RESUMEN
Colonic lymphoma is a rare malignant gastrointestinal tumor that can be revealed by an exceptional and serious complication: intestinal obstruction. Treatment is based on surgery and chemotherapy. We here report a case of diffuse colonic large B-cell lymphoma revealed by occlusion and diagnosed based on the examination of surgical specimen in a 64-year-old man who was in complete remission after six courses of R-CHOP.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Colon , Ciclofosfamida , Doxorrubicina , Obstrucción Intestinal , Linfoma de Células B Grandes Difuso , Prednisona , Rituximab , Vincristina , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/complicaciones , Neoplasias del Colon/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/patología , Ciclofosfamida/administración & dosificación , Vincristina/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Prednisona/administración & dosificación , Doxorrubicina/administración & dosificación , Rituximab/administración & dosificación , Inducción de RemisiónRESUMEN
BACKGROUND Human herpesvirus-8 (HHV-8)-associated diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS), is a rare form of lymphoid malignancy. It poses unique challenges in diagnosis in the setting of human immunodeficiency virus (HIV) infection and concomitant multiorgan dysfunction. CASE REPORT We describe the case of a 26-year-old man who initially presented with pre-syncope and was found to have HIV, with a CD-4 count of 20 cells/µL. His initial clinical presentation was significant for nonspecific symptoms, isolated anemia, and bilateral pleural effusions without gross lymphadenopathy, which was initially attributed to acute HIV infection. However, his hospital course was complicated by anasarca, renal failure, liver dysfunction, pancytopenia, and microscopic hematuria, which required a more comprehensive diagnostic evaluation. Progressive pancytopenia prompted a bone marrow biopsy, which ultimately revealed HHV-8-associated DLBCL, NOS (HDN). We describe his complicated hospital course and eventual diagnosis of HDN. This patient's broad differential diagnoses and overlap among various clinical syndromes posed a significant diagnostic challenge. Additionally, his multiorgan failure limited his treatment options. CONCLUSIONS The management of HHV-8-associated DLBCL, NOS is complex, requiring a multifaceted approach to ensure prompt diagnosis and treatment, especially given difficulty in arriving at an accurate diagnosis due to the significant overlap with other lymphoproliferative disorders and lack of standardized treatment. We highlight the challenges and paucity of data available for management of HDN in the context of a diagnostically challenging case. We discuss the current limitations in diagnosis and treatment of this rare malignancy and the necessity of further investigation, especially in medically complex patients.
Asunto(s)
Infecciones por VIH , Herpesvirus Humano 8 , Linfoma de Células B Grandes Difuso , Humanos , Masculino , Adulto , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/virología , Linfoma de Células B Grandes Difuso/complicaciones , Infecciones por VIH/complicaciones , Infecciones por VIH/diagnóstico , Herpesvirus Humano 8/aislamiento & purificación , Infecciones por Herpesviridae/diagnóstico , Infecciones por Herpesviridae/complicaciones , Diagnóstico DiferencialRESUMEN
Neurolymphomatosis (NL) is a rare neurologic manifestation of non-Hodgkin lymphoma (NHL) with poor prognosis. Investigations including MRI, PET/CT, nerve biopsy and cerebrospinal fluid (CSF) analysis can aid the diagnosis of NL. In this study, we presented a case of NL with co-existing myelin-associated glycoprotein (MAG) antibody. The patient first presented with symptoms of peripheral neuropathy involving multiple cranial nerves and cauda equina, and later developed obstructive hydrocephalus and deep matter lesions. He also had persistently positive MAG antibody, but did not develop electrophysiologically proven neuropathy and monoclonal immunoglobulin. The final brain biopsy confirmed diffuse large B cell lymphoma.
Asunto(s)
Glicoproteína Asociada a Mielina , Neurolinfomatosis , Humanos , Masculino , Neurolinfomatosis/diagnóstico por imagen , Neurolinfomatosis/diagnóstico , Glicoproteína Asociada a Mielina/inmunología , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/complicaciones , Anciano , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Autoanticuerpos/líquido cefalorraquídeoRESUMEN
BACKGROUND: Splenic cysts are uncommon and very rarely malignant therefore their treatment isn't standardized. In case of symptomatic cysts different surgical approaches have been suggested. Primary malignant lymphoma of the spleen comprises less than 1% of non-Hodgkin's lymphomas. To our knowledge, only 203 cases of splenic large B-cell lymphoma (LBCL) have been reported to date and only 2 of them were fibrin-associated splenic cysts. CASE PRESENTATION: 27-year-old model with a 19 × 13 cm splenic cyst without data of malignancy in the preliminary study and therefore treated with laparoscopic deroofing. After histological diagnosis of LBCL with a fibrin/EBV-associated splenic pseudocyst, the patient received 4 cycles of Rituximab and a laparoscopic splenectomy was performed due to resurgence of the pseudocyst. No evidence of malignancy has been found during follow up (EBV viral load every 3 months during the first year, PET-CT every 6 months during the first year and annual afterwards) performed after the splenectomy. DISCUSSION AND CONCLUSIONS: The value of tumor markers and radiology for diagnosis of splenic cysts is put into question. Only 60 cases of Fibrin-associated LBCL (FA-LBCL) have been described in the literature therefore there are no treatment guidelines for them even though surgery together with systemic treatment has been the prevalent route with good results in most cases.
Asunto(s)
Quistes , Esplenectomía , Enfermedades del Bazo , Neoplasias del Bazo , Humanos , Esplenectomía/métodos , Adulto , Quistes/cirugía , Quistes/patología , Enfermedades del Bazo/cirugía , Enfermedades del Bazo/patología , Neoplasias del Bazo/cirugía , Neoplasias del Bazo/patología , Neoplasias del Bazo/complicaciones , Masculino , Pronóstico , Laparoscopía/métodos , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/cirugía , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B/cirugía , Linfoma de Células B/patología , Linfoma de Células B/complicaciones , Linfoma de Células B/diagnóstico , Rituximab/administración & dosificación , Rituximab/uso terapéuticoAsunto(s)
Coinfección , Infecciones por Virus de Epstein-Barr , Infecciones por Herpesviridae , Herpesvirus Humano 4 , Herpesvirus Humano 8 , Linfoma de Células B Grandes Difuso , Humanos , Linfoma de Células B Grandes Difuso/virología , Linfoma de Células B Grandes Difuso/complicaciones , Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones por Virus de Epstein-Barr/virología , Coinfección/virología , Infecciones por Herpesviridae/complicaciones , Infecciones por Herpesviridae/virología , Masculino , Persona de Mediana Edad , FemeninoRESUMEN
BACKGROUND Fluid overload-associated large B-cell lymphoma (FO-LBCL) is a recently described malignant lymphoma that presents with serous effusions in the pleura, peritoneum, and/or pericardium but without an identifiable lymphoma mass. This report describes the case of an 80-year-old man who presented with a pleural effusion and describes the approach to diagnosis and management of FO-LBCL. CASE REPORT We present a case of an 80-year-old man who presented with right pleural effusion and shortness of breath at work. Initial radiological assessment suggested a pleural effusion on the right side, without an identifiable mass, given the patient's symptoms and imaging characteristics. Subsequently, he underwent a pleural fluid puncture and biopsy. Based on the initial pathological assessment, malignant lymphoma, a non-epithelial tumor, was considered likely, but differentiation from reactive proliferative cells was difficult, given the patient's symptoms and cytologic characteristics. Postoperatively, histopathological examination and immunohistochemistry confirmed a diagnosis of FO-LBCL. After 1 year of follow-up, the condition had progressed and the patient died due to recurrence. CONCLUSIONS This report has presented a case of FO-LBCL in an elderly man with pleural effusion and described how this rare and recently described lymphoma was diagnosed and managed.
Asunto(s)
Linfoma de Células B Grandes Difuso , Humanos , Masculino , Anciano de 80 o más Años , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Células Plasmáticas/patología , Derrame Pleural Maligno/etiología , Resultado Fatal , Derrame Pleural/etiologíaRESUMEN
Dermatomyositis (DM) and polymyositis are idiopathic inflammatory myopathies (IIMs), most associated with solid organ malignancies, and less commonly hematological malignancies. We discuss a case of DM associated with diffuse large B-cell lymphoma, followed by a review of literature on the pathogenesis, clinical course, treatment, and prognosis. Various challenges with the diagnosis and management of underlying lymphoproliferative disorders (LPDs) in patients with IIM are discussed. The case demonstrates the importance of being vigilant of the association between IIM and LPD. Cancer screening in patients with IIM is discussed, including the recently published International Guideline for IIM-Associated Cancer Screening. More research is required to address knowledge gaps in cancer screening in IIM.
Asunto(s)
Dermatomiositis , Linfoma de Células B Grandes Difuso , Humanos , Dermatomiositis/diagnóstico , Dermatomiositis/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/complicaciones , Trastornos Linfoproliferativos/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Detección Precoz del Cáncer , PronósticoRESUMEN
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma. Patients with hemophagocytic lymphohistiocytosis (HLH)-associated IVLBCL variants exhibit significantly poor survival. Cytokines play pivotal roles in malignancy-associated HLH as well as in capillary leak syndrome (CLS). The pathogenesis of CLS involves hyperpermeability and transient endothelial dysfunction. Here, we report the first case of HLH-associated IVLBCL variant complicated with CLS. The patient presented with fever, refractory hypoproteinemia, hypotension and severe edema, followed by telangiectasias. Treatment with etoposide and dexamethasone and hydroxyethyl starch-based artificial colloid led to transient improvement. The diagnosis of IVLBCL was confirmed after the sixth bone marrow biopsy. Subsequently, the R-CHOP (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone) regimen was administered and resulted in prompt alleviation of CLS and HLH symptoms. The patient has survived for more than 6 years after combination of immunochemotherapy and autologous peripheral stem-cell transplantation. This case provides some insights into the mechanism and clinical management of IVLBCL complicated with HLH and CLS. Similar cases concerning lymphoma-associated CLSs were also reviewed.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Síndrome de Fuga Capilar , Linfohistiocitosis Hemofagocítica , Linfoma de Células B Grandes Difuso , Humanos , Linfohistiocitosis Hemofagocítica/diagnóstico , Linfohistiocitosis Hemofagocítica/etiología , Linfohistiocitosis Hemofagocítica/complicaciones , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Síndrome de Fuga Capilar/etiología , Síndrome de Fuga Capilar/diagnóstico , Síndrome de Fuga Capilar/terapia , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Vincristina/uso terapéutico , Masculino , Ciclofosfamida/uso terapéutico , Prednisona/uso terapéutico , Doxorrubicina/uso terapéutico , Doxorrubicina/administración & dosificación , Rituximab/uso terapéutico , Persona de Mediana EdadRESUMEN
Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory condition that can be either familial or acquired and, if untreated, frequently results in multiorgan failure and death. Treatment of HLH typically requires a combination of glucocorticoids and cytotoxic chemotherapy. We describe the case of a woman who presented with signs and symptoms concerning for HLH who was later found to have a primary central nervous system (CNS) diffuse large B-cell lymphoma. Her HLH symptoms were successfully treated with high doses of dexamethasone, and her primary CNS lymphoma was treated with high-dose methotrexate and rituximab. This is a rare case of HLH secondary to primary CNS lymphoma where HLH was controlled with steroids alone and did not require the use of an etoposide-based regimen or cyclophosphamide, doxorubicin, vincristine and prednisone.
Asunto(s)
Neoplasias del Sistema Nervioso Central , Etopósido , Linfohistiocitosis Hemofagocítica , Linfoma de Células B Grandes Difuso , Humanos , Linfohistiocitosis Hemofagocítica/tratamiento farmacológico , Linfohistiocitosis Hemofagocítica/complicaciones , Femenino , Etopósido/uso terapéutico , Etopósido/administración & dosificación , Neoplasias del Sistema Nervioso Central/tratamiento farmacológico , Neoplasias del Sistema Nervioso Central/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/complicaciones , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Dexametasona/uso terapéutico , Dexametasona/administración & dosificación , Rituximab/uso terapéutico , Rituximab/administración & dosificación , Metotrexato/uso terapéutico , Metotrexato/administración & dosificación , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Lymphoid neoplasm is a common disease, arising from lymphoid cells. It is divided into Hodgkin lymphoma and non-Hodgkin lymphoma. Non-Hodgkin lymphoma can be intranodular or extranodular, which happens in 25% of primary cases. The most common locations of extranodular non-Hodgkin lymphoma are the skin and gastrointestinal tract. The genital tract is a rare location; most lymphomas arise from the cervix and vagina, while the uterine corpus is an extremely rare location. In our case, the patient was diagnosed with primary extranodular non-Hodgkin lymphoma in different locations of her genital tract. CASE PRESENTATION: A 48-year-old nonparous Syrian woman complained of diffuse abdominal pain, fatigue, debility, high fever, vomiting, and urinary retention for a week. The last menstrual period of the patient was 5 years previously. The physical examination showed periodic abdominal pain with severe fatigue and increased abdominal size. The laboratory investigations were within normal limits except for a low level of hemoglobin and a high level of cancer antigen 125. The radiological investigations showed a uterine sizable lobulated mass with irregular borders and high and heterogeneous density, extending to the right and left ovaries, enlargement lymph nodes around the abdominal aortic and right iliac vessels, and severe right pleural effusion with right inferior lobe atelectasis. A total hysterectomy and oophorectomy were done. The histopathological examination showed that the patient had non-Hodgkin lymphoma (primary tumor). CONCLUSION: Primary non-Hodgkin lymphoma in the female genital tract is an extremely rare disease. Fast diagnosis and treatment can improve the outcomes, so this differential diagnosis should be in our minds even in the absence of systematic manifestations of lymphoma. More studies are needed to explain the pathology of this disease and to put guidelines that determine the perfect methods for diagnosis and treatment.
Asunto(s)
Linfoma de Células B Grandes Difuso , Neoplasias Uterinas , Humanos , Femenino , Persona de Mediana Edad , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Neoplasias Uterinas/complicaciones , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugía , Neoplasias Uterinas/diagnóstico , Histerectomía , Dolor Abdominal/etiología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Diffuse large B-cell lymphoma (DLBCL) secondary to acute lymphoblastic leukemia (ALL) is a rare disease with poor prognosis, usually attributed to delayed diagnosis. To date, only four cases of ALL developing DLBCL have been reported, while none of them exhibiting central nervous system (CNS) symptoms. CASE DESCRIPTION: Here, we report an unusual case of a 15-year-old boy diagnosed with ALL and treated based on the SCCLG-ALL 2016 protocol. While he was receiving maintenance treatment, the patient developed dizziness and vomiting. An Epstein-Barr virus (EBV)-positive DLBCL with CNS involvement was diagnosed from inguinal lymph nodes biopsy, EBV DNA tests and head magnetic resonance imaging (MRI). Meanwhile, a dramatic decrease of immune cells and immunoglobulin was detected in the occurrence of DLBCL. He received therapy based on SCCCG-NHL-2017 protocol immediately after the diagnosis. CONCLUSIONS: We present the first retrospective report of four cases of non-Hodgkin lymphoma (NHL) secondary to ALL between 1990 and 2022. The pathogenesis of secondary DLBCL may be related to infection, immunodeficiency, genetic susceptibility, and treatment. Thus, the detection of EBV DNA during the full course of ALL therapy and genetic tests were needed in the occurrence of secondary DLBCL. Given to the rare rate and insufficient treatment experience, longer follow-up and enough sample size are needed.
Asunto(s)
Linfoma de Células B Grandes Difuso , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Linfoma de Células B Grandes Difuso/complicaciones , Masculino , Adolescente , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológicoAsunto(s)
Leucemia Mieloide Aguda , Linfoma de Células B Grandes Difuso , Síndrome de Shwachman-Diamond , Humanos , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/complicaciones , Leucemia Mieloide Aguda/patología , Leucemia Mieloide Aguda/complicaciones , Masculino , Adulto Joven , Lipomatosis/patología , Lipomatosis/complicaciones , Insuficiencia Pancreática Exocrina/complicaciones , Insuficiencia Pancreática Exocrina/genética , Insuficiencia Pancreática Exocrina/patología , Enfermedades de la Médula Ósea/patología , AdultoRESUMEN
A 65-year-old man with previous history of smoking, controlled HIV infection, treated hepatitis B infection, and type III cryoglobulinemia, was admitted due to right heart failure symptoms and significant weight loss. Despite being haemodynamically stable, he had periods of 1:1 conduction atrial flutter and presented with respiratory alkalosis and metabolic acidosis, as well as acute kidney and hepatic dysfunction, elevated D-dimer and cardiac markers. He underwent imaging with chest computed tomography and echocardiogram that confirmed pulmonary embolism and most notably revealed a significant sized cardiac mass causing almost complete obstruction of the right chambers, with no cleavage plane with the myocardial walls and tricuspid valve. Cardiac magnetic resonance was highly suggestive of malignancy. Cardiac surgery for mass excision and endomyocardial biopsy for diagnosis were considered, but the patient died with obstructive shock unresponsive to medical treatment. The autopsy revealed a primary unspecified diffuse large B-cell lymphoma.
Asunto(s)
Insuficiencia Cardíaca , Neoplasias Cardíacas , Linfoma de Células B Grandes Difuso , Humanos , Masculino , Anciano , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Resultado Fatal , Insuficiencia Cardíaca/etiología , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/complicaciones , Autopsia , Biopsia , Imagen por Resonancia MagnéticaAsunto(s)
Dermatomiositis , Linfoma de Células B Grandes Difuso , Humanos , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/inmunología , Linfoma de Células B Grandes Difuso/complicaciones , Dermatomiositis/inmunología , Dermatomiositis/diagnóstico , Dermatomiositis/sangre , Dermatomiositis/complicaciones , Factores de Transcripción/inmunología , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Masculino , Femenino , Persona de Mediana Edad , AncianoRESUMEN
A 71-year-old woman developed sudden, painful, decreased vision in the left eye accompanied by progressive instability. Initial examination revealed left optic disc edema, and macular optical coherence tomography confirmed the presence of intraretinal and subretinal fluid, as well as hyperreflective material under the retinal pigment epithelium. Subsequent investigations, including brain magnetic resonance imaging and a comprehensive serological analysis, ruled out infectious and autoimmune causes, further complicating the diagnostic picture. The patient's vision in both eyes continued to deteriorate, prompting empirical corticosteroid treatment. While the vision improved, the case took an unexpected turn with worsening neurological symptoms. Ultimately a brain biopsy was consistent with diffuse large B-cell lymphoma.
Asunto(s)
Neuropatía Óptica Isquémica , Tomografía de Coherencia Óptica , Humanos , Femenino , Anciano , Neuropatía Óptica Isquémica/diagnóstico , Tomografía de Coherencia Óptica/métodos , Imagen por Resonancia Magnética , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/complicaciones , Papiledema/diagnóstico , Papiledema/etiología , Diagnóstico Diferencial , Agudeza VisualRESUMEN
Along with infecting hepatocytes, the Hepatitis C virus (HCV) is also a lymphotropic virus. Chronic HCV infection can mutate the Bcl2, a proto-oncogene that inhibits apoptosis. This causes continuous stimulation of B lymphocytes, which results in clonal growth of these immunoglobulin-producing cells. In Western countries, there is a well-documented link between HCV and lymphoproliferative illness. HCV and Non-Hodgkin lymphoma (NHL) have been found to be significantly correlated in Europe, Japan, and the southern United States. There, however, has been no association found in central and northern Europe, the northwestern United States, and some Asian countries. A literature deficit exists in South Asia about the incidence of HCV infection in lymphoma patients. Here, the first documented instance of Diffuse Large B-cell NHL (germinal center type) is reported in a 35-year-old patient. The patient presented to the outpatient department at Ruth KM Pfau, Civil Hospital Karachi, in July of 2022, with the chief complaints of altered bowel habits due to involvement of the anorectal junction and concomitant infection by Helicobacter pylori with a prior history of HCV infection.
Asunto(s)
Coinfección , Infecciones por Helicobacter , Helicobacter pylori , Linfoma de Células B Grandes Difuso , Humanos , Infecciones por Helicobacter/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Helicobacter pylori/aislamiento & purificación , Adulto , Masculino , Hepatitis C/complicaciones , Proto-Oncogenes Mas , Hepatitis C Crónica/complicaciones , Vincristina/uso terapéutico , Doxorrubicina/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Rituximab/uso terapéuticoRESUMEN
Primary cardiac lymphoma is an exceedingly rare malignant tumor, with diffuse large B-cell lymphoma (DLBCL) being the most prevalent histological subtype. This disease has non-specific clinical manifestations, making early diagnosis crucial. However, DLBCL diagnosis is commonly delayed, and its prognosis is typically poor. Herein, we report the case of a 51-year-old male patient with DLBCL who presented with recurrent chest tightness for 4 months as the primary clinical symptom. The patient was admitted to the hospital and diagnosed with acute myocardial infarction and left ventricular hypertrophy with heart failure. Echocardiography revealed a progression from left ventricular thickening to local pericardial thickening and adhesion in the inferior and lateral walls of the left ventricle. Finally, pathological analysis of myocardial biopsy confirmed the diagnosis of DLBCL. After treatment with the R-CHOP chemotherapy regimen, the patient's chest tightness improved, and he was discharged. After 2 months, the patient succumbed to death owing to sudden ventricular tachycardia, ventricular fibrillation, and decreased blood pressure despite rescue efforts. Transthoracic echocardiography is inevitable for the early diagnosis of DLBCL, as it can narrow the differential and guide further investigations and interventions, thereby improving the survival of these patients.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica , Ecocardiografía , Neoplasias Cardíacas , Hipertrofia Ventricular Izquierda , Linfoma de Células B Grandes Difuso , Infarto del Miocardio , Vincristina , Humanos , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/diagnóstico , Infarto del Miocardio/etiología , Infarto del Miocardio/diagnóstico , Resultado Fatal , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Hipertrofia Ventricular Izquierda/etiología , Vincristina/administración & dosificación , Vincristina/uso terapéutico , Doxorrubicina/administración & dosificación , Doxorrubicina/uso terapéutico , Rituximab/uso terapéutico , Rituximab/administración & dosificación , Ciclofosfamida/uso terapéutico , Ciclofosfamida/administración & dosificación , Prednisona/uso terapéutico , Prednisona/administración & dosificaciónRESUMEN
Neurolymphomatosis (NL) is a rare complication of non-Hodgkin's lymphoma, characterized by the infiltration of lymphoma cells into the peripheral nerves. A 54-year-old woman initially presented with right facial palsy without any other significant symptoms and was diagnosed with Bell's palsy. Despite initial improvement, her condition recurred, prompting further evaluation. Magnetic resonance imaging (MRI) revealed contrast enhancement from the tympanic segment to the surface of the masseter muscle along the right facial nerve and an adjacent mass lesion. Biopsy of the mass revealed a diagnosis of T-cell/histiocyte-rich large B-cell lymphoma. Chemotherapy resulted in complete resolution of facial palsy. Follow-up MRI confirmed the absence of contrast enhancement along the facial nerve. Facial palsy was considered to be caused by NL. This case was classified as that of primary NL because the facial palsy was the first manifestation of a hematologic malignancy. Recurrent facial palsy, which is atypical in Bell's palsy, led to further evaluation with MRI, which finally resulted in the diagnosis of malignant lymphoma. In cases of recurrent facial palsy, clinicians should consider various diagnoses, including that of NL, and advocate early imaging tests and biopsy, if possible, for accurate diagnosis and improved outcomes.
Asunto(s)
Parálisis Facial , Imagen por Resonancia Magnética , Neurolinfomatosis , Recurrencia , Humanos , Femenino , Persona de Mediana Edad , Neurolinfomatosis/diagnóstico por imagen , Neurolinfomatosis/patología , Parálisis Facial/etiología , Parálisis de Bell/etiología , Parálisis de Bell/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Rituximab/uso terapéutico , Vincristina/uso terapéutico , Doxorrubicina/uso terapéutico , Ciclofosfamida/uso terapéutico , Prednisona/uso terapéuticoRESUMEN
BACKGROUND: Arterial hypertension is mentioned as a risk factor in cardio-oncology. This study aimed to assess the long-term prognostic value of arterial hypertension (AH) in diffuse large B-cell lymphoma (DLBCL). METHODS: We analysed data collected by the Polish Lymphoma Research Group for the evaluation of the outcomes associated with the use of first-line rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone therapy in patients with DLBCL with coexisting AH. Patients with other cardiovascular comorbidities or premature chemotherapy discontinuation due to cardiovascular toxicity were excluded. RESULTS: Pre-existing AH was diagnosed in 65 of 232 patients with DLBCL (28%) included in the study, and was associated with significantly shorter overall survival values (p<0.00001). The rates of DLBCL recurrence, administration of second-, third-, or fourth-line chemotherapy, and lymphoma-related deaths were similar in patients with and those without AH. Cardiovascular deaths were significantly more frequently observed in patients with pre-existing AH (38.5% vs 3.6%, p<0.0001). In the univariate analysis, AH (p=0.000001), older age (p<0.000001), and diabetes (p=0.0065) were identified as significant predictors of all-cause mortality; however, cardiovascular mortality was associated with AH (p<0.000001), older age (p=0.000008), and dyslipidaemia (p=0.03). Multivariate analysis revealed AH as an age-independent significant predictor of all-cause (p=0.00045) and cardiovascular mortality (p<0.000001). CONCLUSION: In the long-term follow-up of patients with DLBCL, the role of AH, as an important age-independent predictor of premature cardiovascular mortality, was so strong that it may have value for use in close surveillance in cardio-oncology clinics.
Asunto(s)
Hipertensión , Linfoma de Células B Grandes Difuso , Humanos , Linfoma de Células B Grandes Difuso/mortalidad , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Femenino , Polonia/epidemiología , Persona de Mediana Edad , Anciano , Hipertensión/epidemiología , Hipertensión/complicaciones , Tasa de Supervivencia/tendencias , Pronóstico , Estudios Retrospectivos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Estudios de Seguimiento , Factores de Riesgo , Doxorrubicina/uso terapéutico , Doxorrubicina/administración & dosificación , Vincristina/uso terapéutico , Ciclofosfamida/uso terapéutico , Rituximab/uso terapéutico , Rituximab/administración & dosificaciónRESUMEN
OBJECTIVE: To compare the clinical features and prognosis between newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients with and without hemophagocytic syndrome (HPS). METHODS: The clinical data of 45 DLBCL patients in Gansu Provincial Hospital from January 2012 to December 2021 were retrospectively analyzed. The patients were divided into HPS group (15 cases) and non-HPS group (30 cases). The clinical features and prognosis of the two groups were compared, and survival analysis was performed using Kaplan-Meier method. RESULTS: Patients with HSP were mostly characterized by fever, cytopenia and splenomegaly. The levels of ferritin and soluble CD25 increased in all patients. The level of fibrinogen decreased in 66.67% patients, while triglyceride increased in 53.33% patients, and bone marrow hemophagocytosis occurred in 80.00% patients. Compared with non-HSP group, the proportions of patients with advanced stage (Ann Arbor stage III/IV) and lactate dehydrogenase (LDH) ≥240 U/L were higher in HSP group (both P < 0.05). The median survival time of HSP group was 8.0 months, which was significantly shorter than 45.5 months of non-HSP group (P < 0.001). CONCLUSION: The DLBCL patients with HPS have later Ann Arbor stage, higher LDH and shorter overall survival time compared with patients without HPS.