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Machibya M, Damji B, Adamjee S, Kyejo W, Njau A, Ngimba C. Small bowel T-cell lymphoma with perforation in the HIV/AIDS context, a rare case report. Int J Surg Case Rep 2025; 128:111087. [PMID: 40024178 PMCID: PMC11914823 DOI: 10.1016/j.ijscr.2025.111087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2024] [Revised: 02/19/2025] [Accepted: 02/22/2025] [Indexed: 03/04/2025] Open
Abstract
Introduction and Importance. Small bowel lymphomas, which represent <1 % of gastrointestinal cancers, are most found in the ileum due to its high concentration of gut-associated lymphoid tissue. T-cell lymphomas of the small bowel are particularly rare. While increased risk is noted in conditions like celiac disease and immunodeficiency, their occurrence in HIV/AIDS patients is uncommon and poorly understood. The rare complication of gastrointestinal perforation in these cases complicates diagnosis and management. CASE PRESENTATION 42-year-old woman with HIV/AIDS, on antiretroviral therapy for 4 years, presented with a 1-month history of progressively worsening abdominal pain, intermittent fevers, weight loss, and a productive cough. On physical examination, she was cachectic, febrile, and had generalized abdominal tenderness with signs of peritonism. Laboratory investigations revealed anemia, elevated CRP, and ESR, with a CD4 count of 441 cells/mcL. Imaging studies, including abdominal CT, showed free air and fluid suggestive of a perforated viscus. The patient underwent emergency laparotomy, which revealed multiple bowel perforations. Resection was performed, and histopathology confirmed small bowel T-cell lymphoma (anaplastic large cell lymphoma). Despite intensive postoperative care, the patient died on the fourth postoperative day. CLINICAL DISCUSSION Small bowel T-cell lymphoma is rare, especially in HIV/AIDS patients, and poses significant diagnostic challenges. Its presentation is often nonspecific, and perforation is a serious complication. While chemotherapy and surgery are key treatments, T-cell lymphomas are more resistant to therapy, leading to a poor prognosis, particularly when complicated by perforation. CONCLUSION This case highlights the rarity and complexity of small bowel T-cell lymphoma in HIV/AIDS, compounded by gastrointestinal perforation. Early diagnosis, advanced imaging, and multidisciplinary management are essential for improving outcomes. Further research is needed to optimize treatment strategies for this challenging case.
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Affiliation(s)
- Musa Machibya
- Department of General Surgery, The Aga Khan University, P. O Box 38129, Dar Es Salaam, Tanzania.
| | - Bhavish Damji
- Department of General Surgery, The Aga Khan University, P. O Box 38129, Dar Es Salaam, Tanzania
| | - Shabbir Adamjee
- Department of General Surgery, The Aga Khan University, P. O Box 38129, Dar Es Salaam, Tanzania
| | - Willbroad Kyejo
- Department of Family Medicine, The Aga Khan University, P. O Box 38129, Dar Es Salaam, Tanzania
| | - Aidan Njau
- Department of General Surgery, The Aga Khan University, P. O Box 38129, Dar Es Salaam, Tanzania
| | - Caroline Ngimba
- Department of Pathology, The Aga Khan Hospital, P. O Box 2289, Dar Es Salaam, Tanzania
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Li L, Ma H, Niu M, Chen C, Yu C, Zhang H, Jin M. Characterization of primary small intestinal lymphoma: a retrospective study based on double balloon endoscopy. BMC Gastroenterol 2024; 24:116. [PMID: 38504190 PMCID: PMC10953079 DOI: 10.1186/s12876-024-03193-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The diagnosis of primary small intestinal lymphoma (PSIL) is difficult. This study aimed to evaluate the clinical, radiological and endoscopic characteristics of PSIL and provide clue for diagnosis. METHODS A total of 30 patients diagnosed with PSIL who underwent double balloon endoscopy (DBE) in the First Affiliated Hospital of Zhejiang University were retrospectively analyzed. Clinical, radiological and endoscopic data were collected. Univariate analysis was used to determine significant indicators for differentiating three main subtypes of PSIL. Cox regression analysis was performed to assess the risk factors for survival. RESULTS In this study, 10 patients were pathologically diagnosed as diffuse large B-cell lymphoma (DLBCL), 11 were indolent B-cell lymphoma (BCL) and 9 were T-cell lymphoma (TCL). Compared with DLBCL patients, the body mass index (BMI) of TCL patients was significantly lower (p = 0.004). Meanwhile, compared with patients with DLBCL, the patients with indolent BCL had lower levels of C-reactive protein, lactate dehydrogenase (LDH), fibrinogen and D-Dimer (p = 0.004, p = 0.004, p = 0.006, and p = 0.002, respectively), and lower proportion of thicker intestinal wall and aneurysmal dilation in CT scan (p = 0.003 and p = 0.020, respectively). In terms of ulcer morphology, patients with DLBCL had significantly higher proportion of deep ulcers than patients with indolent BCL (p = 0.020, respectively). Cox regression analysis showed that drink (p = 0.034), concomitant colonic ulcers (p = 0.034) and elevated LDH (p = 0.043) are risk factors for mortality in patients with PSIL. CONCLUSIONS This study provides clinical characteristics of patients with PSIL. Thicker intestinal wall and aneurismal dilation detected on CT scan and deeper ulcer on DBE examination helps to establish a diagnosis of DLBCL.
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Affiliation(s)
- Lin Li
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Huijian Ma
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Meng Niu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxiao Chen
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chaohui Yu
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong Zhang
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
| | - Meng Jin
- Department of Gastroenterology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Tian FY, Wang JX, Huang G, An W, Ai LS, Wang S, Wang PZ, Yu YB, Zuo XL, Li YQ. Clinical and endoscopic features of primary small bowel lymphoma: a single-center experience from mainland China. Front Oncol 2023; 13:1142133. [PMID: 37397371 PMCID: PMC10313208 DOI: 10.3389/fonc.2023.1142133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Objective The worldwide incidence of primary small intestinal lymphoma (PSIL) is increasing. However, little is known about the clinical and endoscopic characteristics of this disease. The aim of this study was to investigate the clinical and endoscopic data of patients with PSIL, with the goal of enhancing our understanding of the disease, improving diagnostic accuracy, and facilitating more accurate prognosis estimation. Methods Ninety-four patients diagnosed with PSIL were retrospectively studied at Qilu Hospital of Shandong University between 2012 and 2021. The clinical data, enteroscopy findings, treatment modalities, and survival times were collected and analyzed. Results Ninety-four patients (52 males) with PSIL were included in this study. The median age of onset was 58.5 years (range: 19-80 years). Diffuse large B-cell lymphoma (n=37) was the most common pathological type. Abdominal pain (n=59) was the most frequent clinical presentation. The ileocecal region (n=32) was the most commonly affected site, and 11.7% of patients had multiple lesions. At the time of diagnosis, the majority of patients (n=68) were in stages I-II. A new endoscopic classification of PSIL was developed, including hypertrophic type, exophytic type, follicular/polypoid type, ulcerative type, and diffusion type. Surgery did not show a significant increase in overall survival; chemotherapy was the most commonly administered treatment. T-cell lymphoma, stages III-IV, "B" symptoms, and ulcerative type were associated with poor prognosis. Conclusion This study provides a comprehensive analysis of the clinical and endoscopic features of PSIL in 94 patients. This highlights the importance of considering clinical and endoscopic characteristics for accurate diagnosis and prognosis estimation during small bowel enteroscopy. Early detection and treatment of PSIL is associated with a favorable prognosis. Our findings also suggest that certain risk factors, such as pathological type, "B" symptoms, and endoscopic type, may affect the survival of PSIL patients. These results underscore the need for careful consideration of these factors in the diagnosis and treatment of PSIL.
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Affiliation(s)
- Feng-Yu Tian
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Jue-Xin Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Gang Huang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Wen An
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Li-Si Ai
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Sui Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Pei-Zhu Wang
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
| | - Yan-Bo Yu
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Xiu-Li Zuo
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan-Qing Li
- Department of Gastroenterology, Qilu Hospital, Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Digestive Disease, Jinan, China
- Laboratory of Translational Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
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Love J, Raza H, Kheirkhah P, Ghoulam E, Thaker S, Carroll R. Primary Gastrointestinal T-cell Lymphoma Presenting as Spontaneous Perforation Peritonitis. Cureus 2023; 15:e35028. [PMID: 36938190 PMCID: PMC10023136 DOI: 10.7759/cureus.35028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 02/17/2023] Open
Abstract
Primary T-cell non-Hodgkin lymphoma (NHL) of the gastrointestinal tract (GIT) is a rare, poorly-characterized clinical entity. A well-known complication of intestinal NHL is perforation due to chemotherapy, but perforation as a presenting sign of GIT lymphoma is extremely rare. Here we present a case of spontaneous intestinal perforation secondary to primary intestinal T-cell lymphoma and highlight the importance of early recognition of this uncommon cause of perforation as a crucial step to ensure expedited hematology referral and initiation of appropriate treatment.
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Affiliation(s)
- James Love
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | - Hasan Raza
- Internal Medicine, University of Illinois at Chicago, Chicago, USA
| | | | - Elie Ghoulam
- Gastroenterology and Hepatology, University of Illinois at Chicago, Chicago, USA
| | - Sarang Thaker
- Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Robert Carroll
- Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, USA
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Erkut M, Erkut N, Bektaş Ö, Fidan S, Coşar AM, Sönmez M, Sonmez M. Effect of Clinical, Endoscopic, Radiological Findings, and Complications on Survival in Patients with Primary Gastrointestinal Lymphoma. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2022; 33:909-917. [PMID: 36262100 PMCID: PMC9797772 DOI: 10.5152/tjg.2022.211003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the clinical, endoscopic, and radiological characteristics, complications, survival outcomes, and prognostic factors of patients with primary gastrointestinal lymphoma. METHODS This study retrospectively analyzed the demographic, laboratory, endoscopic, and radiological characteristics and treatment outcomes of 43 patients with newly diagnosed primary gastrointestinal lymphoma. RESULTS The median age was 62 years (range: 26-83). The primary lesion location was the gastric in 33 (77%) patients and the intestinal in 10 (23%) patients. The most common lesions were the corpus (33%) and corpus+antrum (24%) in primary gastric lymphoma and the ileum (60%) in primary intestinal lymphoma. The most common endoscopic findings were diffuse infiltrative lesion (23%) and massforming (33%), while the most common computed tomography finding was wall thickening (53%). Wall thickening and mass-forming at computed tomography were greater in primary intestinal lymphoma than in primary gastric lymphoma (P = .034). Complications were observed in 9 (21%) patients and 13 (31%) patients who underwent surgery. Complication and surgery rates were higher in primary intestinal lymphoma than in primary gastric lymphoma (P = .003 and P = .014, respectively). Five-year overall survival and 5-year eventfree survival rates were 75% and 72%, respectively. Univariate analysis showed that intestinal involvement, advanced clinical stage, a high International Prognostic Index score, mass-forming and wall thickening at computed tomography, extranodal involvement, and complication were found to adversely affect survival. Multivariate analysis revealed that intestinal involvement and a high International Prognostic Index score were independent prognostic factors for overall survival and event-free survival. CONCLUSION Patients with primary gastrointestinal lymphoma with intestinal involvement and high International Prognostic Index score should be followed closely.
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Affiliation(s)
- Murat Erkut
- Department of Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon,Corresponding author: Murat Erkut, e-mail:
| | - Nergiz Erkut
- Department of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon,Corresponding author: Murat Erkut, e-mail:
| | - Özlen Bektaş
- Department of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Sami Fidan
- Department of Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Arif Mansur Coşar
- Department of Gastroenterology, Karadeniz Technical University Faculty of Medicine, Trabzon
| | - Mehmet Sönmez
- Department of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon
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Abstract
PURPOSE OF REVIEW The diagnosis of small bowel lymphoma (SBL) can be challenging, as they are very rare and also have a varied presentation. In this review, we aim to provide a broad overview of the types of SBL and also about the various modalities used for their diagnosis. We also discuss the overview of treatment strategies for a gastroenterologist. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) and devise-assisted enteroscopy (DAE) has revolutionized the way we investigate the small bowel. DAE also makes it possible to obtain histological samples for further characterization of SBL. This has led to a significant improvement in diagnosis and management of the disease in conjunction with cross-sectional imagining. SUMMARY The diagnosis and management of small bowel lymphoma remains challenging despite the development of newer techniques such as SBCE and DAE. The current available diagnostic modalities have limitations; in the absence of a gold standard, the current investigative modalities compliment each other in reaching the final diagnosis.
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Affiliation(s)
- Priya Oka
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
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Tian Y, Li C, Tian R, Tian Q, Qiao S. T-Cell Non-Hodgkin Lymphoma of the Ileum Presenting as Perforation and Peritonitis: A Case Report. Front Surg 2022; 9:810360. [PMID: 35372472 PMCID: PMC8964512 DOI: 10.3389/fsurg.2022.810360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background Non-Hodgkin lymphoma (NHL) of the ileum, presenting as perforation and peritonitis, is a rare disease, derived from intestinal intraepithelial T lymphocytes. The degree of malignancy is extremely high. The pathogenesis of ileal perforation caused by NHL remains unclear, as well as the chromosome and immune system abnormalities, which may be related to NHL, and are indistinguishable from other benign and malignant conditions and are clinically nonspecific. Case Report We describe an 84-year-old man with abdominal pain for 4 days, which was aggravated for 3 h. The pain was in the upper abdominal region and was initially considered to be due to gastrointestinal perforation. He had persistent insidious pain, accompanied by nausea, vomiting, and fever. Physical examination indicated that the patient had pain all over the abdomen; also, rebound pain and muscle tension, and bowel sounds were reduced on auscultation. An abdominal CT scan showed free gas in the abdominal cavity. The patient was diagnosed with peritonitis due to hollow viscus perforation. A prompt exploratory laparotomy was performed. Intraoperative findings showed perforations in the ileum that are approximately 40 cm from the ileocecal region, which were 3–8 mm in size. A segmental distribution was observed, and the intestinal contents overflowed with purulent discharge around the perforation surface. Resection and ileostomy were performed, and the clinical histopathological examination confirmed T-cell lymphoma. The patient was advised to visit the Oncology Department for further chemotherapy. Conclusion Timely emergency surgery is the key to the treatment of ileal perforation caused by T-cell lymphoma. Resection and ileostomy were performed as intervention measures, and subsequent histopathological examination manifested T-cell lymphoma.
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Affiliation(s)
- Yong Tian
- Department of Gastrointestinal Surgery, Tongren City People's Hospital, Tongren, China
| | - Chuanfang Li
- Department of Gastrointestinal Surgery, Tongren City People's Hospital, Tongren, China
| | - Rusong Tian
- Department of Gastrointestinal Surgery, Tongren City People's Hospital, Tongren, China
| | - Qingming Tian
- Department of Gastrointestinal Surgery, Tongren City People's Hospital, Tongren, China
| | - Song Qiao
- Department of Gastrointestinal Surgery, Tongren City People's Hospital, Tongren, China
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Cha RR, Baek DH, Lee GW, Park SJ, Lee JH, Park JH, Kim TO, Lee SH, Kim HW, Kim HJ. Clinical Features and Prognosis of Patients with Primary Intestinal B-cell Lymphoma Treated with Chemotherapy with or without Surgery. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2021; 78:320-327. [DOI: 10.4166/kjg.2021.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/01/2021] [Accepted: 09/06/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Ra Ri Cha
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Gyeong Won Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang Institute of Health Sciences, Jinju, Korea
| | - Seun Ja Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jong Ha Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Heon Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
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Zhang C, Zhang X, Liu Z, Tao J, Lin L, Zhai L. The impact of surgery on long-term survival of patients with primary intestinal non-Hodgkin lymphomas based on SEER database. Sci Rep 2021; 11:23047. [PMID: 34845308 PMCID: PMC8630038 DOI: 10.1038/s41598-021-02597-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 11/08/2021] [Indexed: 12/15/2022] Open
Abstract
Evidence regarding the need for surgery for primary intestinal non-Hodgkin lymphoma (PINHL) patients with chemotherapy is limited and controversial. We aimed to investigate the specific impact of surgery on survival of PINHL patients. Data from PINHL patients (aged > 18 years) with chemotherapy between 1983 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We concerned about overall survival (OS) and improved cancer-specific survival (CSS). Propensity score matching (PSM) analysis was also used to explore the reliability of the results to further control for confounding factors. Finally, we screened 3537 patients. Multivariate regression analysis showed that patients with surgery and chemotherapy had better OS (hazard ratio [HR] 0.83; 95% confidence interval [CI] 0.75–0.93; p = 0.0009) and CSS (HR 0.87; 95% CI 0.77–0.99; p = 0.0404) compared with the non-operation group after adjusting for confounding factors. After PSM analysis, compared with non-surgery, surgery remained associated with improved OS (HR 0.77; 95% CI 0.68–0.87; p < 0.0001) and improved CSS (HR 0.82; 95% CI 0.72–0.95; p = 0.008) adjusted for baseline differences. In the large cohort of PINHL patients with chemotherapy older than 18 years, surgery was associated with significantly improved OS and CSS before and after PSM analysis.
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Affiliation(s)
- Cuifen Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaohong Zhang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeyu Liu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiahao Tao
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lizhu Lin
- Cancer Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, Guangzhou, 510405, Guangdong, China.
| | - Linzhu Zhai
- Cancer Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, Guangzhou, 510405, Guangdong, China.
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Malipatel R, Patil M, Rout P, Correa M, Devarbhavi H. Primary Intestinal Lymphoma: Clinicopathological Characteristics of 55 Patients. Euroasian J Hepatogastroenterol 2021; 11:71-75. [PMID: 34786359 PMCID: PMC8566158 DOI: 10.5005/jp-journals-10018-1345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Gastrointestinal (GI) tract is the most common site of extranodal lymphoma accounting for 30–40% of the cases. In Western countries, stomach is the most common site of GI lymphoma, whereas in the Middle East and Mediterranean countries, small intestine is commonly involved. Studies about primary intestinal lymphoma (PIL) are heterogeneous in anatomical distribution, presentation, and histological subtypes. The present study was aimed at studying the anatomical distribution, histological subtypes, and clinical characteristics at tertiary care centers. Materials and methods The present study was retrospective, conducted between 2006 and 2020. Patient's data were collected from institutional medical records. PIL was diagnosed by Lewin's criteria. After histological diagnosis, PIL was classified as per the World Health Organization (WHO) criteria and staging was done according to the Ann Arbor classification as modified by Musshoff. Results A total of 941 lymphoma cases were diagnosed during the study period between 2006 and 2020 consisting of 238 Hodgkin's lymphoma and 703 non-Hodgkin's lymphoma (NHL) cases. PIL constituted 5.8% of all lymphoma cases (55 out of 941) and 50.9% (55 of 108) of all primary GI lymphoma. Median age at diagnosis was 44 years and comprised predominantly males (85.45%). Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma were the most common histological subtype (78%) seen. Two patients with primary Hodgkin's lymphoma involving the intestine were seen. T-cell lymphoma was seen in three (5.4%) patients. Ileocecal region was the most common site involved (27%). The common presenting complaints were intestinal obstruction (40%) requiring surgical resection and abdominal pain (32%). Majority of the patients presented in the early stages (I and II). Conclusion Our study demonstrates the pattern of distribution and various histological subtypes of PIL including the rare variants like primary intestinal Hodgkin's lymphoma. Relatively more number of patients presented with intestinal obstruction requiring surgery in comparison with other studies. How to cite this article Malipatel R, Patil M, Rout P, et al. Primary Intestinal Lymphoma: Clinicopathological Characteristics of 55 Patients. Euroasian J Hepato-Gastroenterol 2021;11(2):71–75.
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Affiliation(s)
- Renuka Malipatel
- Department of Pathology, St John's Medical College, Bengaluru, Karnataka, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St John's Medical College, Bengaluru, Karnataka, India
| | - Pritilata Rout
- Department of Pathology, St John's Medical College, Bengaluru, Karnataka, India
| | - Marjorie Correa
- Department of Pathology, St John's Medical College, Bengaluru, Karnataka, India
| | - Harshad Devarbhavi
- Department of Gastroenterology, St John's Medical College, Bengaluru, Karnataka, India
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Wang M, Ma S, Shi W, Zhang Y, Luo S, Hu Y. Surgery shows survival benefit in patients with primary intestinal diffuse large B-cell lymphoma: A population-based study. Cancer Med 2021; 10:3474-3485. [PMID: 33931950 PMCID: PMC8124121 DOI: 10.1002/cam4.3882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 03/04/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The clinical characteristics and prognosis of primary intestinal diffuse large B-cell lymphoma (PI-DLBCL) are rarely reported. We aimed to explore the role of surgery in patients with PI-DLBCL. METHODS Adult PI-DLBCL patients were included from the Surveillance, Epidemiology, and End Results database. The effect of surgery was evaluated by Kaplan-Meier and Cox proportional regression analyses. Propensity score matching (PSM) was used to reinforce our results. Lasso regression was utilized to determine independent risk factors of overall survival (OS) for a nomogram and a novel web-based calculator. The performance of the model was measured via concordance index, receiver operating characteristic curve, and calibration plots in both cohorts. RESULTS Overall, 1602 patients with PI-DLBCL were analyzed. Surgery significantly improved survival in both univariate and multivariate analyses (p = 0.007, p < 0.001, respectively). Before PSM, local tumor destruction (LTD) displayed a survival advantage over resection in patients without chemotherapy (p = 0.034). After PSM, surgery was still identified as a beneficial factor for OS (p = 0.0015). However, there was no statistical difference between LTD and resection (p = 0.32). The nomogram for 3-, 5-, and 10-year OS predictions exhibited dependable consistency between internal and external validation. CONCLUSION This study approves the beneficial effect of surgery on clinical endpoints in PI-DLBCL patients. For those who are not suitable for resection, LTD may also be a practical option. The predictive nomogram and the web-based calculator could help clinicians individually evaluate the prognosis and optimize personalized treatment decisions for these patients.
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Affiliation(s)
- Moran Wang
- Institute of HematologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shengling Ma
- Institute of HematologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Wei Shi
- Institute of HematologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yuanyuan Zhang
- Department of OncologyTongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Shanshan Luo
- Institute of HematologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Yu Hu
- Institute of HematologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
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Alvarez-Lesmes J, Chapman JR, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery EA, Lossos IS, Sussman D, Poveda J. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 2021; 145:1585-1596. [PMID: 33836528 DOI: 10.5858/arpa.2020-0661-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The gastrointestinal (GI) tract is the most common site of extranodal non-Hodgkin lymphoma, accounting for 20% to 40% of all extranodal lymphomas. The majority of these are systemic processes secondarily involving the GI tract. Primary GI lymphomas are less common, accounting for approximately 10% to 15% of all non-Hodgkin lymphoma. Most non-Hodgkin lymphoma involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. OBJECTIVE.— To review the lymphoproliferative neoplasms of B-cell and T-cell lineage involving the luminal GI tract according to the most prevalent subtypes at each anatomic site. DATA SOURCE.— Systematic search of the PubMed database for updated literature on GI lymphomas epidemiology, subtypes, clinical, endoscopic, and genetic findings. Histologic images are derived from our collection of clinical cases. CONCLUSIONS.— The GI tract is the most common site of extranodal lymphoproliferative neoplasms. Recognition of the most frequently encountered GI lymphomas is imperative for patient management and treatment.
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Affiliation(s)
- Jessica Alvarez-Lesmes
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Jennifer R Chapman
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Daniel Cassidy
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Yi Zhou
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Monica Garcia-Buitrago
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Elizabeth A Montgomery
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Izidore S Lossos
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida (Lossos).,Department of Molecular and Cellular Pharmacology (Lossos), University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Sussman
- Division of Digestive Health and Liver Diseases (Sussman), University of Miami Miller School of Medicine, Miami, Florida
| | - Julio Poveda
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
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Hissong E, Yantiss RK. Intraoperative Evaluation of the Gastrointestinal Tract. FROZEN SECTION PATHOLOGY 2021:15-48. [DOI: 10.1007/978-3-030-71308-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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14
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Foukas PG, Bisig B, de Leval L. Recent advances upper gastrointestinal lymphomas: molecular updates and diagnostic implications. Histopathology 2020; 78:187-214. [PMID: 33382495 DOI: 10.1111/his.14289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
Approximately one-third of extranodal non-Hodgkin lymphomas involve the gastrointestinal (GI) tract, with the vast majority being diagnosed in the stomach, duodenum, or proximal small intestine. A few entities, especially diffuse large B-cell lymphoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, represent the majority of cases. In addition, there are diseases specific to or characteristic of the GI tract, and any type of systemic lymphoma can present in or disseminate to these organs. The recent advances in the genetic and molecular characterisation of lymphoid neoplasms have translated into notable changes in the classification of primary GI T-cell neoplasms and the recommended diagnostic approach to aggressive B-cell tumours. In many instances, diagnoses rely on morphology and immunophenotype, but there is an increasing need to incorporate molecular genetic markers. Moreover, it is also important to take into consideration the endoscopic and clinical presentations. This review gives an update on the most recent developments in the pathology and molecular pathology of upper GI lymphoproliferative diseases.
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Affiliation(s)
- Periklis G Foukas
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Bettina Bisig
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Laurence de Leval
- Second Department of Pathology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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15
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Ma WL, Yeh KH, Yao M, Tang JL, Lin CW, Wang YT, Yeh YC, Wang HP, Cheng AL, Kuo SH. Comparison of clinicopathological features and treatment outcomes in aggressive primary intestinal B- and T/NK-cell lymphomas. J Formos Med Assoc 2020; 120:293-302. [PMID: 33289640 DOI: 10.1016/j.jfma.2020.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 09/26/2020] [Accepted: 10/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Primary intestinal lymphomas (PILs) are rare, and this study compared the clinical outcomes of aggressive primary intestinal B-cell lymphomas (aB-PILs) and T/natural killer-cell lymphomas (T/NK-PILs). METHODS The clinical information of patients diagnosed with aggressive PILs at our institution between 1995 and 2015 were retrospectively investigated. Pathological subtypes were confirmed according to the 2016 revision of the World Health Organization classification. The correlation between clinicopathological features and overall survival (OS) was determined using univariate and multivariate analyses. RESULTS Cases of T/NK-PILs had higher initial bowel perforation incidence (67% vs. 7%, P < 0.001) and lower complete response rate to first-line chemotherapy regimens (22% vs. 69%, P = 0.009) than aB-PILs. Patients with aB-PILs had a better 5-year event-free survival rate (55.8% vs. 13.9%, P = 0.026) and a 5-year OS rate (74.3% vs. 29.6%, P = 0.036) than those with T/NK-cell lymphomas. Multivariate analysis identified that female gender and stage III/IV were unfavorable prognostic factors. Among the 54 patients with diffuse large B-cell lymphoma (DLBCL), those with International Prognostic Index (IPI) scores of 0-2 had a better 5-year OS rate than those with scores of 3-5 (84.2% vs. 46.8%, P = 0.002). IPI scores of 3-5 (P = 0.026) and tumors located in the large intestine (P = 0.015) were poor prognostic factors based on the multivariate analysis. CONCLUSION The prognosis of T/NK-PILs was less favorable than that of aB-PILs. Female gender, stage III/IV disease, DLBCL with IPI scores of 3-5, or tumors in the large intestine were poor prognostic factors.
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MESH Headings
- Adult
- Aged
- Female
- Humans
- Immunophenotyping
- Intestinal Perforation/epidemiology
- Intestinal Perforation/etiology
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, T-Cell, Peripheral/mortality
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Middle Aged
- Retrospective Studies
- Survival Rate
- Treatment Outcome
- Young Adult
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Affiliation(s)
- Wei-Li Ma
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kun-Huei Yeh
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Ming Yao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Jih-Luh Tang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Hematological Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chung-Wu Lin
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yu-Ting Wang
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Chun Yeh
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ann-Lii Cheng
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Sung-Hsin Kuo
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan; Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Radiation Oncology, National Taiwan University Cancer Center, National Taiwan University College of Medicine, Taipei, Taiwan.
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16
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Dong BL, Dong XH, Zhao HQ, Gao P, Yang XJ. Primary intestinal extranodal natural killer/T-cell lymphoma, nasal type: A case report. World J Clin Cases 2020; 8:234-241. [PMID: 31970192 PMCID: PMC6962063 DOI: 10.12998/wjcc.v8.i1.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary intestinal extranodal natural killer/T-cell lymphoma, nasal type (PI-ENKTCL) is a rare non-Hodgkin’s lymphoma (NHL) subtype, and its prognosis is extremely poor. Clinical characteristics of the disease are not obvious and easily misdiagnosed. In this case report, we describe a patient with PI-ENKTCL who presented with intermittent hematochezia. The advantages of positron emission tomography/computed tomography (PET-CT) as a useful diagnostic tool and the role of surgery as an important therapy are highlighted.
CASE SUMMARY A 45-year-old man, hospitalized due to intermittent hematochezia, underwent gastroscopy, colonoscopy, biopsy and CT, but no cause was found. Hence, we carried out a multidisciplinary team (MDT) discussion on the causes and treatment of this patient, and it was decided to perform PET-CT imaging with a MDT discussion of the results. PET-CT demonstrated a diagnosis of lymphoma and it was decided to surgically resect the lesion, and a R0 resection was successfully performed. Postoperative pathology showed negative resection margins, and examination of the lesion confirmed the diagnosis of PI-ENKTCL. After surgery, the patient underwent a follow-up period of 6 mo and received 6 cycles of gemcitabine, oxaliplatin and L-asparaginase. No recurrence or metastasis occurred.
CONCLUSION PI-ENKTCL is rare, and MDT discussion is required during diagnosis. PET-CT can be performed for imaging diagnosis. Treatment is based on surgical resection, and the best treatment regimen is determined according to postoperative pathological results to improve prognosis and to extend survival in patients.
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Affiliation(s)
- Bao-Long Dong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Xiao-Hua Dong
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Hui-Qi Zhao
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Peng Gao
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
| | - Xiao-Jun Yang
- Department of General Surgery, Gansu Provincial Hospital, Lanzhou 730000, Gansu Province, China
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17
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Zhao RJ, Zhang CL, Zhang Y, Sun XY, Ni YH, Luo YP, Li J, Qian JM. Enteral fistula as initial manifestation of primary intestinal lymphoma. Chin Med J (Engl) 2020; 133:101-102. [PMID: 31923114 PMCID: PMC7028188 DOI: 10.1097/cm9.0000000000000598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Rui-Jie Zhao
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chun-Lan Zhang
- Department of Hematology, West China Hospital, Chengdu, Sichuan 610047, China
| | - Yan Zhang
- Department of Hematology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xi-Yu Sun
- Department of General Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Yue-Hui Ni
- Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ya-Ping Luo
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ji Li
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Jia-Ming Qian
- Department of Gastroenterology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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18
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Wang G, Chang Y, Wu X, Li X, Li L, Zhang M. Prognostic nomogram for overall survival in upper aerodigestive tract extranodal natural killer/T-cell lymphoma, nasal type, stages IE and IIE: A SEER-based study. Oncol Lett 2019; 18:3493-3500. [PMID: 31516567 PMCID: PMC6732941 DOI: 10.3892/ol.2019.10719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
The present study aimed to develop a widely accepted prognostic nomogram for stage IE and IIE extranodal natural killer/T-cell lymphoma (ENKTCL) of the upper aerodigestive tract by using the Surveillance, Epidemiology, and End Results program database. A total of 396 patients with ENKTCL were included in the present study and were divided into training (n=280) and validation (n=116) cohorts. The Kaplan-Meier method and Cox regression model were used to evaluate the prognostic value of multiple clinical parameters on overall survival. The C-index and calibration curves were both used to determine the predictive and discriminatory capacities of the nomogram. In the training cohort, multivariate analysis demonstrated that age, primary site, radiation therapy and stage were independent prognostic factors. Nomograms with a C-index of 0.717 in the training cohort and a C-index of 0.737 in the validation cohort were developed. The calibration curves reported excellent consistency between predicted and real survival in patients with ENKTCL. In addition, a subgroup analysis of 264 patients who were receiving chemotherapy revealed that based on chemotherapy, supplementation with radiation therapy was significantly beneficial to patients survival. In conclusion, the present study demonstrated that this prognostic model may serve as a novel tool for improving prediction of survival outcomes and may therefore be used in clinical applications.
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Affiliation(s)
- Gangjian Wang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Yu Chang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xiaolong Wu
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Xin Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Ling Li
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, P.R. China
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Yildirim N, Turkeli M, Akdemir MN, Simsek M, Tekin SB. Evaluation of 22 Primary Gastrointestinal Lymphoma Patients. Eurasian J Med 2019; 51:53-56. [PMID: 30911257 DOI: 10.5152/eurasianjmed.2019.16071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective Primary gastrointestinal non-hodgkin lymphomas (PGI-NHL) are uncommon diseases with treatment modalities including chemotherapy, surgery, and radiotherapy. Our aim is to analyze the demographic and clinical features and treatment results of PGI-NHL. Materials and Methods 286 patients diagnosed with lymphoma who referred to Ataturk University Medical Faculty Hospital between July 2001 and April 2014 were surveyed retrospectively and 22 (7.6%) PGI-NHL cases whose primary lesions were in gastrointestinal system were included. Results Mean age was 47 (min.25-max.77) and 14 (63.6%) of them were men. The origin was determined as small intestines (50%), stomach (31.8%) and colon (18.2%), respectively. The most common complaint and pathologic subtype were abdominal pain (68.2%) and diffuse large B cell lymphoma (86.4%), respectively. The Lugano Classification was as follows: stage 1 (18.2%), stage 2 (59.1%), and stage 4 (22.7%). Surgery and chemotherapy were administered to 40.9% of patients. Complete and partial response and disease progression were established in 72.1%, 4.5% and 13.6% of the patients, respectively. Mean survival time was 99.6±16 months. Mean overall survival time was determined significantly longer in small bowel group than gastric group (119±15 vs. 50±24 months) (p=0.039). Age, gender, Eastern Cooperative Oncology Group performance status, International Prognostic Index, stage, histological type, tumor size, LDH level, albumin level, Hemoglobin level and treatment options were not associated with survival. Conclusion Demographic and clinical characteristics of our series were similar with Middle Eastern and African countries. Optimal treatment options or prognostic factors for PGI-NHL are not clear. There is a need for randomized prospective studies including large number of patients and long follow-up period.
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Affiliation(s)
- Nilgun Yildirim
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Turkeli
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Mehmet Naci Akdemir
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Melih Simsek
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Salim Basol Tekin
- Department of Medical Oncology, Atatürk University School of Medicine, Erzurum, Turkey
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20
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Shi Z, Ding H, Shen QW, Lu XG, Chen JY, Chen X, Tang X. The clinical manifestation, survival outcome and predictive prognostic factors of 137 patients with primary gastrointestinal lymphoma (PGIL): Strobe compliant. Medicine (Baltimore) 2018; 97:e9583. [PMID: 29505542 PMCID: PMC5943112 DOI: 10.1097/md.0000000000009583] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This retrospective study aimed to investigate clinical characteristics and prognostic factors in patients with primary gastrointestinal lymphoma (PGIL) of Chinese population.From January 2001 to December 2015, 137 patients diagnosed with PGIL were recruited. The clinical features, treatment, and follow-up information were analysed.The median patient age was 62.3 years. With 18.47 months follow-up, the 2-year progress-free survival and overall survival rate was 74.9% and 75.5%, respectively. The overall response rate was 33.6%. Age≥60 years, advanced Lugano staging (≥stage IIE), elevated lactate dehydrogenase (LDH) levels, ≥2 extra-nodal involved sites, National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI)≥4, Ki-67≥50% were associated with worse prognosis in univariate analysis (P < .05). By multivariate analyses, we determined that the involvement of extra-nodal involved sites was the only statistically significant poor prognostic factor in PGIL.Age, staging, LDH levels, NCCN-IPI, Ki-67 especially involvement of multiple extra-nodal sites were associated with poor overall survival of PGIL.
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Affiliation(s)
| | | | | | - Xin Gang Lu
- Department of Traditional Chinese Medicine of Hua’dong Hospital Affiliated to Fu’dan University, Shanghai, People's Republic of China
| | | | - Xi Chen
- Department of Medical Oncology
| | - Xi Tang
- Department of Medical Oncology
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21
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Milburn JA, Leeds JS, White SA. Endoscopic management of duodeno-ileal fistula secondary to diffuse B-cell lymphoma. J Surg Case Rep 2017; 2017:rjx249. [PMID: 29423158 PMCID: PMC5798150 DOI: 10.1093/jscr/rjx249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/10/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022] Open
Abstract
Lymphoma arising in the gastrointestinal tract is relatively common and can affect multiple sites. The development of a gastrointestinal fistula secondary to lymphoma is very rare and has not previously been reported between the duodenum and ileum. This is the first reported care where a fistula secondary to lymphoma has been treated by an endoscopic covered duodenal stent occluding the defect rather than surgical intervention. This strategy permitted early commencement of curative intent chemotherapy which led to tumour shrinkage and fistula closure.
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Affiliation(s)
- James A Milburn
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK
| | - John S Leeds
- Department Gastroenterology, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK
| | - Steven A White
- Department of HPB and Transplant Surgery, Freeman Hospital, Newcastle-upon-Tyne NE7 7DN, UK
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22
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Skulimowski A, Hogendorf P, Poznańska G, Smolewski P, Strzelczyk J, Durczynski A. Successful hemihepatectomy following chemotherapy for primary liver lymphoma: case report and review of literature. POLISH JOURNAL OF SURGERY 2017; 89:54-58. [PMID: 29154242 DOI: 10.5604/01.3001.0010.5609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Non-Hodgkin lymphomas (NHL) comprise a heterogeneous group of B-cell and T-cell neoplasms. Diffuse large B-cell lymphoma (DLBCL), the most common type of NHL, accounts for around 30-40% of NHL cases. However, primary hepatic location of NHLs is rare and constitutes 0.01% of all NHL cases. Due to this rarity and a lack of large randomized trails, it is still unclear what treatment should be used for primary hepatic DLBCLs. In this study, we report of a female patient with primary hepatic DLBCL who was successfully treated with neoadjuvant chemotherapy and surgery. We also shortly review the literature regarding surgical treatments for primary GI tract NHLs. Taking into account our experience and the current literature, surgical treatment with postoperative chemotherapy seems to be a feasible option for patients with focal primary hepatic DLBCLs.
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Affiliation(s)
- Aleksander Skulimowski
- Department of General and Transplant Surgery, Barlicki Teaching Hospital, Medical University of Lodz, Lodz, Poland
| | - Piotr Hogendorf
- Department of General and Transplant Surgery, Medical University, Łód
| | - Grażyna Poznańska
- Department of Anaesthesiology and Intensive Therapy, Barlicki University Hospital in Łódź
| | - Piotr Smolewski
- Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Janusz Strzelczyk
- Department of General and Transplant Surgery, Barlicki Teaching Hospital, Medical University of Lodz, Lodz, Poland
| | - Adam Durczynski
- Department of General and Transplant Surgery, Barlicki Teaching Hospital, Medical University of Lodz, Lodz, Poland
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The role of surgical management in primary small bowel lymphoma: A single-center experience. Eur J Surg Oncol 2017; 43:1886-1893. [PMID: 28751057 DOI: 10.1016/j.ejso.2017.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/04/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Information on primary small intestinal lymphoma is more limited than for gastric lymphoma because most of the previous studies did not focus on the former. Few prognostic indicators in primary intestinal lymphoma have been reliably established because of limited patient numbers and variations in criteria for patient selection. In this study, we retrospectively reviewed the clinical and pathological characteristics of small intestinal lymphoma cases from our hospital, to determine prognostic factors and to clarify the effect of surgical resection on prognosis. METHODS Eighty-two patients were enrolled in this retrospective study between January 1997 and December 2012. Patients were divided into two groups based on whether or not they underwent surgical management. Gross resection was defined as complete removal of the primary lesion(s), as confirmed by the naked eye. Combined therapy refers to concurrent surgery and chemotherapy. The clinicopathological characteristics and long-term outcomes of patients were analyzed and compared between the two groups. RESULTS Most of the patients had abdominal pain (75.6%), and some had loss of body weight (29.3%) and bowel perforation (22.0%). Sixty-two patients (75.6%) underwent surgical management. Patients in the surgery group presented with fewer B symptoms (fever, night sweats, and weight loss; P = 0.035) but more bulky disease (P = 0.009). The ileocecal region was the most common site of solitary involvement (34.1%). The most common reason for surgery was for tumor-related complications (61.3%). Seven patients (11.3%) developed major complications of surgery, but these were not related to the indication, timing, or type of surgery. Only major surgical complications were statistically significant in relation to early mortality (P = 0.004). The estimated 5-year progression-free survival (PFS) was 35.1% and 5-year overall survival (OS) was 43.2%. Univariate analysis revealed that patients in the surgery group had improved 5-year PFS (P = 0.028). T-cell lymphoma, involvement of multiple gastrointestinal regions and extranodal involvement, higher scores for International Prognostic Index (IPI), more advanced Ann Arbor stage, lactate dehydrogenase (LDH) levels above 215 U/L, and management without combined therapy were prognostic for shorter PFS and OS in univariate analyses. Individuals who received R0 resection or gross resection had improved 5-year PFS and OS. Cox regression analysis demonstrated that primary T-cell lymphoma was an independent negative prognostic factor for both OS and PFS. CONCLUSION Combined therapy is an independent prognostic factor for long-term survival in small intestinal lymphoma. Gross resection is recommended in patients with small intestinal lymphoma and leads to improved PFS without significantly increasing the risk of complications. Emergency surgery does not lead to poor prognosis. However, caution is warranted in the management of all patients, because of the high risk of post-operative complications and potential for early mortality.
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Zheng SM, Zhou DJ, Chen YH, Jiang R, Wang YX, Zhang Y, Xue HL, Wang HQ, Mou D, Zeng WZ. Pancreatic T/histiocyte-rich large B-cell lymphoma: A case report and review of literature. World J Gastroenterol 2017; 23:4467-4472. [PMID: 28706431 PMCID: PMC5487512 DOI: 10.3748/wjg.v23.i24.4467] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 04/26/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
Primary pancreatic lymphoma (PPL) is an extremely rare form of extranodal malignant lymphoma. The most common histological subtype of PPL is diffuse large B cell lymphoma (DLBCL). In rare cases, PPL can also present as follicular lymphoma, small lymphocytic lymphoma, and T cell lymphoma either of non-Hodgkin’s lymphoma or of Hodgkin’s lymphoma. T-cell/histiocyte-rich large B-cell lymphoma (T/HRBCL) is an uncommon morphologic variant of DLBCL with aggressive clinical course, it is predominantly a nodal disease, but extranodal sites such as bone marrow, liver, and spleen can be involved. Pancreatic involvement of T/HRBCL was not presented before. Herein, we report a 48-year-old male who was hospitalized with complaints of jaundice, dark brown urine, pale stools, and nausea. The radiological evaluation revealed a pancreatic head mass and, following operative biopsy, the tumor was diagnosed as T/HRBCL. The patient achieved remission after six cycles of CHOP chemotherapy. Therefore, T/HRBCL can be treated similarly to the stage-matched DLBCL and both of them get equivalent outcomes after chemotherapy.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Bile Ducts/diagnostic imaging
- Bile Ducts/surgery
- Biopsy
- Chemotherapy, Adjuvant/methods
- Cholangiopancreatography, Endoscopic Retrograde
- Choledochostomy
- Cyclophosphamide/therapeutic use
- Diagnosis, Differential
- Doxorubicin/therapeutic use
- Gastroenterostomy
- Histiocytes/pathology
- Hodgkin Disease/diagnosis
- Humans
- Jaundice/etiology
- Jaundice/surgery
- Jejunum/surgery
- Liver Function Tests
- Lymph Nodes/pathology
- Lymphatic Metastasis
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Mesentery/pathology
- Middle Aged
- Nausea/etiology
- Nausea/surgery
- Pancreas/diagnostic imaging
- Pancreas/pathology
- Pancreatic Neoplasms/complications
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/pathology
- Pancreatic Neoplasms/therapy
- Pancreatitis/diagnosis
- Prednisone/therapeutic use
- Stomach/surgery
- Tomography, X-Ray Computed
- Vincristine/therapeutic use
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25
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Primary rare anaplastic large cell lymphoma, ALK positive in small intestine: case report and review of the literature. Diagn Pathol 2016; 11:83. [PMID: 27612448 PMCID: PMC5017047 DOI: 10.1186/s13000-016-0539-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 09/02/2016] [Indexed: 02/07/2023] Open
Abstract
Background Primary anaplastic large cell lymphoma, ALK positive in small intestine is clinically rare and the clinical, radiological and pathological information are generally not available. Here, we report a case of 32-year-old male with ALK positive anaplastic large cell lymphoma at the junction of jejunum and ileum, and highlight the clinicopathological features and the differential diagnosis of this type lymphoma. Case presentation The patient presented with right middle abdominal mass for 1 month with sporadic pain. Computed tomography (CT) showed a mass measured 8.5 × 7.4 × 4 cm at the junction of jejunum and ileum. The diagnosis was made after pathological examination of the excised tissue by enterectomy. Grossly, the mass was located predominately in intestinal wall with grayish appearance and blurry boundary. Microscopically, almost all layers of the intestinal wall were infiltrated by pleomorphic tumor cells with diffuse and cohesive growth pattern. The neoplastic cells were mainly medium to large size with moderate basophilic cytoplasm. Most of them had hyperchromatic nuclei and prominent nucleoli. “Hallmark” cells were easily detected. Immunohistochemically, tumor cells are characterized by CD30, ALK, CD5, TIA-1, Granzyme B, EMA positive staining, and CD2, CD3, CD7, CD4, CD8, CD20, CD79a negative staining. The Epstein-Barr virus encoded RNAs (EBERs) genome was also negative. A diagnosis as primary small intestinal ALK positive anaplastic large cell lymphoma was finally made. The patient received CHOP chemotherapy and is alive till now without recurrence 5 months after enterectomy. Conclusions Primary small intestinal ALK positive anaplastic large cell lymphoma is rare. The accurate diagnosis should be based on combined consideration of clinical characteristics, CT image and pathological features, and should be distinguished from other lymphomas or solid tumors in small intestine.
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Lightner AL, Shannon E, Gibbons MM, Russell MM. Primary Gastrointestinal Non-Hodgkin's Lymphoma of the Small and Large Intestines: a Systematic Review. J Gastrointest Surg 2016; 20:827-39. [PMID: 26676930 DOI: 10.1007/s11605-015-3052-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/30/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND Primary gastrointestinal non-Hodgkin's lymphoma (PGINHL) of small and large intestines is a group of heterogeneous, rare malignancies. Optimal treatment practices remain undefined. METHODS A systematic review (2003-2015) was performed to assess tumor characteristics, treatment practices, and treatment outcomes of PGINHL of small and large intestines. RESULTS Twenty-eight studies (1658 patients) were included; five focused on follicular lymphoma subtype. Of the non-follicular patients, 59.3% presented with abdominal pain, 37.2% were located in ileocecum, and 53.6% were diffuse large B cell lymphoma subtype. The majority of patients (60.7%) were treated with a combination of surgery and chemotherapy. Forty-three percent of studies concluded an overall survival benefit with surgery; none reported increased postoperative morbidity or mortality. Survival outcomes were not typically stratified by emergent versus elective surgery. Multivariate analysis within individual studies associated B cell lymphoma and ileocecum location with higher survival, while advanced stage and B symptoms were associated with poorer survival. Patients with asymptomatic follicular lymphoma had no progression with a watchful waiting approach. CONCLUSIONS The majority of patients with non-follicular small and large intestinal PGINHLs are treated with both chemotherapy and surgery. Although surgery appears to be an important part of the treatment algorithm, definitive statements regarding its survival benefit remain limited due to lack of patient stratification based on timing and indication for surgery.
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Affiliation(s)
- Amy L Lightner
- Department of Surgery, David Geffen School of Medicine at the University of California at Los Angeles, 200 1st St. SW Rochester, MN 55905, Los Angeles, CA, USA.
| | - Evan Shannon
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Melinda Maggard Gibbons
- Department of Surgery, David Geffen School of Medicine at the University of California at Los Angeles, 200 1st St. SW Rochester, MN 55905, Los Angeles, CA, USA
| | - Marcia M Russell
- Department of Surgery, David Geffen School of Medicine at the University of California at Los Angeles, 200 1st St. SW Rochester, MN 55905, Los Angeles, CA, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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27
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Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
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Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
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28
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Vetro C, Romano A, Amico I, Conticello C, Motta G, Figuera A, Chiarenza A, Raimondo CD, Giulietti G, Bonanno G, Palumbo GA, Raimondo FD. Endoscopic features of gastro-intestinal lymphomas: From diagnosis to follow-up. World J Gastroenterol 2014; 20:12993-13005. [PMID: 25278693 PMCID: PMC4177478 DOI: 10.3748/wjg.v20.i36.12993] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/28/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Many progresses have been done in the management of gastrointestinal (GI) lymphomas during last decades, especially after the discovery of Helicobacter pylori-dependent lymphoma development. The stepwise implementation of new endoscopic techniques, by means of echoendoscopy or double-balloon enteroscopy, enabled us to more precisely describe the endoscopic features of GI lymphomas with substantial contribution in patient management and in tailoring the treatment strategy with organ preserving approaches. In this review, we describe the recent progresses in GI lymphoma management from disease diagnosis to follow-up with a specific focus on the endoscopic presentation according to the involved site and the lymphoma subtype. Additionally, new or emerging endoscopic technologies that have an impact on the management of gastrointestinal lymphomas are reported. We here discuss the two most common subtypes of GI lymphomas: the mucosa-associated lymphoid tissue and the diffuse large B cell lymphoma. A general outline on the state-of-the-art of the disease and on the role of endoscopy in both diagnosis and follow-up will be performed.
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MESH Headings
- Animals
- Endoscopy, Gastrointestinal
- Endosonography
- Helicobacter Infections/complications
- Helicobacter Infections/microbiology
- Helicobacter pylori/pathogenicity
- Humans
- Intestinal Neoplasms/diagnostic imaging
- Intestinal Neoplasms/microbiology
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Neoplasm Grading
- Predictive Value of Tests
- Stomach Neoplasms/diagnostic imaging
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Treatment Outcome
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Chen DW, Pan Y, Yan JF, Mou YP. Laparoscopic resection of synchronous gastric cancer and primary small intestinal lymphoma: A case report. World J Gastroenterol 2014; 20:6353-6356. [PMID: 24876758 PMCID: PMC4033475 DOI: 10.3748/wjg.v20.i20.6353] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 02/09/2014] [Accepted: 03/05/2014] [Indexed: 02/06/2023] Open
Abstract
Synchronous gastric cancer and primary small intestinal lymphoma are extremely rare. A 49-year-old woman was referred to our hospital with a history of upper abdominal pain for two weeks and was diagnosed with synchronous cancer. During hospitalization, the patient underwent laparoscopic distal gastrectomy + resection of bilateral ovaries + partial resection of both small intestine and descending colon. Pathological examination revealed a synchronous cancer consisting of early gastric cancer with poorly differentiated adenocarcinoma located in mucosa, with lymph node metastasis (3+/29) (T1N1M0, stage IB); and diffuse large B cell lymphoma of small intestine involving descending colon and bilateral ovaries, with lymph node metastasis (2+/5) (Ann Arbor IIE). The patient recovered well, without any obvious complications and was discharged on post-operative day 7. The patient received six cycles of chemotherapy after operation. She has been doing well with no evidence of recurrence for 13 mo.
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30
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Kim DH, Lee D, Kim JW, Huh J, Park SH, Ha HK, Suh C, Yoon SM, Kim KJ, Choi KD, Ye BD, Byeon JS, Song HJ, Jung HY, Yang SK, Kim JH, Myung SJ. Endoscopic and clinical analysis of primary T-cell lymphoma of the gastrointestinal tract according to pathological subtype. J Gastroenterol Hepatol 2014; 29:934-43. [PMID: 24325295 DOI: 10.1111/jgh.12471] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Little is known about the clinicopathological characteristics of primary gastrointestinal T-cell lymphomas (PGITL). This study evaluated the clinical and endoscopic features of the pathological subtypes of PGITL. METHODS Forty-two lesions in 36 patients with PGITL were assessed, including 15 enteropathy-associated T-cell lymphomas (EATL), 13 peripheral T-cell lymphomas (PTCL), 10 NK/T-cell lymphomas (NK/TL), and four anaplastic large cell lymphomas (ALCL). RESULTS PTCL occurred more frequently in the stomach and duodenum and NK/TL more frequently in the small and large intestines (P = 0.009). The endoscopic features of the four subtypes were similar (P = 0.124). Fifteen of 41 lesions (36.6%) were Epstein-Barr virus (EBV) positive, with NK/TL more likely to be EBV positive than the other types (P < 0.001). First endoscopy and first computed tomography (CT) scan indicated that 65.4% and 51.4% of the lesions, respectively, were malignant, and that 43.2% and 42.3%, respectively, were GI lymphomas. The two modalities together correctly diagnosed about half of the lesions before biopsy. Intestinal perforation was associated with small bowel location (P < 0.001) and infiltrative type (P = 0.009), and was more common in NK/TL than in the other subtypes (P = 0.015). Multivariate analysis showed that higher international prognosis index (P = 0.008) and the presence of complications (P = 0.006) were associated with poor prognosis. Survival was poorer in patients with small bowel lesions than with lesions at other locations (P = 0.048). CONCLUSIONS The four main pathological types of PGITL differed in clinical characteristics. As PGITL was often not diagnosed by initial endoscopic or radiological examination, a high index of suspicion is necessary to ensure its early diagnosis.
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Affiliation(s)
- Do Hoon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Li M, Zhang S, Gu F, Xiao W, Yao J, Chao K, Chen M, Li J, Zhong B. Clinicopathological characteristics and prognostic factors of primary gastrointestinal lymphoma: a 22-year experience from South China. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:2718-2728. [PMID: 24966993 PMCID: PMC4069930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/28/2014] [Indexed: 06/03/2023]
Abstract
Primary gastrointestinal lymphoma (PGIL) is a kind of relatively rare cancer and easily misdiagnosed due to its unspecific signs in digestive tract. Data including 216 patients histologically diagnosed as PGIL between January 1991 and October 2012 from The First Affiliated Hospital of Sun Yat-sen University were reviewed. This study was to investigate the clinicopathological features and prognosis, and make the comparison between the different sites of PGIL. Abdominal pain (75.9%) was the most frequent symptom and intermediate-grade lymphoma (53.7%) presented as the most common histological type. Intestine (55.1%) was the most common site involved, followed by stomach (38.5%), both intestine and stomach (6.4%). PGIL of different original site showed distinguished clinicopathological characteristics that patients in Stomach and GI group were older than Intestine group (Mean age: 54 and 53 vs. 43 years, p<0.001); diarrhea, B symptom, abdominal mass and complication occurred more in intestine group. Histologically, high-grade lymphoma (especially T-cell type) almost located in Intestine group (82.5%). Five-year overall survival (OS) and event-free survival (EFS) for all PGIL patients were 56.4% and 49.3%, respectively. Stomach group had better OS (72.3%) and EFS (48.4%) than Intestine group (43.1% and 23.6% respectively), but it lost the significance in the multivariate analysis. Univariate and multivariate analysis revealed that performance status, lactate dehydrogenase (LDH) level and histological type were independent prognostic factors for PGIL.
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Affiliation(s)
- Minrui Li
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Shenghong Zhang
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Fang Gu
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Weiwei Xiao
- Division of Radiation Oncology, Cancer Center of Sun Yat-sen UniversityGuangzhou 510080, P.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhou 510080, P.R. China
| | - Jiayan Yao
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Kang Chao
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Minhu Chen
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Juan Li
- Division of Hematology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
| | - Bihui Zhong
- Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen UniversityGuangzhou 510080, P.R. China
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Abstract
INTRODUCTION Intestinal lymphomas can present as surgical complications such as perforation. There is little data regarding the risk factors, clinical features, management, and prognosis of bowel perforation in patients with intestinal lymphoma. The aims of this study were to analyze the risk factors for this complication and to describe the clinical picture. PATIENTS AND METHODS All patients undergoing surgery for lymphoma-related perforation between 2002 and 2012 in the University Hospital of Dijon were retrospectively analyzed. The clinical, histological, and imaging features were recorded. RESULTS Six patients underwent emergent laparotomy for this cause: in three patients, the perforation revealed the underlying disease, and in the other three patients, it occurred during chemotherapy treatment for known lymphoma. The clinical picture was a typical acute peritonitis in the first group, but was nonspecific and insidious in the chemotherapy-induced group. In all cases, aggressive lymphomas were present, and three patients had coexisting infection with the human immunodeficiency virus. CONCLUSION Lymphoma-related perforation presents as an acute peritonitis in previously untreated patients in which it reveals the disease. However, it may be induced by chemotherapy and present with nonspecific insidious symptoms. The prognosis is also different according to these characteristics. The particularities of this disease warrant its knowledge to ensure an optimal management.
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Sun ZH, Zhou HM, Song GX, Zhou ZX, Bai L. Intestinal T-cell lymphomas: A retrospective analysis of 68 cases in China. World J Gastroenterol 2014; 20:296-302. [PMID: 24415885 PMCID: PMC3886022 DOI: 10.3748/wjg.v20.i1.296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 11/02/2013] [Accepted: 11/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical features, diagnosis, treatment and prognosis of intestinal T-cell lymphomas (ITCL) by retrospective analysis.
METHODS: Sixty-eight patients who were diagnosed with ITCL in case reports in the Chinese literature were compiled and reviewed. Age, gender, CD56 expression, surgical management, multifocal nature, perforation and cyclophosphamide chemotherapy were analyzed as the prognostic factors. The Kaplan-Meier method was adopted for the univariate analysis and the cumulative survival curve analysis.
RESULTS: The male-to-female ratio was 1.52 to 1. The median age was 41.7 years. Twenty-seven patients had symptoms of abdominal pain or diarrhea. Thirty-six of 60 patients with temperature records had high fevers at the onset of the illness. Twenty-six of 34 patients who underwent fiberoptic colonoscopy were misdiagnosed with Crohn’s disease, intestinal tuberculosis or cancer. Sixty-one patients underwent surgery. Twelve of 61 surgical patients required a second operation for anastomotic leakage or secondary perforation. The sites of lesion involvement were the jejunum (8.82%), ileum (29.41%), ileum and colon (4.41%), colon (55.88%) and appendix (1.47%). The median cumulative survival rate was 3 mo (3.00 ± 0.48).
CONCLUSION: Efforts should be made to correctly diagnose ITCL and select the proper operative approach that may reduce serious complications and create opportunities for further treatment.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- CD56 Antigen/analysis
- Chemotherapy, Adjuvant
- China
- Colonoscopy
- Diagnostic Errors
- Digestive System Surgical Procedures/adverse effects
- Female
- Humans
- Intestinal Neoplasms/immunology
- Intestinal Neoplasms/mortality
- Intestinal Neoplasms/pathology
- Intestinal Neoplasms/therapy
- Kaplan-Meier Estimate
- Lymphoma, Extranodal NK-T-Cell/immunology
- Lymphoma, Extranodal NK-T-Cell/mortality
- Lymphoma, Extranodal NK-T-Cell/pathology
- Lymphoma, Extranodal NK-T-Cell/therapy
- Lymphoma, T-Cell/immunology
- Lymphoma, T-Cell/mortality
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/therapy
- Male
- Middle Aged
- Postoperative Complications/surgery
- Predictive Value of Tests
- Reoperation
- Time Factors
- Treatment Outcome
- Young Adult
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Köksal AR, Alkim H, Ergun M, Boga S, Bayram M, Alkim C, Eryilmaz OT. First case of T-cell/histiocyte-rich-large B-cell lymphoma presenting with duodenal obstruction. Libyan J Med 2013; 8:22955. [PMID: 24345670 PMCID: PMC3866841 DOI: 10.3402/ljm.v8i0.22955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
MESH Headings
- Abdominal Pain/etiology
- Adult
- Antibodies, Monoclonal, Murine-Derived/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Disease-Free Survival
- Doxorubicin/administration & dosage
- Duodenal Obstruction/complications
- Duodenal Obstruction/etiology
- Gastroscopy
- Histiocytes/pathology
- Humans
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Nausea/etiology
- Positron-Emission Tomography
- Prednisone/administration & dosage
- Remission Induction
- Rituximab
- T-Lymphocytes/pathology
- Treatment Outcome
- Vincristine/administration & dosage
- Vomiting/etiology
- Weight Loss
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Affiliation(s)
- Ali Riza Köksal
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey;
| | - Huseyin Alkim
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Meltem Ergun
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Salih Boga
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Mehmet Bayram
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Canan Alkim
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
| | - Ozlem Ton Eryilmaz
- Department of Gastroenterology Sisli Etfal Education and Research Hospital Istanbul, Turkey
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35
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Tabata R, Tabata C, Nagai T, Yasumizu R, Kojima M. Richter syndrome with follicular colonization of chronic lymphocytic leukemia/small lymphocytic lymphoma cells mimicking follicular lymphoma. Int J Surg Pathol 2013; 22:736-43. [PMID: 24249845 DOI: 10.1177/1066896913509011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Follicular colonization is occasionally observed in marginal zone lymphoma. In rare cases, it has also been associated with mantle cell lymphoma. Chronic lymphocytic leukemia typically involves nodal or extranodal tissues as diffuse proliferation by complete effacement of the normal architecture. The involvement of chronic lymphocytic leukemia may be less frequently limited to the interfollicular areas. Here, we report a case of Richter syndrome of the small intestine that was initially diagnosed as follicular lymphoma of the gastrointestinal tract because of a partial follicular growth pattern in addition to a mainly diffuse proliferation pattern. The follicular pattern mimicking follicular lymphoma was shown to be composed of reactive follicles with follicular colonization of the original chronic lymphocytic leukemia cells. As the prognoses of Richter syndrome and follicular lymphoma of gastrointestinal tract are quite different, clinicians must carefully diagnose these conditions to avoid a misdiagnosis.
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Affiliation(s)
- Rie Tabata
- Hyogo Prefectural Tsukaguchi Hospital, Hyogo, Japan
| | | | - Tomoko Nagai
- Hyogo Prefectural Tsukaguchi Hospital, Hyogo, Japan
| | | | - Masaru Kojima
- Dokkyo Medical University School of Medicine, Tochigi, Japan
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Matysiak-Budnik T, Jamet P, Fabiani B, Nion-Larmurier I, Marjanovic Z, Ruskoné-Fourmestraux A. Primary intestinal B-cell lymphoma: a prospective multicentre clinical study of 91 cases. Dig Liver Dis 2013; 45:947-52. [PMID: 23816692 DOI: 10.1016/j.dld.2013.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/12/2013] [Accepted: 05/20/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Clinical presentation, diagnosis and prognosis of different primary intestinal lymphomas have not been well described and compared so far. Our aim was to prospectively analyse a series of consecutive patients presenting different types of B-cell primary intestinal lymphomas. METHODS Adult patients with primary intestinal lymphoma, collected between 1991 and 2000 within the multicenter national study in France were evaluated and followed up prospectively. Clinical features and treatment outcomes were analyzed and compared among different groups of lymphomas. RESULTS Among 91 cases of B-cell primary intestinal lymphomas identified, 38 (41%) were diffuse large B cell lymphomas, 34 (37%) mantle cell lymphomas, 12 (13%) follicular lymphomas, 5 (5%) marginal zone MALT-lymphomas, and 2 (3%) Burkitt's lymphomas. A differential diagnosis could be made on the basis of tumour cell morphology and phenotype assessed by immunohistochemistry. Clinical presentation of the different types of lymphomas varied with respect to age, symptoms, circumstances of diagnosis, and stage. Overall survival was the poorest for mantle cell lymphomas while diffuse large B cell lymphomas could be cured if in complete remission after first line treatment. CONCLUSIONS This study underlines the existence, within the B-cell primary intestinal lymphomas, of several distinct entities with different clinico-pathological features and prognosis, whose identification is important for choosing appropriate therapeutic strategy.
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Affiliation(s)
- Tamara Matysiak-Budnik
- Institute of Digestive Diseases (IMAD) and Department of Gastroenterology, Hotel Dieu Hospital, Nantes.
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Prognostic characteristics of gastrointestinal tract NK/T-cell lymphoma: an analysis of 47 patients in China. J Clin Gastroenterol 2013; 47:e74-9. [PMID: 23948755 DOI: 10.1097/mcg.0b013e31829e444f] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The gastrointestinal tract is the most common primary site of extranodal lymphomas, whereas gastrointestinal natural killer/T-cell (GINKT) lymphomas are relatively rare. To date, neither the prognostic characteristics nor the clinical features or optimal therapeutic approach for GINKT has yet been defined. PATIENTS AND METHODS In this study, a retrospective analysis was carried out on clinical data obtained from 47 patients diagnosed with GINKT lymphoma between May 1999 and August 2011 at West China Hospital. RESULTS Patients had a median age of 37 years. Thirty-five of the patients were men (74.5%). The common clinical manifestations included fever (78.7%) and abdominal pain (76.6%). Seventeen patients had intestinal perforation (36.2%). All patients showed ulcerative lesions; the most common site of involvement was the colon (27/47; 57.4%), followed by the jejunoileum and ileocecum (14/47; 29.8%). The median survival period was 2.83 (95% confidence interval, 0.27-29) months. Age, perforation, B syndrome, staging according to Lugano system, and surgery were independent prognostic risk factors for GINKT lymphoma. CONCLUSIONS This study concluded that GINKT lymphoma is prone to perforation, hemorrhage, and other complications; moreover, the prognosis is very poor. The Lugano staging is a relatively suitable staging system. Surgery before perforation is a key therapy factor that affected prognosis. Although the roles played by chemotherapy and radiotherapy are unclear, combination therapy is necessary.
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A Retrospective Analysis of Clinicopathological Characteristics, Treatment, and Outcome of 27 Patients of Primary Intestinal Lymphomas. J Gastrointest Cancer 2013; 44:417-21. [PMID: 23820932 DOI: 10.1007/s12029-013-9519-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Kobayashi H, Nagai T, Omine K, Sato K, Ozaki K, Suzuki T, Mori M, Muroi K, Yano T, Yamamoto H, Ozawa K. Clinical outcome of non-surgical treatment for primary small intestinal lymphoma diagnosed with double-balloon endoscopy. Leuk Lymphoma 2012; 54:731-6. [DOI: 10.3109/10428194.2012.725850] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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