Occurrence Of non-Hodgkin Lymphoma Research Articles

The impact of two different rituximab-based strategies in cryoglobulinaemic vasculitis secondary to Sjögren's disease: a monocentric cohort study.

To compare two different rituximab (RTX)-based therapeutic approaches on vasculitic and lymphoproliferative-related disease activity and on non-Hodgkin lymphoma (NHL) development in a cohort of patients affected by cryoglobulinaemic vasculitis secondary to Sjögren's disease (Sjögren-CryoVasc). Three Sjögren-CryoVasc treatment groups were identified: 1) early RTX induction followed by maintenance; 2) late RTX induction with possible on-demand retreatment; 3) no RTX treatment. The following outcomes were evaluated: a) changes in cumulative ESSDAI, considering vasculitic-related and lymphoproliferative-related domains and changes in ESSDAI specific to each single vasculitic-related and lymphoproliferative-related domain; b) development of NHL; c) occurrence of persistent hypogammaglobulinemia associated with serious infections. 13 Sjögren-CryoVasc patients were identified: 1) 5/13 treated earlier with RTX with subsequent maintenance; 2) 5/13 treated late with RTX with possible on-demand retreatment; 3) 3/13 not treated with RTX. The two RTX groups showed a decrease in the ESSDAI score with group 1 showing the most substantial reduction (p=0.028). Patients receiving RTX exhibited significant improvement in cutaneous, PNS, and articular vasculitic-related ESSDAI domains (p=0.007; p=0.006; p=0.03, respectively). By contrast RTX did not greatly affect the lymphoproliferative-related ESSDAI domains, even if an improvement was noted in the glandular and nodal domains for group 1 (p=0.03; p=0.03, respectively). No differences in NHL occurrence or safety concerns were observed among the groups. RTX is an effective and safe treatment to control Sjögren-CryoVasc disease activity with a greater impact when administered earlier with a maintenance regimen. RTX alone cannot, however, affect the possible evolution of Sjögren-CryoVasc into an overt NHL.

Hepatitis Virus-associated Non-hodgkin Lymphoma: Pathogenesis and Treatment Strategies.

Over the last decade, epidemiological studies have discovered a link between hepatitis C virus (HCV) and hepatitis B virus (HBV) infection and non-Hodgkin lymphoma (NHL). The regression of HCV-associated NHL after HCV eradication is the most compelling proof supporting HCV infection's role in lymphoproliferative diseases. HBV infection was found to significantly enhance the incidence of NHL, according to the epidemiological data. The exact mechanism of HCV leading to NHL has not been fully clarified, and there are mainly the following possible mechanisms: (1) Indirect mechanisms: stimulation of B lymphocytes by extracellular HCV and cytokines; (2) Direct mechanisms: oncogenic effects mediated by intracellular HCV proteins; (3) hit-and-run mechanism: permanent genetic B lymphocytes damage by the transitional entry of HCV. The specific role of HBV in the occurrence of NHL is still unclear, and the research on its mechanism is less extensively explored than HCV, and there are mainly the following possible mechanisms: (1) Indirect mechanisms: stimulation of B lymphocytes by extracellular HBV; (2) Direct mechanisms: oncogenic effects mediated by intracellular HBV DNA. In fact, it is reasonable to consider direct-acting antivirals (DAAs) as first-line therapy for indolent HCV-associated B-NHL patients who do not require immediate chemotherapy. Chemotherapy for NHL is affected by HBV infection and replication. At the same time, chemotherapy can also activate HBV replication. Following recent guidelines, all patients with HBsAg positive/HBV DNA≥2,000 IU/mL should be treated for HBV. The data on epidemiology, interventional studies, and molecular mechanisms of HCV and HBV-associated B-NHL are systematically summarized in this review.

Oral Malignant Non-Hodgkin Lymphoma: A Retrospective Single-Center Study

This study aimed to retrospectively evaluate the incidence of oral non-Hodgkin lymphoma (NHL) in patients referred to the Academic Hospital of the Magna Graecia University of Catanzaro from 2002 to 2020. A retrospective single-center study was performed. Patients with a histologically confirmed diagnosis of oral NHL were included. Demographic data and clinical parameters were digitally recorded, focusing on the NHL-specific localization and symptomatology. The study sample was evaluated by analyzing descriptive statistics with absolute and relative frequencies. A total of 26 patients with intraoral NHL were identified with a progressive increase in NHL occurrence during the observation period. Clinical manifestations included swelling/mass (80.7%), eventually associated with pain and ulcerations. The most common localizations were in soft tissues: buccal mucosa (38.4%), tongue (19.2%), gingiva (11.5%), cheek (11.5%). Oral NHL is rare. Clinical manifestations were unspecific, so a misdiagnosis could occur. The extranodal B-cell form of oral NHL, particularly diffuse large B-cell lymphoma, was the most common frequent oral NHL in this southern Italian population, with a progressively increased occurrence in almost 20 years.

Development of a Questionnaire for the Search for Occupational Causes in Patients with Non-Hodgkin Lymphoma: The RHELYPRO Study.

Non-Hodgkin lymphoma (NHL), multiple myeloma and chronic lymphocytic leukemia are possibly related to environmental and/or occupational exposure. The primary objective of this study was to develop a questionnaire for screening patients with these blood disorders who might benefit from a specialized consultation for possible recognition of the disease as an occupational disease. The study included 205 subjects (male gender, 67.3%; mean age, 60 years; NHL, 78.5%). The questionnaire performed very satisfactorily in identifying the exposures most frequently retained by experts for their potential involvement in the occurrence of NHL. Its sensitivity and specificity in relation to the final expertise were 96% and 96% for trichloroethylene, 85% and 82% for benzene, 78% and 87% for solvents other than trichloroethylene and dichloromethane, 87% and 95% for pesticides, respectively. Overall, 15% of the subjects were invited to ask National Social Insurance for compensation as occupational disease. These declarations concerned exposure to pesticides (64%), solvents (trichloroethylene: 29%; benzene: 18%; other than chlorinated solvents: 18%) and sometimes multiple exposures. In conclusion, this questionnaire appears as a useful tool to identify NHL patients for a specialized consultation, in order to ask for compensation for occupational disease.

High Concentrations of Serum Soluble E-Cadherin in Patients With Q Fever.

Cadherins switching is a hallmark of neoplasic processes. The E-cadherin (E-cad) subtype is one of the surface molecules regulating cell-to-cell adhesion. After its cleavage by sheddases, a soluble fragment (sE-cad) is released that has been identified as a pro-carcinogenic inflammatory signal in several bacteria-induced cancers. Recently we reported that Q fever, a disease due to Coxiella burnetii infection, can be complicated by occurrence of non-Hodgkin lymphoma (NHL). Therefore, we studied E-cad switching in Q fever. The sE-cad levels were found increased in the sera of acute and persistent Q fever patients, whereas they remained at the baseline in controls groups of healthy donors, people cured of Q fever, patients suffering from unrelated inflammatory diseases, and past Q fever patients who developed NHL. These results indicate that sE-cad can be considered as a new biomarker of C. burnetii infection rather than a marker of NHL-associated to Q fever. We wondered if changes in sE-cad reflected variations in the CDH1 gene transcription. The expression of E-cad mRNA and its intracellular ligand β-catenin was down-regulated in peripheral blood mononuclear cells (PBMCs) of patients with either acute or persistent forms of Q fever. Indeed, a lower cell-surface expression of E-cad was measured in a minority (<5%) subpopulation of HLADR+/CD16+ monocytes from patients with acute Q fever. However, a very strong increase in E-cad expression was observed on more than 30% of the HLADR+/CD16+ monocytes of persistent Q fever patients, a cell subpopulation known to be a target for C. burnetii in humans. An experimental in vitro infection of healthy donors' PBMCs with C. burnetii, was performed to directly evaluate the link between C. burnetii interaction with PBMCs and their E-cad expression. A significant increase in the percentage of HLADR+/CD16+ monocytes expressing E-cad was measured after PBMCs had been incubated for 8 h with C. burnetii Nine Mile strain. Altogether, these data demonstrate that C. burnetii severely impairs the E-cad expression in circulating cells of Q fever patients.

PS1474 NON‐HODGKIN LYMPHOMA IN PATIENTS WITH MYELOPROLIFERATIVE NEOPLASMS

Background:Development of aggressive B‐cell lymphomas during JAK1/2 inhibitor therapy in patients with myeloproliferative neoplasms (MPN) were reported in 2018 European Haematology Association Meeting in Stockholm. It's important to evaluate the incidence of lymphomas in patients with ruxolitinib.Aims:We conducted a retrospective study to evaluate the incidence and clinical characteristics of lymphomas in patients with MPN.Methods:We reviewed laboratory data and clinical record of the patients with MPN diagnosed until Dec 2017 in Tokyo Women's Medical University Hospital.Results:Among 207 patients with MPN, including 129 essential thrombocytosis (ET), 68 polycythemia vera (PV), and 10 primary myelofibrosis (PMF), three patients (1.4%) developed an aggressive non‐Hodgkin Lymphoma (NHL) (Table). Among 207 patients with MPN 15 patients (7.2%) received ruxolitinib. Two of three patients developing NHL had a history of ruxolitinib treatment. There was significant difference in the incidence of NHL occurrence between MPN patients with ruxolitinib treatment (2/15, 13.3%) and those without ruxolitinib treatment (1/192, 0.5%) (Fisher's exact test, P = 0.014). Initial symptoms of lymphoma were extra‐nodal mass (cutaneous or colon mass) in two patients with ruxolitinib treatment. Times from starting ruxolitinib treatment to the diagnosis of lymphoma in these two patients were 2 and 16 months, respectively. They did not achieve complete response by anti‐lymphoma chemotherapy, and died from AML. In contrast, the DLBCL patient without ruxolitinib achieved complete response and is still alive.Summary/Conclusion:The occurrence of lymphoma was more common in patients with ruxolitinib than in the non‐administered group. Porpaczy et al reported that pre‐existing B‐cell clones in myelofibrosis developed to B‐cell lymphoma after ruxolitinib treatment. In the present cases, lymphoma occurred within relatively short period after starting ruxolitinib treatment, suggesting that there were pre‐existing lymphoma clones before ruxolitinib treatment. Extra‐nodal site involvements were seen in present cases similar to the previous reports, suggesting biological difference of lymphoma complicated with MPN patients. Unlike previous report, one T‐cell lymphoma case was included in the present study. It remains unclear whether there is difference in clinical features and mechanisms between B‐cell lymphoma and T‐cell lymphoma development in MPN patients with ruxolintinib treatment. It may be underestimated to the occurrence of lymphoma if biopsy may not perform depending on the condition of patient. We need to careful watch and actively examine the tumor in MPN.image

Reduced-Intensity Chemotherapy in Patients With Advanced-Stage Hodgkin Lymphoma: Updated Results of the Open-Label, International, Randomised Phase 3 HD15 Trial by the German Hodgkin Study Group.

The international, randomized phase 3 HD15 trial established 6xeBEACOPP as standard therapy for patients with newly diagnosed advanced-stage Hodgkin lymphoma (HL) within the German Hodgkin Study Group (GHSG). We performed a follow-up analysis to assess long-term efficacy and safety of this approach. Between 2003 and 2008, 2182 patients aged 18 to 60 years were recruited and randomized in a 1:1:1 ratio between 8 or 6 cycles of eBEACOPP or 8 cycles of the dose-dense BEACOPP-14 regimen, each followed by 30 Gy radiotherapy in case of positron emission tomography (PET)-positive residual lesions ≥2.5 cm. The study aimed at demonstrating non-inferiority regarding efficacy of the 2 experimental arms on a significance level of 2.5% each. The intention-to-treat analysis comprised 2126 patients with a median follow-up of 102 months. Ten-year progression-free survival was 81% (97.5% CI 77–85) with 8xeBEACOPP, 84% (80–87) with 6xeBEACOPP, and 84% (80–87) with 8xBEACOPP-14; the non-inferiority margin of 1.51 for the hazard ratio (HR) could be excluded for both comparisons (6xeBEACOPP, HR = 0.7, 97.5% CI 0.5–1.0; 8xBEACOPP-14, HR = 0.9, 97.5% CI 0.7–1.2). Overall survival at 10 years was 88% (85–91), 90% (88–93), and 92% (89–94), respectively. A total of 142 second malignancies corresponding to 10-year cumulative incidences of 10%, 7%, and 7% and standardized incidence ratios of 4.3, 2.5, and 2.8 were reported for 8xeBEACOPP, 6xeBEACOPP, and 8xBEACOPP-14, respectively. This updated analysis of the HD15 trial thus confirms the efficacy and reports on the long-term safety of a shortened first-line chemotherapy consisting of 6xeBEACOPP followed by PET-guided radiotherapy in advanced-stage HL.

Simultaneous occurrence of non-Hodgkin lymphoma, renal cell carcinoma and oncocytoma: A case report.

We herein report the case of a 74 year-old woman with a diffuse large B-cell lymphoma and bilateral renal masses identified on computed tomography scans during the initial staging process. Following partial bilateral nephrectomy, histopathological examination revealed renal cell carcinoma (RCC) and oncocytoma in the left and the right kidneys, respectively. Shortly afterwards, lymphoma of the left palatine tonsil was diagnosed and the patient received chemotherapy with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP regimen), followed by radiotherapy. Due to metastasis of the RCC to the right breast, pancreas and the area of the left psoas major muscle, systemic treatment with pazopanib was commenced. To the best of our knowledge, this is the first reported case of simultaneous diagnosis of non-Hodgkin lymphoma (NHL), RCC and oncocytoma. The aim of this study was to review the related literature, discuss issues regarding the management of this unusual case and identify possible common etiopathological mechanisms underlying the simultaneous occurrence of NHL, RCC and oncocytoma.

Residential cancer cluster investigation nearby a Superfund Study Area with trichloroethylene contamination.

Trichloroethylene (TCE) is an industrial solvent associated with liver cancer, kidney cancer, and non-Hodgkin's lymphoma (NHL). It is unclear whether an excess of TCE-associated cancers have occurred surrounding the Middlefield-Ellis-Whisman Superfund site in Mountain View, California. We conducted a population-based cancer cluster investigation comparing the incidence of NHL, liver, and kidney cancers in the neighborhood of interest to the incidence among residents in the surrounding four-county region. Case counts and address information were obtained using routinely collected data from the Greater Bay Area Cancer Registry, part of the Surveillance, Epidemiology, and End Results program. Population denominators were obtained from the 1990, 2000, and 2010 US censuses. Standardized incidence ratios (SIRs) with two-sided 99 % confidence intervals (CIs) were calculated for time intervals surrounding the US Censuses. There were no statistically significant differences between the neighborhood of interest and the larger region for cancers of the liver or kidney. A statistically significant elevation was observed for NHL during one of the three time periods evaluated (1996-2005: SIR = 1.8, 99 % CI 1.1-2.8). No statistically significant NHL elevation existed in the earlier 1988-1995 (SIR = 1.3, 99 % CI 0.5-2.6) or later 2006-2011 (SIR = 1.3, 99 % CI 0.6-2.4) periods. There is no evidence of an increased incidence of liver or kidney cancer, and there is a lack of evidence of a consistent, sustained, or more recent elevation in NHL occurrence in this neighborhood. This evaluation included existing cancer registry data, which cannot speak to specific exposures incurred by past or current residents of this neighborhood.

Centroblastic Variant of Non-Hodgkin′s Lymphoma of Mandible: A Rare Case Report

Non-Hodgkin's lymphoma (NHL) is the most common lymphoma that presents in extranodal areas without lymphoid tissue. It occurs in <5% of cases in the jaws and the maxilla are more commonly involved than mandible. The most common symptom is that of a nonpathognomic swelling mimicking odontogenic pathology with a mobile tooth. The lesion usually gets aggravated after extraction and presents as a painful nonhealing socket with symptoms of paresthesia. Diffuse large B-cell lymphoma is the most common subtype and has a better prognosis and overall survival in patients. The treatment of NHL is by a combination of chemotherapy and radiotherapy. We present a rare case report of occurrence of NHL in the least preferred site of mandible with nonhealing socket following extraction of mobile tooth, diagnosed on histopathology and confirmed by immunohistochemistry.

CXCL13 and CCL11 Serum Levels and Lymphoma and Disease Activity in Primary Sjögren's Syndrome.

Non-Hodgkin's lymphoma (NHL) is a severe complication of primary Sjögren's syndrome (SS). Ectopic germinal centers (GCs) in the salivary glands are predictors of the occurrence of NHL. Given the association between CCL11 and CXCL13 and ectopic GCs, we assessed the link between these chemokines and NHL, as well as the association between these chemokines and disease activity, in patients with primary SS. Serum levels of CCL11 and CXCL13 were evaluated by multiplex assay in 385 patients included in the Assessment of Systemic Signs and Evolution of Sjögren's Syndrome (ASSESS) cohort. The association between chemokine levels, B cell biomarkers, and patient subsets was assessed using Spearman's test for continuous data and the nonparametric Mann-Whitney U test for categorical data. Multivariate analyses were performed to identify parameters associated with lymphoma and disease activity. Seventeen patients had a history of lymphoma, and 5 of them had developed NHL during followup. The median serum levels of CCL11 and CXCL13 in the total cohort were 106.48 pg/ml (interquartile range 69.33-149.85) and 108.31 pg/ml (interquartile range 58.88-200.13), respectively. Patients with lymphoma had higher levels of CXCL13 than did patients without lymphoma (P = 0.006) and a trend toward a higher level of CCL11 (P = 0.056). Low C4 and high BAFF levels were associated with NHL on multivariate analysis (P = 0.01 and P = 0.0002, respectively). CCL11 and CXCL13 levels correlated positively with the rheumatoid factor titer, the κ-to-λ free light chain ratio, and the β2 -microglubulin level. CXCL13 was the only parameter associated with disease activity on multivariate analysis. These findings demonstrate a link between CXCL13 and CCL11 and disease activity and lymphoma. This highlights the continuum between chronic B cell activation, disease activity, and lymphomagenesis in patients with primary SS.

Non‐Hodgkin lymphoma in Romania: a single‐centre experience

Epidemiologic studies of non-Hodgkin lymphoma (NHL) in Eastern Europe are scarce in the literature. We report the experience of the "Ion Chiricuta" Institute of Oncology in Cluj-Napoca (IOCN), Romania, in the diagnosis and outcome of patients with NHL. We studied 184 consecutive NHL patients diagnosed in the Pathology Department of IOCN during the years 2004-2006. We also obtained epidemiological data from the Northwestern (NW) Cancer Registry. In the IOCN series, the most common lymphoma subtype was diffuse large B-cell lymphoma (43.5%), followed by the chronic lymphocytic leukaemia/small lymphocytic lymphoma (21.2%). T-cell lymphomas represented a small proportion (8.2%). The median age of the patients was 57 years, with a male-to-female ratio of 0.94. Patients with indolent B-cell lymphomas had the best overall survival, whereas those with mantle cell lymphoma had the worst survival. The NW Cancer Registry data showed that the occurrence of NHL in the NW region of Romania was higher in men [world age-standardized incidence rate/100 000 (ASR)-5.9; 95% CI 5.1-6.6] than in women (ASR-4.1; 95% CI 3.5-4.7) with age-standardized male-to-female ratio of 1.44 (p = 0.038). Chronic lymphocytic leukaemia/small lymphocytic lymphoma was the most common NHL in the NW region of Romania, accounting for 43% of all cases, followed by diffuse large B-cell lymphoma (36%). The 5-year, age-standardized cumulative relative survival for NHL in the County of Cluj in NW Romania, for the period of 2006-2010, was 51.4%, with 58.4% survival for men and 43.2% for women. Additional studies of NHL in Eastern Europe are needed. Copyright © 2015 John Wiley & Sons, Ltd.

The role of pregnancy induced hormonal milieu in lymphoma progression

The occurrence of non-Hodgkin lymphomas (NHLs) is a significant challenge in HIV positive (HIV+) patients in the era of antiretroviral therapy (ART). Risk-stratification of these patients is vitally important. The study’s purpose was to analyze prognostic factors that could impact the survival of HIV+ patients with aggressive B-cell NHL. Patients with HIV associated aggressive B-cell NHL were identified between 1998 and 2012. Patients with indolent and primary central nervous system lymphoma were excluded. Clinical data including CD4 count, HIV viral load and opportunistic infections (OI) were analyzed using the Kaplan Meier method and statistical significance was assessed using the log-rank test. A total of 55 patients were included. The male: female ratio was 7/1. Median age was 43 years (29-65). The median time from HIV to NHL diagnosis was 29 months (0 e 284). Forty four (80%) had advanced stage (III/IV). The Eastern Cooperative Oncology Group performance status was 0-1 in 62%. The most common histologies were Diffuse Large B Cell Lymphoma 33 (62%) and Burkitt’s lymphoma 18 (33%). Bulky disease was present in 6 (11%), B symptoms in 18 (33%), elevated LDH in 20 (36%), and CD4 count < 100/mL at diagnosis in 11 (20%) patients. The mean Hb, SA and CD4 count were 12.1 g/dL, 3.73 g/dL and 224/uL. The median CD4 count at diagnosis was 180 (5 e 680). A serum albumin (SA) < 3.7 g/dL and Hb < 10 g/dl were present in 33% and 20.5% of patients, respectively. Twenty eight (51%) had ART at diagnosis. Sixty-one percent of patients received chemoimmunotherapy; the most common regimen was R-CHOP (50%). The cohort’s median OS was 29 months. The OS at 5 years was 42%. Poorer OS was associated with SA< 3.7 g/dl (median OS 11 m, HR: 3.15 [CI: 1.23-8.06], p1⁄40.017), IPI score 3(median OS 8 m, HR: 3.87 [CI: 1.53-9.73], p1⁄40.003), Hb < 10 g/dl (median OS 4 m, HR: 3.72 [CI 1.43-9.63], p1⁄40.012). The CD4 count and VL at diagnosis did not impact OS. A history of OIs had a trend toward worse OS (p1⁄40.056). Anemia and hypoalbuminemia are associated with poorer OS in HIV associated aggressive B-cell NHLs. These factors could be used as prognostic markers at NHL diagnosis in HIV+ patients. Future validation in larger studies will be needed.

Analysis of Prognostic Factors in Patients with HIV-Associated Aggressive B-Cell Non-Hodgkin Lymphomas

The occurrence of non-Hodgkin lymphomas (NHLs) is a significant challenge in HIV positive (HIV+) patients in the era of antiretroviral therapy (ART). Risk-stratification of these patients is vitally important. The study’s purpose was to analyze prognostic factors that could impact the survival of HIV+ patients with aggressive B-cell NHL. Patients with HIV associated aggressive B-cell NHL were identified between 1998 and 2012. Patients with indolent and primary central nervous system lymphoma were excluded. Clinical data including CD4 count, HIV viral load and opportunistic infections (OI) were analyzed using the Kaplan Meier method and statistical significance was assessed using the log-rank test. A total of 55 patients were included. The male: female ratio was 7/1. Median age was 43 years (29-65). The median time from HIV to NHL diagnosis was 29 months (0 e 284). Forty four (80%) had advanced stage (III/IV). The Eastern Cooperative Oncology Group performance status was 0-1 in 62%. The most common histologies were Diffuse Large B Cell Lymphoma 33 (62%) and Burkitt’s lymphoma 18 (33%). Bulky disease was present in 6 (11%), B symptoms in 18 (33%), elevated LDH in 20 (36%), and CD4 count < 100/mL at diagnosis in 11 (20%) patients. The mean Hb, SA and CD4 count were 12.1 g/dL, 3.73 g/dL and 224/uL. The median CD4 count at diagnosis was 180 (5 e 680). A serum albumin (SA) < 3.7 g/dL and Hb < 10 g/dl were present in 33% and 20.5% of patients, respectively. Twenty eight (51%) had ART at diagnosis. Sixty-one percent of patients received chemoimmunotherapy; the most common regimen was R-CHOP (50%). The cohort’s median OS was 29 months. The OS at 5 years was 42%. Poorer OS was associated with SA< 3.7 g/dl (median OS 11 m, HR: 3.15 [CI: 1.23-8.06], p1⁄40.017), IPI score 3(median OS 8 m, HR: 3.87 [CI: 1.53-9.73], p1⁄40.003), Hb < 10 g/dl (median OS 4 m, HR: 3.72 [CI 1.43-9.63], p1⁄40.012). The CD4 count and VL at diagnosis did not impact OS. A history of OIs had a trend toward worse OS (p1⁄40.056). Anemia and hypoalbuminemia are associated with poorer OS in HIV associated aggressive B-cell NHLs. These factors could be used as prognostic markers at NHL diagnosis in HIV+ patients. Future validation in larger studies will be needed.

Occurrence of Non-Hodgkin Lymphoma after the Diagnosis of Persistent Polyclonal B-cell Lymphocytosis

Persistent polyclonal B cell lymphocytosis (PPBL) is a rare indolent condition characterized by a polyclonal expansion of B cells associated with binucleated lymphocytes observable on blood smears. Though polyclonal, recurrent genetic abnormalities have been described in PPBL, supernumerary isochromosome 3q (+i(3)(q10)) being the most frequently described. We report here two clinical observations showing the occurrence of NHL after the diagnosis of PPBL. These observations lead us to recommend a closer follow-up of PPBL patients and raise the question of a relationship between PPBL and NHL.

Generalized gingival enlargement in non-Hodgkins lymphoma during pregnancy: A rare case report

Lymphoma is the second most common neoplasm of the head and neck region. Non-Hodgkin's lymphoma (NHL) affects not only lymphoid organs but other organs and tissues that do not contain lymphoid cells. NHL cases occur extranodally and in 3% of these cases the initial presentation may be in the oral cavity. This case report presents an unusual occurrence of NHL in a young pregnant female presenting as generalized gingival enlargement which was the first and only clinical manifestation of the malignancy. CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY The present case emphasizes the importance of the diagnosis of gingival enlargement, as this can be the manifestation Early diagnosis may allow treatment of early stage disease, resulting in a better prognosis for the patient Thus, an interdisciplinary approach among periodontist, gynecologist, pathologist, and oncologist will help in precise and timely diagnosis and treatment of such malignancies.

Does gender matter in non-hodgkin lymphoma? Differences in epidemiology, clinical behavior, and therapy.

Non-Hodgkin lymphoma (NHL) is one of the most common hematologic malignancies worldwide. The incidence of NHL has been rising for several decades; however, in the last 20 years, it reached a plateau. NHL incidence among males is significantly higher than in females. In addition to gender itself, gravidity has a protective role against NHL occurrence. Gender also matters in terms of NHL clinical characteristics. For example, female predominance was found in three extra-nodal sites (the breast, thyroid, and the respiratory system) occasionally involved in NHL. The diagnosis of NHL during pregnancy is associated with a unique clinical behavior. It is usually diagnosed in the second or third trimester and in advanced stage. Furthermore, the histological subtype is highly aggressive, and reproductive organ involvement is common. The reduced rate of NHL among females may be explained by direct effects of estrogens on lymphoma cell proliferation or by its effect on anti-tumor immune response. Gender has an important role in responsiveness to standard B cell NHL treatment. Among older adults, women benefited more from the addition of the anti-CD20 antibody rituximab to standard chemotherapy regimens. This phenomenon can be explained by the difference in clearance rate of rituximab that was found to be significantly lower among older females than older males. In mantle cell lymphoma, women receiving lenalidomide have higher rates of response. An understanding of the mechanisms responsible for gender-associated NHL differences will ultimately improve the clinical approach, allowing for a more accurate assessment of prognosis and patient-tailored treatment.

Analysis of prognostic factors in patients with HIV-associated aggressive B-cell non-Hodgkin lymphomas.

e19512 Background: The occurrence of non-Hodgkin lymphomas (NHLs) is a major challenge in HIV positive (HIV+) patients in the era of antiretroviral therapy (ART). Risk stratification of these patie...

Unusual colocutaneous fistula from intussuscepted paediatric descending colon lymphoma: A very rare pathology

Occurrence of Non-Hodgkin lymphoma in the colon of children is extremely rare. Ignorance, nonavailability of experts and poverty affect management of affected patients. Descending colon and sigmoid colon are very uncommon sites for the involvement of Non-Hodgkin lymphoma and less than 10 cases involving children have been described in world literatures. A 13 year old Kanuri boy presented with 3 years of recurrent abdominal colics and distension and eventual spontaneous enterocutaneous fistula 4 days prior to presentation. Patient was chronically ill looking and grossly wasted. The abdomen was soft with a non tender suprapubic mobile mass measuring 10cm x 14 cm. There was diagnostic dilemma which was not assisted by cheap ultrasonography and patient could not afford the sophisticated CT scan and contrast enema. Exploratory laparotomy revealed colocutaneous fistula and descending colon intussusception with a huge fungating mass as the lead point confirmed histologically to be a Non-Hodgkin's lymphoma. The challenge of lack of fund affected prompt presentation and also limited decision taken on investigation and management of the patient. High index of suspicion and meticulous management of the patient in spite of the challenges led to a good outcome. This probably might be the first reported case of a descending colon lymphoma from this subregion or even in Africa.Keywords: Abdominal masses in children, acute abdomen, enterocutaneous fistula, lymphoma, poverty, ignorance and neglect, scarcity of specialists,

NON-HODGKIN LYMPHOMA (NHL) LINKAGE WITH RESIDENCE NEAR HEAVY ROADS - A CASE STUDY FROM HAIFA BAY, ISRAEL

Background and Aims: Some of the risk factors for Non-Hodgkin Lymphoma (NHL) are related to environmental exposure and occupations. However, studies into a possible linkage between NHL and residence near heavy traffic roads are lacking. NHL rates of Israeli Jews are among the highest in the world while the highest NHL rate within Israel is in Haifa Metropolis. The study analyzed the possible linkage between NHL morbidity and residence near heavy traffic roads among the Jewish population in the Haifa Metropolitan Area. Methods: Addresses of 1436 patients (94.5% of all cases, 1995-2004) were geocoded. Only patients residing in the metropolis at least 10 years prior to the diagnosis were included (gender, age). The density values were interpolated by the Inverse Distance Weighted (IDW) method. The number of NHL patients was calculated for buffer zones, extending by a 50-meter increment from a main road. By dividing the actual number of NHL patients (male/female) in each buffer zone by the value of the –density coefficient”, we obtained the “density adjusted” number of patients in each zone. Testing for the statistical significance of the differences across buffer zones was performed using a non-parametric Chi-square test. Results: The road distances for each NHL patient ranged from 0 to 700m, with the median distance of 56.5m. About half of the NHL’ patients appear to live in a distance of less than 50m from a main road. The analysis indicates steady decline in the “density adjusted” numbers of patients as a function of increasing road distances (P&lt;0.01). Differences between genders / age groups or socioeconomic levels were not found. Conclusions: The much higher occurrence of NHL in areas near main roads may be indicative of disease risks. Future studies may compare the relative contribution of residence near traffic to other factors such as industrial air pollution.