Lymphoma Presenting Research Articles

Comparative Analysis of Biopsy Techniques for Cervical Lymphoma: A Retrospective Cohort Review.

Lymphoma is the most common neck mass malignancy in adults but can present diagnostic challenges due to controversy surrounding the best initial biopsy approach. In this study, the authors characterize the diagnostic pathway in adults with lymphoma (or leukemia) presenting initially as a neck mass and examine the biopsy procedures required for diagnosis in a large community-based practice setting. Using data from a retrospective cohort of 4103 adults referred to otolaryngology with a neck mass (5% found to be malignant), the authors identified the subset with lymphoma (or leukemia) and examined the time to diagnosis and the number and type of biopsies required for diagnosis. Among 73 adults with lymphoma or leukemia that initially presented with a neck mass (25% diffuse large B-cell lymphoma, 32% Hodgkin lymphoma, 18% follicular lymphoma, and 25% other lymphoma/leukemia), 70% required repeated biopsies for diagnosis. Overall, 93% required a core-needle biopsy (CNB) or an excisional biopsy for diagnosis, although 64% of patients underwent fine-needle aspiration (FNA) for their first biopsy. Patients undergoing initial FNA were diagnosed a median of 19 days after presentation (95% required additional biopsy), whereas those undergoing initial CNB were diagnosed a median of 5 days after presentation (only 25% required additional biopsy). These data highlight the limited diagnostic utility of FNA for lymphoma presenting as a neck mass and support consideration of CNB when lymphoma is suspected in a neck mass to minimize repeat biopsy and time to diagnosis. Lymphoma represents a diagnostic challenge. CNB represents an opportunity to improve diagnostic efficiency, although additional research is needed to ascertain impacts on cost and side effects in various health care environments.

Linfoma ocular unilateral em um felino

The aim of this report is to describe the occurrence of unilateral intraocular lymphoma in a feline infected with Feline Immunodeficiency Virus – FIV and Feline leukemia virus – FELV. Lymphoma is a neoplasm of higher prevalence in cats as well as secondary intraocular neoplasms. The uvea is the most common site for the occurrence of lymphoma due to its wide vascularity, but there are reports in several sites of the ocular bulb. Felines with FIV and FELV infections are predisposed to the presentation of lymphoma. In the present case, a feline who tested positive for FIV and FELV was observed, presenting ophthalmologic alterations in the right eye characteristic to uveitis, such as mild corneal opacity, iris bombe, blackened pigmentation points in the iris, irregularity in pupillary cleft and irresponsive pupillary reflex to direct light stimulus. After death, a necropsy was performed, and the presence of neoformation in the iris was noted, as well as signs of metastasis in the kidneys, compatible with lymphoma.

Leukemic Phase of ALK-Negative Anaplastic Large Cell Lymphoma Presenting as Leukostasis: The First Case Report in Thailand

Anaplastic large cell lymphoma (ALCL) is an aggressive T-cell lymphoma characterized by hallmark cells that are CD30-positive. ALCL is subcategorized as anaplastic lymphoma kinase (ALK)-positive and ALK-negative types. The leukemic phase of ALK-negative ALCL is extremely rare and usually has a poor prognosis. We report the first case of the leukemic phase of ALK-negative ALCL in Thailand. A 60-year-old man presented bilateral cervical lymphadenopathy and night sweats for 6 months. He was admitted to the hospital with acute fever, progressive dyspnea on exertion, severe headache and blurred vision. His complete blood count revealed marked leukocytosis (352.5 x 109/L) with numerous atypical medium- to large-sized mononuclear cells. The results of his laboratory investigations were compatible with spontaneous tumor lysis syndrome and disseminated intravascular coagulation. The flow cytometry analysis from bone marrow aspiration along with histopathologic findings and immunohistochemistry from bone marrow study were consistent with ALK-negative ALCL. The patient was treated with leukapheresis, renal replacement therapy and high-dose dexamethasone. After achieving hemodynamic stability, a computed tomography scan of the brain was performed due to persistent alteration of consciousness. The results showed extensive intracerebral hemorrhage with severe brain edema and tonsillar herniation. Due to this complication, the treatment plan was adjusted to palliative care with supportive treatment after discussion with his family. The patient subsequently passed away from septic shock.

Clinical characteristics of lymphoma patients presenting with fever of unknown origin misdiagnosed with connective tissue diseases.

Recognizing and diagnosing lymphoma in patients with fever of unknown origin (FUO) can be challenging, and misdiagnosis is not uncommon. To improve understanding of the clinical characteristics of lymphoma patients presenting with FUO who were misdiagnosed with autoimmune diseases. A retrospective, observational study of 140 consecutive patients with FUO and lymphoma presenting to a tertiary center between January 2017 and December 2023. Patients were divided into those who were correctly diagnosed and those misdiagnosed as connective tissue diseases (CTD) and the clinical features compared. Of 140 lymphoma patients with FUO, 21 patients (15.0%) were misdiagnosed as CTD. The median time between symptom onset and diagnosis was significantly longer in the misdiagnosed group than in the non-misdiagnosed group (11.0 (IQR 6.0, 22.5) months vs. 4.0 (2.5, 9.0) months; p = 0.001). The misdiagnosed group had significantly less lymph node and bone marrow involvement and more skin rashes than the non-misdiagnosed group (47.6% vs. 70.6%, p = 0.039; 23.8% vs. 47.9%, p = 0.040; 47.6% vs. 25.2%, p = 0.036), as well as significantly lower ESR (p = 0.026) and hsCRP (p = 0.049). The misdiagnosed group had higher frequency of ANA/ANCA (57.1% vs. 27.7%; p = 0.008) and anti-phospholipid antibody (42.9% vs. 6.1%; p = 0.008) positivity. The distribution of lymphoma subtypes was different between groups (p = 0.058). Lymphoma patients with an atypical presentation and FUO suggesting inflammatory systemic disease are easily misdiagnosed. Autoantibody positivity is not rare in lymphoma patients with an atypical presentation and FUO, so close follow-up and repeated histopathological examination may be helpful to establishing a correct diagnosis.

Primary pulmonary Hodgkin lymphoma presenting as cavitary lung lesions.

Primary pulmonary Hodgkin lymphoma presenting as cavitary lung lesions.

Initial Characterization and Outcome Assessment of Anal Lymphomas in a Large-Size Contemporary Cohort: A Population-Based SEER Database Study (2000–2022)

Introduction: Anal lymphoma (AL) is a rare presentation of extranodal lymphomas, characterized by occurrence in the anal area and largely understudied due to its infrequency. This study aimed to address gaps in knowledge about AL’s demographic and clinical profiles, treatments, and survival outcomes, leveraging data from the SEER program. Methods: We conducted a retrospective analysis of 79 AL cases identified in the SEER database from 2000 to 2022; 36 stage I AL cases were identified and defined as localized primary anal lymphoma (L-PAL). Data on demographics, tumor specifics, treatment modalities, and survival were analyzed using the Kaplan-Meier method and Cox proportional hazards models. Results: The majority of AL cases were diffuse large B-cell lymphoma (70.9%). Other notable subtypes included anaplastic T-cell lymphoma, marginal zone lymphoma, B-cell non-Hodgkin lymphoma, Burkitt lymphoma/leukemia (each accounting for 6.3%), followed by follicular lymphoma and mantle-cell lymphoma (each at 1.3%). AL primarily affected younger males (median age 50), with a significant majority being Caucasian. Initial stages (I and II) were more commonly observed, and treatments varied, with chemotherapy being most prevalent (67.1%), followed by radiation (30.4%) and surgery (30.4%). The 5- and 10-year overall survival (OS) rates were 59.4% and 44.1%, respectively, while the corresponding cancer-specific survival (CSS) rates were 67.9% and 58.0%, respectively. Age was a significant prognostic factor for OS but not for CSS. Radiotherapy tended to improve CSS in the AL population. Conclusion: This research corresponds to the first in-depth analysis of AL, highlighting its distinct demographic patterns, clinical features, and responses to various treatments, distinguishing it from other types of anal cancers. Our results underscore the importance of developing specialized diagnostic and treatment strategies. To enhance our understanding and management of this uncommon form of lymphoma, future studies should aim for broader and more collaborative international research efforts.

Coexistence of T‐Cell Lymphoblastic Lymphoma and Ichthyosis Vulgaris: A Case Report

Ichthyosis vulgaris (IV) is an inherited disorder characterized by the scaling of the skin. It is caused by mutations in the filaggrin gene. IV is a reactive skin manifestation that may be associated with malignant hematological disease. Its association with neoplastic diseases such as Hodgkin lymphoma, anaplastic large‐cell lymphoma, and mycosis fungoides has been reported. T‐cell non‐Hodgkin lymphoma (T‐NHL) with ichthyosis has been rarely reported in the literature. Here, we report a case of T‐cell lymphoma with congenital IV caused by a desmoglein 1 (DSG1) gene mutation associated with hyper‐IgE syndrome (HIES). A 7‐year‐old male patient with a diagnosis of congenital IV had a biopsy performed at an external center due to multiple lymphadenopathies, which revealed T‐cell lymphoblastic lymphoma. A homozygous variant in the DSG1 gene was detected through whole‐exome sequencing. The diagnosis of HIES was confirmed through clinical evaluation, including elevated serum IgE levels and associated symptoms. Skin findings, growth retardation, and HIES overlap with Online Mendelian Inheritance in Man (OMIM) #615508, and parental carrier status was confirmed. The association between ichthyosis and lymphoma was determined based on the presence of lymphoma in a patient with congenital ichthyosis and the identification of a genetic mutation in DSG1. In conclusion, the coexistence of lymphoma and IV is rare. The mechanisms of their formation are different, and they can occur independently. Rare genetic syndromes or inherited diseases can cause different health problems, such as lymphoma and ichthyosis, to occur together.

Diffuse large B-cell lymphoma presenting as atypical foot pain: First reported case of primary cuboid bone involvement

Diffuse large B-cell lymphoma presenting as atypical foot pain: First reported case of primary cuboid bone involvement

Diffuse large B-cell lymphoma presenting as acute lumbosacral plexopathy with persistent lower back pain and fatigability

ABSTRACT Various types of lymphoma can involve the lumbosacral plexus, mainly diffuse large B-cell lymphoma, in which cancer-related persistent fatigue and fatigability (a new concept that assesses fatigue to specific activities) can occur. We report a rare case of acute right L2-S1 lumbosacral plexopathy secondary to diffuse large B-cell lymphoma, presenting with persistent lower back pain and pronounced fatigability. A 49-year-old male with controlled primary hypothyroidism experienced progressive lower back pain extending to the right lower limb, accompanied by dysesthesias and significant fatigue exacerbated by physical activities. Clinical examination revealed asymmetrical lower limb weakness, an absent right ankle reflex, and a positive straight leg raise test indicative of lumbosacral plexopathy. Comprehensive serological and imaging evaluations, including MRI and 18F-FDG PET-CT, identified lumbosacral spine lesions and widespread lymphomatous involvement. Immunohistochemical analysis confirmed the presence of CD20+, CD10+, bcl2+, bcl6+, and MUM1+ cells, establishing a diagnosis of diffuse large B-cell lymphoma. This case underscores the importance of considering lymphomatous lumbosacral plexopathy in the differential diagnosis of fatigability and lower back pain to prevent misdiagnosis and ensure timely, appropriate treatment. Further studies are suggested to explore the implications of lymphoma on neuropathy and chronic fatigability among survivors.

Atypical presentation of primary adrenal lymphoma with adrenal insufficiency and hypercalcemia in an elderly male A diagnostic and therapeutic challenge

Primary Adrenal Lymphoma PAL is an exceedingly rare form of extra nodal lymphoma that mostly targets the adrenal glands, frequently manifesting with nonspecific symptoms that may result in a postponed diagnosis.

Rare Cutaneous Primary Presentation of Extracavitary Primary Effusion Lymphoma.

Primary effusion lymphoma (PEL) is a rare and aggressive B-cell lymphoma typically associated with human herpesvirus 8 (HHV-8) and Epstein-Barr virus infections. It classically presents as a malignant effusion in body cavities, but rarely presents with an extracavitary variant characterized by solid tumors in lymph nodes or extranodal sites such as the gastrointestinal tract, skin, lungs, and nervous system. This case report describes an unusual presentation of primary cutaneous extracavitary PEL in an HIV-positive patient that has only been reported in 8 cases previously. The patient presented with a skin nodule in the right supraclavicular area. Histopathologic examination showed a malignant infiltrate in the dermis composed of sheets of plasmablasts. The immunophenotype of the cells shows the characteristic coinfection with HHV-8 and Epstein-Barr virus. The case presented herein contributes to expand the reported literature on primary cutaneous extracavitary PEL and performs a comprehensive review of this entity, which most dermatopathologists are unfamiliar with.

About a Case: Orbital Plasmablastic Lymphoma in an Immunocompetent Patient

Plasmablastic lymphoma (PBL) is considered as an aggressive rare variant of diffuse large B-cell lymphoma (DLBCL) that has a predilection to develop in immunodeficient patients, particularly HIV-positive individuals. It is a rare CD20-negative aggressive lymphoma with a poor prognosis and a therapeutic challenge for pathologists. This report highlights the development of orbital PBL in a 45-year-old immunocompetent male. It includes the clinical presentation, radiological characteristics, histological appearances, immuno-histochemical particularities, and therapeutic response criteria of plasmablastic lymphoma.

Simultaneous Presentation of Gastric and Orbital Mucosa-Associated Lymphoid Tissue Lymphoma: A Case Report.

Mucosa-associated lymphoid tissue lymphoma or MALToma occurs in 8% of B-cell non-Hodgkin lymphoma according to the latest WHO classification. The most involved site of MALToma is stomach. We describe a rare case of concurrent gastric and orbital mucosa-associated lymphoid tissue lymphoma (MALToma) of a female who presented with progressive proptosis and abdominal pain. We performed six courses of chemotherapy (Rituximab) and gastric and orbital radiation with a dose of 34 Gy/20 Fr and 30 Gy/20 Fr, respectively. This case underscores the efficacy of a multimodal treatment strategy in achieving successful outcomes.

Calvarial Lymphoma Presenting with Unusual Scalp Swelling.

Calvarial Lymphoma Presenting with Unusual Scalp Swelling.

Intravascular large B-cell lymphoma presenting with non-occlusive mesenteric ischaemia

Intravascular large B-cell lymphoma presenting with non-occlusive mesenteric ischaemia

Utilizing medical thoracoscopy for the diagnosis of B-cell lymphoma presenting with pleural effusion: A case series.

A third of patients with non-Hodgkin's lymphoma (NHL) develop pleural effusion during the disease course for various reasons. In most cases, lymphoma-related pleural effusion is a manifestation of widespread systemic disease, signifying a high tumour burden and therefore, a poorer prognosis. On the other hand, primary pleural lymphomas (PPLs) exhibit exclusive or dominant involvement of serous cavities, without detectable solid tumour masses. PPL is an uncommon disease and is of two types: primary effusion lymphoma (PEL) and diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI). PPLs not related to PELs and DLBCL-CIs are exceedingly rare. Herein, we describe four patients with biopsy proven B-cell NHL. One had no extra-pleural involvement at the time of diagnosis, indicating PPL. In all cases, histopathological examination of pleural biopsies obtained via medical thoracoscopy (MT) were crucial in clinching the final diagnosis. Clinicians are alerted to the potential relationship between exudative effusion and NHL as well as the role of MT in the diagnosis of B-cell NHL.

Asymptomatic presentation of diffuse large B-cell lymphoma as isolated submental lymphadenopathy

Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma, Diffuse larger B-cell lymphoma (DLBCL) being most common type of NHL. Patients usually present at later stage with b-symptoms, lymphadenopathy and organomegaly. Isolated asymptomatic lymphadenopathy is a rare presentation. A 50-year-old female presented with complaints of swelling in the sub mental region. It increased in size over 1month without any associated local or systemic symptoms. On examination a firm, non-tender, mobile swelling of around 2×1.5 cm was present at sub mental region. Abdominal examination revealed no organomegaly. Blood picture- HB- 9.7 gm/dl, TLC- 5200/mm3, neutrophils/ lymphocytes/ eosinophil/ basophils-43.4/44.4/5.1/0.4 and Platelets-2.41 lakhs/mm3. Ultrasonography study was suggestive of necrotic lymph node. Fine needle aspiration cytology demonstrated nonspecific reactive lymphadenitis. After routine pre-operative workup patient was taken up for lymph node excision in elective OR under general anesthesia and the excised lymph node was sent for biopsy. A histopathological diagnosis of diffuse large B-cell lymphoma was made and confirmed with Immunohistochemistry (IHC), (CD20-diffuse positive; CD3-focal positive; Cyclin D-negative; BCL6-positive; CD10- focally positive). Post-operative hospital stay was uneventful. Our case was atypical with asymptomatic presentation with isolated lymphadenopathy with suspicious lymphocytosis. Diagnosis was only possible by histopathology.

Simultaneous diagnosis of adult-onset Still's disease and lymphoma: A case report and systematic review of the literature.

Differentiating Adult-Onset Still's Disease (AOSD) from lymphoma is challenging. A 23-year-old female presented with polyarthralgia, fever, rash, lymphadenopathy, and abnormal labs. She met AOSD criteria and was diagnosed with non-Hodgkin lymphoma. Treatment led to improvement. The differentiation between Adult-onset Still's Disease (AOSD) and lymphoma remains challenging in our context. The Faustrel score facilitates the simultaneous diagnosis of these conditions. A 23-year-old woman presented with chronic polyarthralgia in a febrile context. A physical examination revealed peripheral joint syndrome, a maculopapular rash on the trunk, and peripheral lymphadenopathy. Laboratory tests showed neutrophils leukocytosis, hyperferritinemia, and a glycosylated ferritin fraction of 12%. A lymph node biopsy revealed a malignant non-Hodgkin lymphoma, and the patient met the diagnostic criteria for AOSD according to Faustrel. She received corticosteroid therapy and four courses of Rituximab. After 6 months, clinical and biological improvements were noted. It is essential to consider the possibility of an association between atypical clinical presentations of lymphoma and AOSD.

Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) presenting in an asymptomatic patient after sports trauma

Primary splenic diffuse large cell lymphoma is unusual and accounts for 2% of all splenic lymphomas. The symptoms included left upper abdominal pain, indigestion, loss of appetite, generalized weakness, fever, anemia, and thrombocytopenia or elevated C Reactive Protein. The current case report, to our knowledge the first of its kind, presents unusual clinicopathologic findings, where the patient remained asymptomatic until the time of diagnosis but showed extensive splenic involvement with stage IV disease. Alternatively, the morphologic findings in this case were like to those seen in other Primary Splenic Diffuse Large B Cell Lymphoma reported in the literature. In conclusion, the present report emphasizes the need for additional case studies and research on the biology of this unusual subset of lymphoma.

Comparison of CHOP-19 and CHOP-25 for treatment of peripheral nodal B-cell lymphoma in dogs: A European multicenter retrospective cohort study.

Peripheral nodal B-cell lymphomas (PNBCL) represent the most common presentation of lymphomas in dogs. Multiagent CHOP (C = cyclophosphamide, H = hydroxydaunorubicin [Doxorubicin], O = Oncovin, P = prednisolone)-based chemotherapy protocols have been widely accepted as gold standard 1st-line treatment. CHOP-25 and CHOP-19 are most commonly prescribed but have never been directly compared. Our primary aim was to compare outcomes of dogs diagnosed with PNBCL, treated using a 1st-line CHOP-19 or CHOP-25 protocol. A secondary objective was to determine the impact of protocol-related variables on outcomes. Five hundred two dogs from 16 European oncology referral centers. One hundred fifty-five dogs were treated with CHOP-19 and 347 dogs with CHOP-25. Retrospective, multicentric cohort study of dogs diagnosed with PNBCL between 2014 and 2021. The 6-month, 1-year, and median progression-free survival (PFS) were 56.5% (95% confidence interval [CI], 49.2-65.0), 14.1% (95% CI, 9.4-21.0), and 196 days (95% CI, 176-233) with CHOP-19; and 56.4% (95% CI, 51.4-61.9), 17% (95% CI, 13.4-21.6), and 209 days (95% CI, 187-224) with CHOP-25. The 1-year, 2-year and median overall survival (OS) were 36.9% (95% CI, 29.7-46.0), 13.5% (95% CI, 8.6-21.1), and 302 days (95% CI, 249-338) with CHOP-19; and 42.8% (95% CI, 37.7-48.7), 15.4% (95% CI, 11.7-20.4), and 321 days (95% CI, 293-357) with CHOP-25. No significant difference in PFS and OS was found between the 2 protocols. Our study confirmed similar outcomes for dogs with PNBCL treated with 1st-line CHOP-19 or CHOP-25. Both protocols therefore could be used as a standard of care in future trials.