RESUMEN
Rituximab is a monoclonal antibody against the CD20 molecule which is used to treat B-cell lymphomas. In 60% of low-grade B lymphomas in which rituximab was effective at first, there was no clinical response in a second treatment and a few cases of follicular lymphomas (FL) with transformation to diffuse large B-cell lymphoma (DLBCL) have been reported. We describe a new case and hypothesize about the mechanisms of transformation: a 52-year-old man, in follow-up during 8 years for FL, who after rituximab treatment and complete remission of FL showed progressive disease involving the liver and duodenal mucosa. Immunohistochemical and molecular studies were performed on paraffin-embedded tissue samples of lymph nodes, the small intestine, and liver tumors. After rituximab treatment, biopsies of a liver lesion and the small bowel both showed CD20-negative large B-cell lymphoma. Molecular study of the initial and relapse specimens shows a CDR2 IgH rearrangement with the same height and t14;18 (MBR). The rapid relapse with the same rearrangement of IgH seems to support the interpretation that the change of grade of lymphoma and loss of CD20 expression occurred before rituximab treatment. The existence of a varying proportion of a CD20-negative cell population in every B-cell lymphoma which does not respond to rituximab should therefore be considered. The reduction of CD20 expression could be a resistance mechanism to rituximab retreatment in DLBCL as a consequence of the progression of low-grade B-cell non-Hodgkin's lymphoma (B-NHL). It is necessary to perform new biopsies to evaluate CD20 expression in relapse or the progression of B-cell lymphoma after rituximab treatment.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/análisis , Antineoplásicos/uso terapéutico , Linfoma de Células B/patología , Linfoma Folicular/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/patología , Anticuerpos Monoclonales de Origen Murino , Transformación Celular Neoplásica/inmunología , Transformación Celular Neoplásica/patología , Humanos , Linfoma de Células B/inmunología , Linfoma Folicular/patología , Linfoma de Células B Grandes Difuso/inmunología , Masculino , Persona de Mediana Edad , RituximabRESUMEN
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Asunto(s)
Inmunohistoquímica/clasificación , Inmunohistoquímica/métodos , Inmunohistoquímica/normas , Inmunohistoquímica/tendencias , Epítopos , Antígenos/análisis , Antígenos , Antígenos de Diferenciación/análisis , Antígenos de Diferenciación , Anticuerpos/análisis , Anticuerpos , Calor , Ácido Cítrico/análisis , Ácido Cítrico , Concentración de Iones de Hidrógeno , Inmunoadhesinas CD4/análisis , Inmunoadhesinas CD4 , Antígenos Comunes de Leucocito/análisis , Antígenos Comunes de Leucocito , Técnicas de Cultivo , Técnicas de Cultivo/métodos , Técnicas de Cultivo/clasificaciónRESUMEN
BACKGROUND: No cytologic reports on spermatic cord sarcomas have been published. CASE: A 64-year-old man presented with a slowly growing, painless, left spermatic cord enlargement. Fine needle aspiration (FNA) obtained < 1 mL of bloody fluid consisting of solitary, mark-edly anaplastic and pleomorphic tumor giant cells occasionally arranged in small fragments. Rare atypical spindle cells could be observed. Some reactive lymphocytes were observed intermingled with tumor cells. Immunohistochemistry displayed vimentin reactivity and negativity for keratins and leukocytic common antigen. The specimen removed showed a well-circumscribed, 30-mm, yellowish solid tumor. Touch imprints displayed pleomorphic tumor cells showing intense anisonucleosis; a moderate amount of clear, sometimes microvacuolated cytoplasm; and tissue fragments with a storiform pattern. Histologic examination revealed microscopic and immunohistochemical features of malignant fibrous histiocytoma (MFH) arising in soft tissues of the spermatic cord. CONCLUSION: FNA of a spermatic cord lesion may reveal a pleomorphic sarcoma. A pleomorphic appearance together with some spindle elements and compatible immunocytochemistry could help diagnose spermatic cord MFH. This is one of the few reports dealing with FNA cytology of paratesticular tumors and the first report, to the best of our knowledge, showing the cytologic characteristics of a case of spermatic cord MFH.
Asunto(s)
Enfermedades de los Genitales Masculinos/patología , Histiocitoma Fibroso Benigno/patología , Neoplasias de los Tejidos Blandos/patología , Cordón Espermático/patología , Biopsia con Aguja , Enfermedades de los Genitales Masculinos/cirugía , Histiocitoma Fibroso Benigno/cirugía , Humanos , Masculino , Persona de Mediana Edad , Neoplasias de los Tejidos Blandos/cirugía , Cordón Espermático/cirugíaRESUMEN
BACKGROUND: The aim of this study is to assess the proportion of Hodgkin disease (HD) expressing Epstein-Barr virus (EBV) in our area (Tarragona-Spain). PATIENTS AND METHODS: A retrospective study was performed on paraffin embedded HD tissues from 49 patients to examine the presence of latent membrane protein (LMP-1) by immunohistochemistry and for EBER-1 in situ hybridization. RESULTS: Overall, EBV (EBER-1 and/or LMP positive) was expressed in 20 cases (40.8%). This percentage was higher, but not significant, in mixed cellularity, and significant higher in patients over 55 years old. No differences between sexes were observed. CONCLUSIONS: EBV is associated with 40.8% of HD in area of Tarragona.
Asunto(s)
Herpesvirus Humano 4 , Enfermedad de Hodgkin/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , EspañaRESUMEN
BACKGROUND: Although the cytologic features of cervical cystic lesions are well established, no cytology reports on lymphangioma in adults have been published. CASE: A 60-year-old male presented with a slowly growing, upper laterocervical, painless enlargement. Fine needle aspiration (FNA) obtained 15 mL of yellowish fluid, consisting predominantly of a uniform population of small and round lymphocytes without mitosis or atypia and with some histiocytes intermingled with them. Some centrocytes and occasionally centroblasts and plasma cells could also be observed. Immunohistochemistry performed on cell block sections displayed polyclonal B lymphocytes mixed with T cells. The specimen showed a clearly circumscribed, 50-mm, cystic lesion with a multilocular appearance and abundant, yellowish liquid. Microscopic examination demonstrated cystic lymphangioma arising from the medullary portion of a lymph node. CONCLUSION: FNA cytology permits a suggested diagnosis of lymphangioma. This is one of the few reports of FNA cytology of lymphangioma and, to the best of our knowledge, this entity has not previously been found as a neck mass in an adult.