple sites of extranodal involvement, with or without neck lymphadenopathy, may suggest a diagnosis of non-Hodgkin's lymphoma.

Primary lymphoma of the uterine cervix

Primary lymphoma of the cervix is very rare. A case report is presented and 24 cases published in the English literature are reviewed. Evaluation, staging, treatment, and prognosis of this rare tumor are discussed.

Primary cutaneous lymphoma of the head and neck.

One hundred three patients with Stage I and II extranodal primary lymphomas of the head and neck were reviewed. Six patients (5%) presented with cutaneous lesions, five with single site and one with multiple sites of involvement. Histopathology was malignant lymphoma (ML) large cell (3), ML small cleaved cell (1), ML small lymphocytic (1), and ML mixed large and small cell (1). Five of six patients relapsed following initial treatment. Four patients were treated with primary radiation therapy, three of which had relapses outside the treatment area. One patient was treated with intralesional steroid injection and also recurred outside the treated area. One patient was treated with radiation and chemotherapy and recurred outside the treatment area. Three patients are alive without disease, two died of disseminated disease, and one died of unrelated causes. Isolated cutaneous presentation of head and neck lymphoma is uncommon. Radiation therapy appears to have been curative in one patient with localized disease. Four patients recurred outside the radiation portals despite careful staging, suggesting that systemic therapy may be necessary for disease control.

The management of extranodal head and neck lymphomas.

The results from 156 patients with extranodal head and neck lymphomas treated at Stanford (Calif) University School of Medicine are combined with the experience of other investigators to recommend the management of these lymphomas. The tonsil and sinuses were the most common sites of presentation, and the most common histology was diffuse histiocytic lymphoma. The histologic classification systems are described as well as the use of immunohistochemistry in diagnosis. The appropriate staging procedures and the Ann Arbor staging system are discussed. Following the staging of 948 patients, 66% were found to have stage I or stage II disease and 34% had more widespread disease. Treatment with radiotherapy is discussed. Patterns of relapse following local radiotherapy for 360 relapsing patients with stage I and II disease showed a 73% distal relapse rate. Various treatment programs are recommended based on site, stage, and histology.