B-cell Lymphoma Presenting Research Articles

Diffuse Large B-cell Lymphoma Presenting as Upper Gastrointestinal Bleeding

Gastric lymphoma is a rare cause of GI bleeding. We hereby report a case of diffuse large B-cell lymphoma that extensively invaded the stomach, spleen and pancreatic tail and demonstrates the aggressive nature of the disease and our diagnostic and therapeutic approach. A 74-year-old woman with a history of peptic ulcer disease presented with dark output from her nasogastric tube and melena. CT without contrast two months ago showed a large necrotic mass invading the spleen, for which she underwent a non-diagnostic CT-guided para-aortic lymph node biopsy as well as laparoscopic biopsy of greater curvature lymph node and retroperitoneal mass that was suspicious for lymphoma. On presentation, she was febrile, hypotensive and tachycardic. She was intubated and sedated. Labs revealed a Hgb of 7.9 g/dL, WBC 33.8 K/mm, AST 125 IU/L, ALP 186 U/L, alb 1.6 g/dL, T bili 2.4 mg/dL. CT scan on admission showed heterogeneous neoplasm involving the pancreatic tail, gastric body, spleen and metastatic upper abdominal lymphadenopathy (Figure 1). PET demonstrated an intensely FDG-avid confluent mass involving the pancreatic tail, spleen and greater curvature of the stomach with FDG-avid abdominal adenopathy (Figure 2). EGD showed a nonbleeding, large infiltrative non-circumferential mass on the lesser curvature of the stomach (Figure 3). A review of the prior laparoscopic biopsies showed large atypical cells of B-cell origin based on PAX5, CD19 and CD79a expression, diagnosis of a diffuse large B-cell lymphoma was made. Results of EGD with biopsy and laparoscopic biopsy were consistent. Given recurrent active bleeding requiring vasopressors and transfusions, IR was consulted and hemostasis achieved with embolization of left gastric and splenic artery. However, she died soon after discharge due to the diffuse nature of the disease. Diffuse large B-cell lymphoma is the most common type of non-Hodgkin lymphoma. Since DLBCL can advance quickly, it usually requires immediate chemotherapeutic treatment once the diagnosis is established. Surgery is considered as second-line treatment for severe perforation, bleeding, or a need for palliative treatment. An EGD can help confirm the diagnosis and rule out other sources of bleeding. In this setting, EGD biopsy could have obviated the need for a laparoscopic biopsy. Given the extent of tumor involvement in our case, endoscopic hemostasis is rarely successful and IR is necessary for hemostasis.Figure: A large mass inseparable from the pancreatic tail and gastric antrum inferiorly was seen on CT abdomen/pelvis. This appears to invade the spleen at the splenic hilum and the largest component of the mass measures up to 11 x 7.2 x 12 cm.Figure: Intensely FDG-avid confluent mass with central necrosis is noted involving the pancreatic tail, spleen and greater curvature of the stomach, correlating to hypoenhancing mass noted on CT measuring approximately 11.5 x 7.2 cm.Figure: EGD showed a large, infiltrative mass with oozing and stigmata of recent bleed.

Diffuse Large B-Cell Lymphoma Presenting as a Pancreatic Mass

Primary lymphomas of the gastrointestinal tract are rare; however is the most common site of extranodal involvement. When presenting as a primary lesion, a distinction from an epithelial malignancy is critical given the difference in therapy and prognosis. Primary pancreatic lymphomas represent cancer. On physical exam, he looked chronically ill, had pale conjunctiva, tenderness to palpation in epigastric area,and palpable inguinal lymphadenopathy. Initial CBC, chemistries and liver function tests were unremarkable. LDH was elevated and CA19-9 level was normal. An abdominal CT revealed a pancreatic tail mass measuring 3.1 x 2.3 cm associated with duodenal wall thickening, peripancreatic, supraclavicular, mediastinal and inguinal lymphadenopathy. Also, a cardiac intraventricular mass that measured 6.3 x 4cm was seen occluding almost all the right ventricle.Important to note is that the liver was unremarkable. A PET CT scan showed multiple FDG-avid lesions including the pancreatic tail and cardiac masses, with a foci of highest tracer uptake near the duodenum. An ultrasound guided biopsy of a neck nodule for immunohistochemistry showed large cells with vesicular nuclei and prominent nucleoli; the cells stained positive for CD20, CD45, suggesting diffuse large B-cell lymphoma (DLBCL). He received rituximab,cyclophosphamide, doxorubicin, vincristine, prednisone, and entecavir.Figure: Pancreatic tail mass approximately 3.1 x 2.3cm.Figure: There is a foci of severe high tracer uptake of the pancreas.Figure: Multiple hypermetabolic lesions are evident.After completion of first course, he was discharged home. While at home he developed gastrointestinal bleeding that required hospitalization. At that time and while his performance status declined, he refused further treatment. This case shows that a distinction between DLBCL and pancreatic adenocarcinoma is challenging but extremely important since treatment and prognosis are very different. This patient presented with abdominal symptoms and radiologic evidence of a pancreatic mass with regional and distant lymphadenopathy initially suggesting a primary pancreatic neoplasm. However, the absence of liver metastases, B symptoms, cardiac involvement and the extensive lymphadenopathy suggested a lymphoproliferative disease. The early suspicion of this rare presentation of Non-Hodgkin's lymphoma involving the pancreas, duodenum and right ventricle helped establish timely and appropriate therapy given the high mortality associated with this disease.

A rare case of systemic diffuse B-cell lymphoma presenting as pancreatitis

A rare case of systemic diffuse B-cell lymphoma presenting as pancreatitis

Diffuse large B-cell lymphoma presenting as bilateral renal infiltration leading to acute kidney injury.

Acute kidney injury (AKI) because of bilateral renal infiltration is an uncommon presentation of diffuse large B-cell lymphoma (DLBCL). A 52-year-old man presented to our institution with AKI and complaints of fatigue. Ultrasonography revealed a large, 15cm granulomatous mass arising from the bilateral kidneys. The mass was biopsied laparoscopically, and histopathological analysis revealed evidence of DLBCL. The patient subsequently underwent R-CHOP therapy (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Chemotherapy resulted in a rapid decrease in mass size and improvement in kidney function. However, after five courses of R-CHOP, relapse was observed in the central nervous system, and the patient died 220days after the initial onset of AKI. Post-mortem analysis of renal tissue confirmed the initial diagnosis of DLBCL-associated renal infiltration. To our knowledge, this is the first report of DLBCL presenting as bilateral renal infiltration and AKI.

Qualitative study of patient perspectives on B-cell non-Hodgkin lymphoma: Impact of patient education.

e18109 Background: This qualitative study explored the impact of an online, patient-focused education activity on B-cell NHL ( http://www.cancercoachlive.com/ ), developed by the Leukemia and Lymphoma Society, University of Nebraska, and PlatformQ Health, to improve patient knowledge on B-cell NHL and offer strategies to enhance quality of life through better disease and side effect management. Methods: 12 qualitative interviews were conducted using a semi-structured interview guide. Questions focused on knowledge of B-cell NHL epidemiology, prognosis, and typical presentation; diagnostic and imaging tests; efficacy and side effects of treatments used to treat B-cell NHLs; and actions to improve quality of life and overall health. Interviews were recorded and transcribed verbatim, and analyzed using constant comparative method with software support (NVivo 11, QSR International). Results: Participants, aged 43-78 (mean 60 years, 8 female), were diagnosed with a B-cell NHL 2-24 years prior to interview. Participants demonstrated understanding of B-cell NHL, with good recall on typical presentation of B-cell lymphoma, the importance of blood tests and laboratory/diagnostic procedures and what to expect during these tests. Six participants recalled traumatic experiences with bone marrow biopsy and suggest additional education for newly diagnosed patients. Participants were knowledgeable about treatment options covered by the program (i.e. active surveillance, chemotherapy, radiation therapy, stem cell transplant), and were interested in more information on treatment options across the B-cell disease trajectory. Not all participants could recall information on targeted therapies from the program, and there was low awareness about clinical trials as a treatment option, indicating need for further education. Conclusions: Overall, participants had a positive impression of the education activity. They judged the content to be comprehensive, accurate, and realistic. Participant descriptions suggest that education continues to play a role in allaying fears and anxieties even among patients who have learned to live with B-cell NHL and who have been managing their disease for several years.

Diffuse Large B-Cell Lymphoma Presenting as Bilateral Internal Auditory Canal Lesions

Diffuse Large B-Cell Lymphoma Presenting as Bilateral Internal Auditory Canal Lesions

Rituximab with dose-adjusted EPOCH as first-line treatment in patients with highly aggressive diffuse large B-cell lymphoma and autologous stem cell transplantation in selected patients.

AimTo assess the benefit of rituximab with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (R-DA-EPOCH) regimen as a first-line treatment for patients with diffuse large B-cell lymphoma (DLBCL) presenting with unfavorable or aggressive features, and autologous stem cell transplantation (ASCT) as a part of the first-line treatment for selected DLBCL patients with additional aggressive features.MethodsWe retrospectively analyzed 75 newly diagnosed DLBCL patients with Ki-67+≥80% or International Prognostic Index ≥2 who were treated with R-DA-EPOCH between 2005 and 2015. Of 24 DLBCL patients with additional aggressive features (Ki-67+≥90% or age-adjusted IPI≥2) who were planned to receive consolidation with ASCT, 17 patients underwent the procedure. We determined the overall response rate (ORR), complete remission (CR), partial remission (PR), 5-year overall survival (OS), and progression free survival (PFS) in all DLBCL patients and specifically those planned to receive ASCT.ResultsAll 75 patients included in the analysis started one or more cycles of therapy. The ORR, CR, and PR rates were 80%, 55%, and 25%, respectively. The response was non-evaluable in 10 of 75 patients due to treatment discontinuation. The OS and PFS rates for all 75 patients were 70% and 61%, respectively, and 80% and 79%, respectively, for 24 planned-to-receive-ASCT patients. Age (≤65 vs >65 years) had no prognostic impact on OS and PFS (P = 0.994 and P = 0.827, respectively).ConclusionOur retrospective analysis of one of the largest DLBCL patient cohorts outside the US National Cancer Institute showed that R-DA-EPOCH is a very effective therapeutic option as a first-line treatment of DLBCL patients with unfavorable prognostic features irrespective of their age. ASCT provided additional benefit for DLBCL patients with additional aggressive features.

A case of intra-vascular large B-cell lymphoma presenting with multiple organ system involvement

A case of intra-vascular large B-cell lymphoma presenting with multiple organ system involvement

Extranodal involvement in young patients with diffuse large B-cell lymphoma: distribution, prognostic value and treatment options.

ObjectiveExtranodal involvement represents a peculiar presentation of diffuse large B-cell lymphoma (DLBCL). Previous studies have suggested that older patients are more prone to extranodal involvement. This study retrospectively addressed the distribution, prognostic value and treatment options of extranodal involvement in young patients with DLBCL.MethodsA total of 329 patients were enrolled according to the inclusion requirements. The effects of gender, extranodal involvement, age-adjusted international prognostic index (aaIPI), rituximab infusion and radiotherapy on patient outcomes were evaluated.ResultsAmong these patients, 59% presented extranodal involvement in 16 anatomic sites. More than one instance was linked to many poorer clinical characteristics and poorer survival compared with either nodal disease or one instance. In patients with one extranodal lesion, multivariate analysis revealed that the site of extranodal involvement, but not the aaIPI or rituximab infusion, was independently related to the outcome, and radiotherapy had a negative influence on survival.ConclusionsExtranodal involvement is common in younger patients and exhibits a ubiquitous distribution. The site of extranodal involvement is of strong prognostic significance. Radiotherapy for extranodal lesions does not improve patient outcomes.

前縦隔に巨大腫瘤を呈した縦隔原発大細胞型B 細胞性リンパ腫の1 例

前縦隔に巨大腫瘤を呈した縦隔原発大細胞型B 細胞性リンパ腫の1 例

P103 Acquired angioedema: a rare presentation of splenic marginal zone B-cell lymphoma

P103 Acquired angioedema: a rare presentation of splenic marginal zone B-cell lymphoma

Prolymphocytoid Transformation of a Splenic B-Cell Lymphoma Presenting as a Spontaneous Splenic Rupture

Prolymphocytoid Transformation of a Splenic B-Cell Lymphoma Presenting as a Spontaneous Splenic Rupture

Primary Diffuse Large B-Cell Lymphoma Presenting as Intra-abdominal Necrotic Abscesses

Primary Diffuse Large B-Cell Lymphoma Presenting as Intra-abdominal Necrotic Abscesses

Diffuse large B-cell lymphoma presenting with neurolymphomatosis: a case report

Diffuse large B-cell lymphoma presenting with neurolymphomatosis: a case report

Primary Cutaneous Marginal Zone B-Cell Lymphoma Presenting as a Small Mass on Temple Area.

Primary Cutaneous Marginal Zone B-Cell Lymphoma Presenting as a Small Mass on Temple Area.

Primary diffuse large B-cell lymphoma of the dura with skull and scalp involvement: A case report and brief review of the literature.

Primary dural lymphoma (PDL) refers to a lymphoma with epidural or subdural involvement and is a rare subtype of primary central nervous system lymphoma. Diffuse large B-cell lymphoma (DLBCL) presenting as PDL is extremely rare. The present study reports a case of PDL with skull and scalp involvement in a 56-year-old man. Magnetic resonance imaging (MRI) revealed that the tumor was located under the right parietal inner plate and was attached to the dura mater. Following contrast-enhanced MRI, markedly enhanced tumor signals were observed, and mild homogeneous enhancement was observed in the diploë and soft tissues under the scalp, near the parietal bone. Under general anesthesia, the patient underwent craniotomy and tumor resection. The postoperative pathological diagnosis was DLBCL. Tumors were additionally identified inside the skull and subcutaneous tissues. The patient was administered chemotherapy postoperatively, and the prognosis subsequent to the 4-year follow-up was favorable. Primary malignant lymphoma should be considered in the differential diagnosis of scalp masses and meningeal lesions. Early diagnosis and individualized treatment is closely associated with a favorable outcome.

B-Cell Lymphoma Presenting as Bilateral Facial Nerve Palsy: Case Report and Literature Review (P2.264)

B-Cell Lymphoma Presenting as Bilateral Facial Nerve Palsy: Case Report and Literature Review (P2.264)

CD20 negative B-cell lymphoma presenting as constrictive pericarditis: Rare etiology of acute heart failure

We describe a case report of a young girl, who presented with symptoms and signs of acute decompensated heart failure not responding to decongestive therapy. Routine 2D echocardiography revealed a diagnosis of constrictive pericarditis. She underwent pericardiectomy, and etiology of it turned out to be CD20 negative B-cell lymphoblastic primary cardiac lymphoma (PCL). Despite intensive medical and surgical management, it was fatal. PCL is uncommon among cardiac tumors and extremely rare in immunocompetent patients. Constrictive pericarditis is a rare clinical diagnosis and manifestation of pericardial involvement in PCL.

Isolated Intravascular Large B-cell Lymphoma Presenting with Diffuse Ground Glass Pulmonary Infiltrates.

A case of 44-year-old man with dyspnea and CT chest demonstrated bilateral infiltration. Patient was failed to improve with antibiotics and steroid. Finally, video-assisted thoracic surgery-guided lung biopsy was performed and surprisingly revealed intravascular large B cell lymphoma. The patient was subsequently started on chemotherapy with considerable clinical improvement. At the time of last follow-up (4years from diagnosis); there was no clinical or radiologic evidence of tumor recurrence.

An Unusual Presentation of B-Cell Lymphoma as a Large Isolated Epiglottic Mass: Case Report and Literature Review.

Extranodal presentation of B-cell lymphoma is uncommon. Isolated primary epiglottic B-cell lymphoma is even rarer. To our knowledge, there has been only one description of isolated B-cell lymphoma presenting as a large epiglottic mass. We report an unusual type of B-cell lymphoma of the epiglottis, as it could not be subtyped based on routine staining and hybridization. The lymphoma presented as a large isolated globular mass pedicled to the epiglottis, occupying most of the oropharynx, but did not have any ball-valving effect or increased respiratory efforts. Initial radiographic findings were nonspecific. The diagnosis of B-cell lymphoma was determined by transoral incisional biopsy under local anesthesia. The condition was treated successfully with chemoradiation. The current standard of treatment for high grade B-cell lymphoma is concurrent chemoradiotherapy, with excellent prognosis. Although rare, B-cell lymphoma should be considered when investigating pedunculated hypopharyngeal masses.