Transformed Lymphoma Is Associated with a Favorable Response to CAR-T-Cell Treatment in DLBCL Patients

(1) Background: CAR-T-cell therapy is a novel therapeutic option for patients with relapsed/refractory diffuse large B-cell lymphoma (r/r DLBCL). The parameters that predict a favorable outcome after CAR-T-cell treatment are a matter of ongoing exploration. (2) Methods: We analyzed 36 consecutive patients with r/r DLBCL receiving tisagenlecleucel or axicabtagene ciloleucel at a single academic institution. We hypothesized that lymphoma subtypes (transformed versus de novo DLBCL) are of prognostic importance. We also assessed age, previous treatment, bridging therapy, remission status at the time of CAR-T treatment and at six months, LDH, the occurrence of CRS or ICANS, and CAR-T-DNA ddPCR kinetics for their prognostic impact. (3) Results: CRS was observed in 24 (67%) patients, and ICANS was observed in 14 (39%) patients. CR was achieved in 20 (56%) patients. Achievement of CR within six months after CAR-T was associated with better PFS (p < 0.0001) and OS (p < 0.0001). Remarkably, transformed (=secondary) lymphoma was associated with a better outcome than de novo disease for PFS (p = 0.0093) and OS (p = 0.0209), and the CR rate was 78% versus 33% (p = 0.0176). Mortality in patients with transformed DLBCL was 23% compared with 56% in de novo patients (p = 0.0209). (4) Conclusion: The presence of transformed DLBCL seems to be associated with a more favorable course after CAR-T treatment than that observed in the de novo DLBCL patients.

A Rare Prostate Pathology: Mantle Cell Lymphoma: A Case Report and Literature Review

Primary or secondary lymphoma of the prostate is a rare condition. Mantle cell lymphoma (MCL) represent 4-9% of all lymphomas. Prostate involvement with MCL is very rare, with only 11 reported cases up to now. Here we present a case with lower urinary tract symptoms and prostate-specific antigen (PSA) elevation diagnosed with MCL of the prostate. Prostate biopsy was performed in a 70-year-old patient due to increased PSA. After the pathology result was reported as prostatic MCL, imaging studies and sampling of additional pathological specimens were performed for staging. An improvement was observed in the urinary system complaints of the patient who started chemotherapy regimen. While prostatectomy was performed in some of the prostatic MCL cases reported previously, in some, no additional treatment was required after chemotherapy. Our case is the only prostatic MCL case with elevated PSA levels, but did not receive the diagnosis of prostate cancer. Physicians should keep in mind that, prostatic MCL can present with nonspecific symptoms. Staging should be performed in patients whose histopathologic diagnosis is lymphoma of the prostate so as to determine appropriate treatment options.

Parotid Gland Lymphoma

Lymphoma accounts for 15% of malignant salivary gland tumors. The parotid gland is the most commonly affected salivary gland (80%). It is generally seen in older men and women. It is associated with human immunodeficiency virus (HIV) infection and in approximately 6% of patients with Sjogrin's syndrome. There are two types: Hodgkin lymphoma and Non-Hodgkin lymphoma. Parotid lymphoma may be primary or secondary (far more common). Primary lymphoma first involves the parotid gland and later other parts of the body including lymph nodes and bone marrow. Secondary lymphoma involves other parts of the body first, such as peripheral blood, lymph nodes, bone marrow, and other organs. Treatment depends upon stage, overall health, age, and subtype of lymphoma. It includes chemotherapy, total or radical parotidectomy, and radiotherapy. If there is no response, or the chance of recurrence is high, then bone marrow transplantation or stem cell transplantation can be considered.

Primary Thyroid Lymphoma

Primary thyroid lymphoma (PTL) is a rare condition and accounts for 5% of all thyroid malignancies. They constitute less than 2 % of all lymphomas. Most PTL’s are non-Hodgkin's lymphomas. It is clinically essential to discriminate between primary or secondary lymphoma of the thyroid as the treatment and prognosis varies. It commonly occurs in women in their sixth and seventh decade. Primary thyroid lymphoma is quite curable without the need for extensive surgery if diagnosed early. We present such a case of a 60- year old female patient presenting with complaints of neck swelling with loss of appetite and dysphagia. Histopathological diagnosis confirmed Primary thyroid lymphoma of B cell origin which was confirmed by immunohistochemistry.

Secondary breast lymphoma. A case report

In this article, in a specific clinical case, the features of the image of secondary lymphoma of the breast with the use of a multimodal clinical-radiological approach were determined and the main literature sources for increasing awareness of this rare but very important pathology are given. Radiologic features of breast lymphomas are non-pathognomonic and may mimic different forms of invasive breast cancer. However, radiologists and clinicians should be aware of this rare pathology to avoid a misinterpretation. The multimodal clinical and radiological approach can be as close as possible to the diagnosis of braest lymphoma, and will pave the way for further diagnostics as biopsy and histopathological evaluation remain the gold-standard for diagnosis. Key words: breast limphoma, digital breast tomosynthesis, full-field digital mammography, breast ultrasound, Selenia Hologic, core needle biopsy.