scholarly journals Rare but Potentially Fatal Presentations of Diffuse Large B-cell Lymphoma: Leukemic Phase or Hemophagocytic Syndrome in Bone Marrow

2022 ◽  
Vol 15 ◽  
pp. 2632010X2110707
Author(s):  
Wan Awatif Wan Mohd Zohdi ◽  
Ahmad Zulhimi Ismail ◽  
Nurasyikin Yusof ◽  
Azlin Ithnin ◽  
Salwati Shuib ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Trephine Biopsy ◽  
Large B Cell Lymphoma ◽  
History Of ◽  
Splenic Biopsy ◽  
Atypical Presentations ◽  
Large B Cell

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin Lymphoma commonly presenting as a solid tumor either by nodal or extra-nodal manifestations. Here we describe two atypical presentations of lymphoma, finally resulting in the diagnosis of DLBCL. Case 1: A 53-year-old man with a previous history of nasopharyngeal carcinoma presented with a two-week history of B-symptoms and hyperleukocytosis. Peripheral blood film showed 78% abnormal mononuclear cells. Immunohistochemical stain showing Ki-67 of 90%, negative c-myc, BCL2 and BCL6, and negative c-MYC with fluorescence in-situ hybridization studies on the trephine biopsy, concluded the diagnosis of CD5+ DLBCL of ABC subtype. He received intravenous cyclophosphamide and oral prednisolone for cytoreduction, followed by 6 cycles of chemo-immunotherapy. However, he succumbed due to severe sepsis after the completion of therapy. Case 2: A 56-year-old lady who was initially investigated for pyrexia of unknown origin was noted to have hemophagocytosis upon bone marrow aspirate examination. The bone marrow trephine biopsy revealed some atypical clusters of B-cells positive for CD20 which was inconclusive. PET-CT scan noted an enlarged hypermetabolic spleen without lymphadenopathy. Splenic biopsy with immunohistochemical studies revealed DLBCL of ABC subtype. The diagnosis was consistent with primary splenic DLBCL. She became unwell post splenic biopsy and was admitted to the intensive care unit where she passed away 2 weeks later from Candida and Sternotrophomonas septicemia. These cases highlight the atypical presentations of a common subtype of NHL in our center. Arriving at the definitive diagnosis can be difficult especially when patients are acutely ill, hampering the necessary invasive procedures for diagnosis. The outcomes of both cases are briefly discussed hoping to spread awareness among clinicians on the rare and acutely critical presentations of DLBCL.

scholarly journals Precision of Histological Bone Marrow Staging in Follicular Lymphoma and Diffuse Large B-cell Lymphoma

2012 ◽  
Vol 35 (6) ◽  
pp. 358 ◽  
Author(s):  
Titi Chen ◽  
Anne McDonald ◽  
Bruce Shadbolt ◽  
Dipti Talaulikar
Keyword(s):  
Bone Marrow ◽  
Follicular Lymphoma ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Weighted Kappa ◽  
Observer Agreement ◽  
Trephine Biopsy ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Introduction: In Non-Hodgkin Lymphoma (NHL), bone marrow histology is the gold standard against which ancillary investigations such as immunophenotyping and gene rearrangement studies are interpreted. There is currently no data on the reproducibility of histological findings. This study was conducted to determine the rates of inter- and intra-observer agreement in histological detection of bone marrow involvement in the two major subtypes of NHL, Diffuse Large B-cell Lymphoma (DLBCL), and Follicular Lymphoma (FL). Methods: The bone marrow slides of randomly selected DLBCL and FL cases were independently examined by two hematologists using standardized reporting criteria on two occasions at least two weeks apart. Samples included both aspirate and trephine biopsy slides. Weighted kappa statistics were used to examine agreement for the discrete measures. Results: Weighted kappa analyses showed variable inter-observer agreement in 38 DLBCL cases [aspirate=0.52; trephine= 0.77] and 38 FL cases [aspirate=0.48; trephine=0.77]. Conclusion: Overall, higher agreement rates were noted with trephine biopsies than with aspirates. Except for the high intra-observer agreement on trephine biopsy assessment in FL, there is poor agreement in histological staging of both FL and DLBCL which demonstrates the limitations of histological diagnosis and the futility of interpreting ancillary tests against histology.

Survival after Autologous Transplantation to Treat Diffuse Large B-Cell Lymphoma with a History of CNS Involvement, Bone Marrow Involvement, or Histologic Transformation.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 5237-5237
Author(s):  
Brandon Hayes-Lattin ◽  
Pritesh Mehta ◽  
Adam Dunn ◽  
Nan Subbiah ◽  
Jose F. Leis ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
Bone Marrow Involvement ◽  
Autologous Transplantation ◽  
B Cell Lymphoma ◽  
Cns Involvement ◽  
Large B Cell Lymphoma ◽  
History Of ◽  
Large B Cell

Abstract Background: Patients with diffuse large B-cell lymphoma (DLBCL) who present with extra-nodal involvement or histologic transformation from low-grade disease have lower rates of survival after conventional-dose therapy. The impact of these features on outcomes after high-dose therapy with autologous transplantation was investigated. Methods: We retrospectively reviewed the outcomes of 64 consecutive patients receiving autologous transplantation from 1995 to 2003 for the treatment of DLBCL. Variables considered were age, gender, histologic transformation, history of bone marrow involvement, history of central nervous system (CNS) involvement, time from diagnosis to transplant, number of pre-transplant regimens, chemosensitivity prior to transplant, conditioning regimen, year of transplant, and the use of peripheral blood or bone marrow stem cells. Survivals were estimated by the Kaplan-Meier method. The Cox proportional hazards regression model was used to test the significance of factors on survival. Univariate association between variables and survival were tested by the log-rank test. Correlation between variables was tested with Spearman’s rank coefficient. Results: The median age at transplant among 64 patients was 53.5 years (17–74). The median overall survival was 3.3 years. Among these patients, 12 had a history of CNS involvement, 10 had a history of bone marrow involvement, and 12 had transformed from low-grade lymphoma. A Cox regression model suggested age <50 (log-rank, p=0.093), <2 regimens prior to transplant (log-rank, p=0.052), and the lack of BEAM as conditioning regimen (log-rank, p=0.019) as multivariate factors for survival. However, the use of BEAM was highly associated with older age (R²= 0.42, p=0.001) and more prior chemotherapy regimens (R²=0.24, p=0.054). A history of extranodal involvement, including prior CNS involvement (p=0.842) or bone marrow involvement (p=0.518), was not associated with lower survival by univariate analysis. No significant association was found between survival and a history of transformation (p=0.484). Conclusions: A history of CNS involvement, bone marrow involvement, or histologic transformation is not associated with lower rates of survival among patients undergoing autologous transplantation for diffuse large B-cell lymphoma at our institution. Patients who present with such histories remain candidates for autologous transplantation.

Bone Marrow Biopsy for the Staging of Diffuse Large B-Cell Lymphoma: Is It Necessary Bilateral Trephine Biopsy?.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4427-4427
Author(s):  
Marcelo Bellesso ◽  
Rodrigo D. Velasques ◽  
Luis F. Pracchia ◽  
Beatriz Beitler ◽  
Vera L. Aldred ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cell ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Prognostic Index ◽  
B Cell Lymphoma ◽  
Median Number ◽  
Trephine Biopsy ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Abstract In this retrospective analysis we study the usefulness of bilateral rather than unilateral iliac trephine biopsies in demonstrating Diffuse Large B-Cell Lymphoma (DLBCL) in the bone marrow (BM). A total of 28 DLBCL cases with BM infiltration were investigated with bilateral iliac trephine biopsy during staging. Our propose was to evaluate the incidence of unilateral BM involvement, and we compare the BM biopsy size with negative and positive BM infiltration. In 28 cases studied it was analyzed 70 BM fragments. These fragments were reviewed separately by pathologist about size and infiltration. In this group, 6 cases (21.4%) were unilaterally positive. The median number of fragment per case was 2.5; the median size of BM fragment was 11.01 mm (± 5.12) and BM fragment per case was 27.53mm. It was not found difference between size BM fragment in negative or positive fragments 11,57mm (±5.2) versus 10.95mm (±5.1), p>0.05, respectively. In 24 cases it was possible to compare negative and positive BM infiltration with age, sex, LDH and computerized tomography (CT) staging. In addition, it was not found difference between unilateral and bilateral BM infiltration about LDH and age, and CT. (Table 1). Conclusion: Although in unilateral infiltration cases did not change risk factor in International Prognostic Index (stage III–IV) by CT, we conclude that bilateral trephine biopsy is superior to unilateral, because bilateral biopsy could increase by 21,4% the detection of BM involvement by DLBCL, without difference between the size in negative versus positive fragments. Table 1. Distribution of Unilateral and Bilateral Bone Marrow infiltration by categories Unilateral infiltration (%) Bilateral infiltration (%) Age < 60 21% 50% Age ≥ 60 4% 25% Sex Male 16% 29% Sex Female 8% 47% CT staging I–II - 35% CT staging III–IV 26% 39% LDH Normal 8% 34% LDH Elevated 16% 42%

Clinical benefit of R-CHOP without splenectomy in stage I primary splenic diffuse large B-cell lymphoma

2022 ◽  
Vol 15 (1) ◽  
pp. e246610
Author(s):  
Tara Rajendran ◽  
Jyoti Ramanath Kini ◽  
Aysha Abna ◽  
Krishna Prasad
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Ct Guided ◽  
Large B Cell Lymphoma ◽  
Pet Ct ◽  
History Of ◽  
Rare Malignancy ◽  
Splenic Biopsy ◽  
Large B Cell

Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is a relatively rare malignancy, and there are no optimal approaches for diagnosis and management. There are less invasive splenic biopsies that effectively obviate diagnostic and elective splenectomies. We report a man in his 50s with 2-day history of pain in the abdomen and who was found to have a splenic mass on PET-CT. A CT-guided core needle splenic biopsy confirmed the diagnosis of PS-DLBCL. He was managed with six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) alone, without splenectomy. The patient attained complete remission, and he is disease free at 6 years of follow-up.

Primary diffuse large B cell lymphoma (DLBCL) of the prostate presenting with lower urinary tract symptoms (LUTS)

2020 ◽  
Vol 13 (12) ◽  
pp. e236280
Author(s):  
Ayesha Nusrat ◽  
Syed Muhammad Nazim
Keyword(s):  
Urinary Tract ◽  
B Cell ◽  
Lower Urinary Tract ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Urinary Tract Symptoms ◽  
History Of ◽  
Large B Cell ◽  
Lower Urinary

Malignant lymphomas of the prostate are very rare tumours and are generally not considered in the clinical or pathological diagnosis of prostatic enlargement. We report a case of a 56-year-old man who presented with long-standing history of low back pain and a 2-month history of voiding lower urinary tract symptoms. He denied any history of urinary retention, trauma, catheterisation or any constitutional symptoms. Examination revealed no lymphadenopathy and hepatosplenomegaly. Digital rectal examination showed an irregular, moderately enlarged nodular prostate. His prostate-specific antigen was 1.54 ng/mL. MRI of the pelvis did not show any focal lesion apart from abnormal signal intensity in the central zone. Bone scan was negative. Transrectal ultrasound-guided prostate biopsy revealed diffuse large B cell lymphoma. Bone marrow biopsy and whole body positron emission tomography/CT were unremarkable. The patient achieved complete remission after receiving six cycles of R-CHOP chemotherapy.

scholarly journals 170 Primary Breast Lymphoma-Mimicking Inflammatory Breast Disease: A Case Report

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Alam ◽  
B Basak ◽  
A Ahsan ◽  
A S Gupta ◽  
S Islam ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Primary Breast Lymphoma ◽  
Palpable Mass ◽  
Large B Cell Lymphoma ◽  
Breast Lymphoma ◽  
History Of ◽  
Large B Cell

Abstract Primary breast lymphoma (PBL) is an unusual clinical entity accounting for 0.4–0.5% of all breast neoplasms. The usual presentation includes a painless palpable mass similar to that of breast carcinoma. Diffuse large B-cell lymphoma (DLBCL) is the most common identifiable type of PBL based on the histopathological examination. We report an unusual case of 22 years old Bangladeshi woman presented with a 6-month history of a lump on left breast. Although the lump was initially small, it began a rapid growth after 4 months. The swelling was localized and did not show any skin involvement or discharge and as she didn’t have any positive familial history of breast carcinoma her primary attending physician diagnosed it as a case of breast abscess. When local incision and drainage proved ineffective, she was referred to us. After doing an immunohistochemistry from incisional biopsy the diagnosis was confirmed as Diffuse Large B-cell Lymphoma. The patient was treated initially by chemotherapy with CHOP therapy followed by wide local excision. Early and accurate diagnosis of PBL is crucial for selecting the appropriate MDT treatment strategies to avert potentially harmful surgical interventions.

scholarly journals Bone Marrow Molecular Markers Associated with Relapsed/Refractory Activated B-Cell-Like Diffuse Large B-Cell Lymphoma

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Di Wang ◽  
Peng Liu ◽  
Yue Zhang ◽  
Hui-Ying Liu ◽  
Di Shen ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Molecular Markers ◽  
B Cell ◽  
Bone Marrow Aspirate ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Significant Finding ◽  
Large B Cell Lymphoma ◽  
Significant Difference ◽  
Large B Cell

Activated B-cell-like diffuse large B-cell lymphoma (ABC-DLBCL) is a common subtype of non-Hodgkin’s lymphoma and is very likely to infiltrate the bone marrow. Over 30% of patients are converted to relapsed/refractory DLBCL after first-line rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, with a poor prognosis. Our aim was to identify molecular markers that might be utilized to predict relapsed/refractory ABC-DLBCL patients. Hence, we collected bone marrow aspirate smears from 202 patients with ABC-DLBCL and detected expression of bone marrow molecular marker proteins by immunocytochemistry. Signal transducer and activator of transcription (Stat)3, nuclear factor (NF)-κB p65, Syk, Bruton’s tyrosine kinase (BTK), and Bcl2 proteins were strongly expressed in bone marrow aspirate smears of ABC-DLBCL patients. The same smear could present positive expression of multiple proteins simultaneously. Positive combinations of protein expression were associated with resistance. The most significant finding was that the Stat3+NF-κB+ group developed resistance, which was significantly higher than that of the Stat3-NF-κB-group (80 vs. 14%). There was a significant difference in two-year relapse-free survival between protein-positive and protein-negative combinations of Stat3-NF-κB (P = 0.005), Bcl2-Stat3 (P = 0.009), Bcl2-Pax5 (P = 0.003), and BTK-Syk (P < 0.001). Thus, we detected key molecules in multiple signaling pathways in bone marrow aspirate smears. At the same time, the results provide further clinical evidence of ABC-DLBCL drug-resistant molecules and provide a theoretical basis for rational second-line treatment after drug resistance.

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