Mucosa-associated lymphoid tissue (MALT) lymphoma (ML) is a type of non-Hodgkin’s lymphoma involving MALT, commonly the stomach or salivary glands, although virtually any mucosal site can be affected. ML originates from B cells in the marginal zone of MALT, and is also called extranodal marginal zone B cell lymphoma. It is a slow-growing cancer that usually responds well to treatment. A 59-year-old female presented with a 1-day history of quadriparesis and dysarthria. Up arrival at the hospital, motor power in the right upper and lower extremities was grade 3/5 according to the Medical Research Council scale, while that in the left leg was 4/5. The patient had been diagnosed with gastric ML 1 year prior, and had received antibiotics during the previous 2 weeks. The emergency magnetic resonance imaging of the brain performed at the time of presentation showed multifocal embolic infarction in the cerebral hemisphere bilaterally, which did not have a cardiac origin. Magnetic resonance angiography revealed no stenotic or occlusive lesions. Secondary prophylaxis with daily administration of 300 mg aspirin was prescribed. The patient was discharged with residual right hemiparesis 2 weeks after the onset of symptoms. Herein, we present a rare case of multifocal cerebral infarction in a gastric ML patient.
Lymphoma, which accounts for 3.5% of all oral cancers, is further divided into Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL). NHL accounts for 96% of lymphomas, and diffuse large B-cell lymphoma (DLBCL) is the most common subtype accounting for 32% of NHL. In the oral cavity, extra-nodal non-Hodgkin's lymphoma may develop in the dentoalveolar region of the maxilla or mandible. It can also mimic inflammatory lesions that occur around periodontal tissues, such as periapical granuloma and chronic osteomyelitis. Misdiagnosis of jaw lymphoma can delay appropriate treatments and worsen the prognosis. Therefore, to avoid delay in diagnosis, clinicians should identify the possible malignancy based on unusual symptoms, clinical findings, radiographic examinations, and histopathological evaluation. We present two cases of DLBCL in the right posterior mandible of a 64-year-old man who was initially misdiagnosed as acute apical abscess and in the right posterior maxilla of an 81-year-old woman who was initially misdiagnosed as chronic periodontitis. These cases demonstrate that it is important for both pathologists and clinicians to consider malignant lesions such as lymphomas in the differential diagnosis of apical radiolucency.
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin's lymphoma, and usually showed painless neck swelling, fever, sweat, and weight loss. Although about 5% of all lymphomas appeared in the oral area, the primary maxillofacial lymphomas were rare and sometimes clinically tended to be misdiagnosed such as chronic periodontitis, osteomyelitits, etc. This study demonstrated three cases of primary DLBCL mimicking localized osteomyelitis at mandible or maxilla. A series of histological and immunohistochemical examination using different biomarkers of lymphoreticular cells were performed to characterize the neoplastic cells of DLBCL. The first case occurred in a 45 years old male exhibiting mandibular osteomyelitis and neck swelling. The second case simply showed a gingival swelling at left upper premolar area in a 55 years old male. And the third case is from an 84 years old female who felt numbness at left lower lip and had severe periodontitis involving regional alveolar bone resorption. All of three cases had experienced no systemic manifestation of lymphoreticular malignancy before the diagnosis of oral lymphoma. Immunostainings of CD3, CD20, TNFα, BCL-2, Ki-67, PCNA, and c-Myc were strongly positive in these tumor cells, while those of p53 and CD31 were slightly positive, and CD56 immunoreaction was negative. These three cases were diagnosed as DLBCL and referred to the hemato-oncology unit for treatment. Therefore, every chronic granulomatous periodontal lesion hardly cured by simple medical treatment should be carefully explored through pathological examination, and it was presumed that DLBCL is closely related to the chronic inflammatory periodontal lesions recruiting mucosa-associated lymphoid cells in older patients. It was also suggested that DLBCL be differentially diagnosed from T-cell lymphoma, Burkitt’s lymphoma, and Hodgkin’s disease, etc. with immunohistochemical determination of tumor cell subtypes as soon as possible in order to be treated with appropriate therapy.
A one-year-old, intact female, Maltese dog was presented with a history of anorexia and regurgitation. Thoracic radiographs and ultrasonography scans suggested an abnormal mass in the cranial mediastinal region, and computed tomography confirmed the origin of this mass. Ultrasound-guided fine needle aspiration cytology showed the presence of intermediate to large lymphoid cells showing mitotic figures. B-cell lymphoma was confirmed by the result of a polymerase chain reaction assay for antigen receptor rearrangement, therefore the patient was diagnosed with primary mediastinal large B-cell lymphoma (PMBL). The patient underwent L-CHOP (L-asparaginase, cyclophosphamide, doxorubicin, vincristine, prednisolone)-based chemotherapy, and showed complete tumoral remission from the beginning of chemotherapy. Seventytwo weeks after the completion of chemotherapy, the patient is still alive without any evidence of metastasis or relapse. A standardized treatment protocol has yet to be established for primary mediastinal lymphoma in dogs. This case report describes the complete remission of PMBL by an L-CHOP-based chemotherapy protocol in a young Maltese. Clinicians should consider that L-CHOP based chemotherapy may be useful against PMBL in dogs.
Extranodal intraoral Hodgkin lymphoma is not common. We report the case of a 78-year-old male patient with ulcer of the mandibular oral mucosa that was not cured for about 3 weeks. In biopsy and histopathologic examination, it was found to be extranodal intraoral Hodgkin lymphoma. Early diagnosis of oral lesions led to early detection of lesions of the opposite neck lymph node in an additional PET-CT scan. We report this case and review relevant literature.
혈관내큰B세포림프종은 악성 림프구의 혈관 내 성장을 보이는 드문 질환으로, 말초혈액 또는 혈관 외 종괴를 보이지 않는다. 이 림프종은 빠른 파종 및 공격적 성향 때문에 나쁜 예후를 가진다. 그러나 질병특유소견이 없어 진단이 어려운 실정이다. 저자들은 십이지장 위장관기질종양의 수술 검체 내에서 혈관내큰B세포림프종이 진단된 증례를 발견하였기에 문헌고찰과 함께 보고하는 바이다.
최근 우리나라에서는 자가면역췌장염의 증례보고가 늘 고 있다. 자가면역췌장염의 정확한 진단은 임상적으로 매우 중요한데, 이는 임상적으로 그리고 영상학적으로 췌장 악성종양과의 감별이 어렵기 때문이다. 자가면역췌장염의 경우, 스테로이드에 대하여 반응이 좋고, 수술적 치료를 피할 수 있다는 점에서 그 의의가 크다. 이번 증례보고에서 저자들은 영상검사에서 자가면역췌장염을 충분히 의심할 만한 환자에서 생검상 림프종으로 확진된 증례를 경험하 였기에, 문헌 고찰과 함께 보고하는 바이다.
광범위큰 B세포 림프종은 비호지킨림프종의 대표적인 아형으로 공격적 림프종이며 원발성으로 담낭에 발생한 림프 종은 일부 증례를 통한 보고가 있지만, 담낭에 단독 재발한 광범위큰 B세포 림프종은 국내에서 보고된 바가 없다. 본 증례는 상복부의 통증과 황달의 임상증상 및 복부컴퓨터단층 촬영 그리고 양전자 방출 단층촬영에서 만성 담낭염과 담낭 암으로 추정하여 수술 후 조직검사를 통해 재발한 광범위큰 B세포 림프종으로 진단할 수 있었다. 저자들은 과거 회장에 발생한 광범위큰 B세포 림프종으로 치료를 시행하여 완전완 화가 유도된 이후 다른 장기 혹은 림프절 전이 없이 단독으로 담낭에 재발한 광범위큰 B세포 림프종 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
Facial numbness restricted to the distribution of the mental nerve(mental neuropathy) is called "numb chin syndrome". The clinical importance of this syndrome is associated with first recognition of involvement of malignant diseases. The malignant neoplasm with numb chin syndrome show rapid progression and high mortality. We present a 43-year-old female who had been treated by radiotherapy for precursor T-cell leukemia/lymphoma involving the central nervous system( CNS) previously and later developed mental nerve invasion without central nervous system recurrence. MRI images revealed the CNS tumor mass remitted, and there was no identified peripheral nervous system(PNS) involvement including the mental nerve invasion, nevertheless the patient complained of consistent numbness and pain on right mandibular area. This is the first case of precursor T-cell leukemia/lymphoma accompanying mental nerve invasion without recurrence for central nervous system. Proper interpretation for mental neuropathy may lead to the prompt diagnosis and therapeutic intervention.
This study was focused on the risk assessment of whether radiofrequency electromagnetic fields generated by mobile phone is cytogenetically toxic or not. We conducted the effects of 835-MHz electromagnetic field (EMF) on DNA strand breaks in mouse thymic
Primary CNS lymphoma (PCNSL) accounts for 1-5% of all primary brain tumors. Early and accurate diagnosis of PCNSL is crucial for proper management and is more likely if a tumor is observed on imaging. We present the PCNSL case of 77-year-old man who developed abrupt neuropsychiatric features from 5 days ago. This case suggests that clinicians should be alert on the possibility of PCNSL and apply prompt MRI evaluation, when elderly patient with chronic heavy alcohol drinking history present abrupt complex neuropsychiatric symptoms in outpatient clinic.
Diagnosis of chronic myelogenous leukemia (CML) and non-Hodgkins lymphoma (NHL) have rarely been made simultaneously in the same patient. We report a rare case of a patient with CML-chronic phase who developed a concurrent Philadelphia (Ph)-negative diffuse large B-cell lymphoma. At the time of diagnosis, cytogenetic analysis of peripheral blood and bone marrow cells revealed the Ph-chromosome translocation in all examined metaphases. A lymph node biopsy showed features of diffuse large B-cell lymphoma, and fluorescence in situ hybridization (FISH) of lymph node tissue for BCR-ABL was negative. The patient was treated with R-CHOP (rituximab, cyclophosphamide, vincristine, adriamycin and prednisone) and imatinib mesylate.
Prognosis of the patients with lung cancer with lung-to-lung metastasis are known to be poor and frequently old aged persons with multiple nodules on imaging study abandon more invasive procedure including bronchoscopy and VATS (Videoassisted thoracoscopic surgery) to get tissue confirmation. Sjogren’s syndrome (SS) associated lung lesion mimicking lung cancer has a chance to have more favorable diseases including lymphoma. A 78-year-old woman with SS was admitted due to slowly progressive exertional dyspnea and multiple nodules on imaging study. She and her family gave up invasive diagnostic procedures at first due to old age but short term rapid change of dyspnea and nodules on chest CT brought out invasive procedures and diffuse large B-cell lymphoma was diagnosed. Dyspnea and nodules on imaging were improved after R-CHOP chemotherapy.
Tumors of the lacrimal gland are uncommon, and most are of epithelial origin. Primary non-Hodgkin’s lymphoma (NHL) of the lacrimal gland is extremely rare. A 45- year-old male was admitted with a complaint of a painless swelling of the right eye superiolateral lesion. We confirmed primary diffuse large B cell lymphoma of the lacrimal gland, and the patient was classified as stage IE. The patient was treated with chemotherapy, followed by radiotherapy. He achieved complete remis-sion, and, after 26 months of follow-up, the patient remained free of disease.
We report on a unique case of diffuse large B-cell lymphoma of the cecum, which presented as a subepithelial tumor. A 62- year-old woman with abdominal pain underwent a colonoscopy, resulting in detection of a subepithelial tumor measuring 2 cm in the cecum. We performed a right hemicolectomy with diagnostic and curative intent; histological examination and immunohistochemical staining of the resected tumor indicated a diagnosis of diffuse large B-cell lymphoma. The patient achieved complete remission with combination chemotherapy.
Development of two different histologic types of lymphoma in the same person is rare. Sequential lymphoma is defined as two different types of lymphoma occurring sequentially in the same person. In particular, sequential Hodgkin’s lymphoma (HL) following non-Hodgkin’s lymphoma (NHL) is extremely rare. A 63-year-old female diagnosed with B-cell NHL at the mass in T3 received treatment with an R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone) protocol for six cycles. However, 12 months later, the patient complained of a left neck mass and excisional biopsy was performed. Microscopically the biopsied tissue showed Reed-Stemberg cells and confirmed the diagnosis of HL. The patient was treated with ABVD (adriamycin, bleomycin, vinblastine and dacarbazine) for four cycles. Although the possibility of a secondary malignancy cannot be excluded, this is a rare case of sequential Hodgkin’s lymphoma following Non-Hodgkin’s lymphoma.