Lymphoma Presenting Research Articles

Rare incidence of mucosa-associated lymphoid tissue lymphoma presenting as buccal fat pad tumor: A case report

Rare incidence of mucosa-associated lymphoid tissue lymphoma presenting as buccal fat pad tumor: A case report

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.

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.

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.

Uncommon presentation of diffuse large B-cell lymphoma: oral and pulmonary involvements in a young patient: a case report

BackgroundDiffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphomas that remains a major diagnostic challenge due to the variety of its clinical presentations. This case highlights the importance of early biopsy of oral lesions without tendency to heal to attain the diagnosis more quickly. To the best of our knowledge, this study is the first to focus on both oral and pulmonary involvements in a patient with diffuse large B-cell lymphoma.Case presentationThe presented case describes an Iranian 18-year-old girl with chronic cough and dyspnea referred for evaluation of the upper jaw due to bone exposure, bone loss, and soft tissue ulceration. Her medical history revealed mediastinal mass, cavitary lesion, and mediastinal lymphadenopathy. However, cytologic and immunohistochemical analysis did not show any evidence of malignancy. In this case a lymphoproliferative disease was suspected but ultimately the oral biopsy diagnosed diffuse large B-cell lymphoma and chemotherapy could be started.ConclusionsSystemic conditions should be considered as a possible cause of oral lesions and a biopsy should also be performed immediately if there is any doubt concerning the nature of the lesion. Moreover, some conditions necessitate multiple biopsies to attain an accurate diagnosis.

The Value of Sysmex White Precursor Cell Channel in Distinguishing Circulating Large Blastoid Lymphoma Cells from Blasts

Abstract Background There are rare cases of lymphoma presenting with circulating large blastoid cells mimicking blasts. These abnormal cells usually are medium to large in size with high nucleus-to-cytoplasmic ratio, fine to slightly condensed chromatin, prominent nucleoli, and scant to moderate amount of cytoplasm. Distinguishing them from real blasts is challenging, and although flow cytometry provides a definitive answer, pathologists may feel compelled to offer a quick preliminary assessment to the clinical team, particularly during weekends when flow cytometry is not accessible. We have recently replaced the old CBC instrument with Sysmex XN-9100 which incorporates a new white precursor cell channel (WPC). WPC channel is triggered only when Sysmex differential channels (WDF+WNR) produce a combined flag of “blasts/abnormal lymphocytes?”. The WPC will then separate this into a specific flag for either cell type or remove the flag if it is normal. Our study aims to explore the effectiveness of the WPC Channel in distinguishing blastoid lymphoma cells from true blasts. Method Between October 2023 and January 2024, we identified four lymphoma cases exhibiting circulating large blastoid cells. For comparative analysis, we included the most recent seven cases of acute myeloid leukemia (AML) and one case of acute lymphoblastic leukemia (ALL), all featuring medium to large-sized blasts. We collected results from initial testing (WDF+WNR) and WPC reflex testing. The reference for our analysis included manual differentials assisted by CellaVision, pathologist reviews, and immunophenotyping results. Results Within four blastoid lymphoma cases, two were diagnosed as blastoid high-grade B-cell lymphomas, one as diffuse large B-cell lymphoma, and another as chronic lymphocytic leukemia with many blast-like cells observed on the cytospin slide (no smear available). Pathologists reviewed the smears and slides of all four cases, categorizing them as blasts or blast-like cells before flow was run. All cases were initially flagged with “Blasts/Abnormal Lymphocyte?” on Sysmex differential channels but were subsequently flagged only with abnormal lymphocytes after the WPC reflex. For comparison, in 7 AML and 1 ALL cases, the WPC channel flagged blasts in 7 out of the 8 cases following the reflex of initial “Blasts/Abnormal Lymphocyte?” flag. The only case flagged with abnormal lymphocytes but not blasts was a case of AML with monocytic differentiation, characterized by many promonocytes and rare blasts. Conclusion The WPC channel accurately characterized the challenging large blastoid lymphoma cells as abnormal lymphocytes in all four cases, where morphology characterization was difficult. The study’s limitation lies in its small sample size. We are actively accumulating additional cases with circulating blastoid lymphoma cells, alongside control leukemia cases, to further assess the efficacy of the WPC channel.

Diffuse Large B-cell Lymphoma (DLBCL) involving the Uterine Corpus presenting with Abnormal Uterine Bleeding: A Rare Case Report

Abstract Introduction/Objective Diffuse Large B-cell Lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma. Lymphomas affecting the female genital system are extremely rare, accounting for about 1% of extra-nodal lymphomas, with DLBCL being the most common type. We present a rare case of uterine lymphoma presenting with abnormal uterine bleeding. Methods/Case Report A 50-year-old female presented with abnormal uterine bleeding and fatigue for the past three weeks. Laboratory work-up showed hemoglobin level of 5.5 g/dL. Pelvic ultrasound revealed thickening of the endometrium and a 1.6 cm hypoechoic uterine lesion along with multiple enlarged bilateral adnexal lymph nodes. Histological examination of the endometrial biopsy demonstrated endometrial fragments with diffuse subepithelial proliferation of large, poorly differentiated cells with round nuclear contours, finely dispersed chromatin, relatively inconspicuous nucleoli and moderate amount of cytoplasm. Many scattered mitoses and apoptotic bodies were present. Primary set of immunohistochemical stains were performed to rule out primary uterine epithelial or mesenchymal tumors. The tumor cells were negative for pan-keratin, high and low molecular weight keratins and positive for CD45. Further work-up demonstrated CD20 positivity. It was diagnosed as DLBCL with a non-germinal center, double expressor phenotype and a high Ki-67 proliferation. Fluorescence in-situ hybridization studies were negative for MYC and BCL6 gene rearrangements and IGH-BCL2 translocation. Further radiological workup revealed diffuse lymphadenopathy with multiple pulmonary and renal nodules consistent with Stage IV DLBCL. She was treated with six cycles of R-CHOP regimen, and complete metabolic response was achieved. Results (if a Case Study enter NA) NA Conclusion Uterine lymphomas are very rare and on small biopsies may histologically mimic poorly differentiated uterine malignancies such as dedifferentiated/undifferentiated carcinomas. Adding lymphoma lineage markers to poorly differentiated tumors is recommended to avoid missing such a rare entity.

Hypercalcemia-Associated Hodgkin's Lymphoma Presenting as Normal Pressure Hydrocephalus: A Case Report

Hypercalcemia-Associated Hodgkin's Lymphoma Presenting as Normal Pressure Hydrocephalus: A Case Report

68Ga-DOTATATE and 18F-FDG PET/CT in a Rapidly Progressing Lymphoma.

68Ga-DOTATATE PET/CT targeting somatostatin receptors is commonly utilized in the imaging of neuroendocrine tumors. However, other malignancies such as lymphomas (both Hodgkin and non-Hodgkin) also have expression of somatostatin receptors, albeit to a lesser degree compared with the neuroendocrine tumors, and thus can be positive on a 68Ga-DOTATATE PET/CT. We describe an atypical presentation of an aggressive large B-cell lymphoma mimicking a metastatic neuroendocrine tumor at initial presentation with high somatostatin receptor expression demonstrated on the 68Ga-DOTATATE PET/CT and a rapidly progressing course on the subsequent 18F-FDG PET/CT.

Syncope as a clinical presentation of cardiac lymphoma: a case report

Primary cardiac lymphoma, an extremely rare type of B-cell non-Hodgkin lymphoma, has an incidence of approximately 0.02-2% among malignant cardiac tumors. It is frequently associated with manifestations such as cardiac rhythm disturbances, refractory pericardial effusion and cardiac masses. Definitive diagnosis is achieved by biopsy, being essential to rule out hematogenous dissemination with PET-CT. The literature indicates a predominance of right chamber involvement and survival that varies significantly according to left ventricular involvement and the presence of arrhythmias. Therapeutic options are not well defined, but chemotherapy such as R-CHOP has shown efficacy, although the prognosis is generally poor due to complications such as disease progression, arrhythmias and sepsis. This case underscores the importance of considering cardiac lymphoma in patients with unexplained cardiac symptoms, highlighting the need for a multidisciplinary and specific diagnostic and therapeutic approach.

Differentiating between Lymphoma and Metastasis Presenting as Solid Cerebellar Mass Lacking Necrosis

Objectives: This study aimed to identify radiologic features that differentiate lymphoma from metastasis manifesting as a solid enhancing mass lacking necrosis in the cerebellum. Methods: Pathologically confirmed 24 primary central nervous system lymphoma (PCNSL) and 32 metastasis patients with solid enhancing cerebellar masses without necrotic or hemorrhagic components were retrospectively analyzed. We evaluated the imaging characteristics using contrast-enhanced magnetic resonance imaging (MRI). The serrate sign was defined as a tumor spreading along white matter with branch-like enhancement or outward spikes. Results: The serrate sign was exclusively identified in the PCNSL group, showing a significant difference compared to the metastasis group (75.0% vs. 0%, p < 0.001). Homogeneous enhancement occurred more frequently in PCNSL than in metastasis (91.7% vs. 21.9%, p < 0.001). Conversely, bulging contour (62.5% vs. 4.2%, p < 0.001) and surface involvement (71.9% vs. 29.2%, p = 0.003) were more prevalent in metastasis than PCNSL. For predicting PCNSL, the serrate sign demonstrated 75.0% sensitivity, 100% specificity, 100% positive predictive value, 84.2% negative predictive value, and 89.3% accuracy. Conclusions: This study found that the serrate sign and homogeneous enhancement are reliable MRI features for differentiating cerebellar PCNSL from metastasis, whereas a bulging contour and surface involvement suggest metastasis. The serrate sign demonstrated diagnostic significance in differentiating PCNSL from metastasis.

Rare Case of Lymphoma Presenting as Axillary Swelling

Rare Case of Lymphoma Presenting as Axillary Swelling

Non-Hodgkin Lymphoma Presenting as an Ulcerated Soft Tissue Mass on Left Thigh: A Rare Case Report

Non-Hodgkin Lymphoma Presenting as an Ulcerated Soft Tissue Mass on Left Thigh: A Rare Case Report

S3789 Melena as the Initial Presentation of Diffuse Large B-Cell Lymphoma with Gastrointestinal Tract Involvement

S3789 Melena as the Initial Presentation of Diffuse Large B-Cell Lymphoma with Gastrointestinal Tract Involvement

S4858 Small Bowel Perforation as Initial Presentation of Duodenal-type Follicular Lymphoma After Ten-year Remission: A Case Report

S4858 Small Bowel Perforation as Initial Presentation of Duodenal-type Follicular Lymphoma After Ten-year Remission: A Case Report

S2929 A Rare Case of Colonic Extranodal Marginal Zone Lymphoma Presenting as a Positive FIT Test

S2929 A Rare Case of Colonic Extranodal Marginal Zone Lymphoma Presenting as a Positive FIT Test

S4821 Navigating Rare Presentations: Recurrent Burkitt Lymphoma Presenting as a Jejunal Mass

S4821 Navigating Rare Presentations: Recurrent Burkitt Lymphoma Presenting as a Jejunal Mass

S2313 Helicobacter pylori-Negative MALT Lymphoma Presenting With Severe Gastrointestinal Bleeding: Insights from a Systematic Review of Published Case Reports

S2313 Helicobacter pylori-Negative MALT Lymphoma Presenting With Severe Gastrointestinal Bleeding: Insights from a Systematic Review of Published Case Reports

S2643 Lymphoma Presenting as Acute Pancreatitis in an 18-Year-Old

S2643 Lymphoma Presenting as Acute Pancreatitis in an 18-Year-Old