From 1987 to 1993, 12 cases of primary gastric malignant lymphoma (PGML) were hospitalized. The incidence of PGML was 1.9% of gastric malignancies during the same period. There were 5 cases in stage Ⅰ, 4 in stage Ⅱ, 1 in stage Ⅲ, and 2 in stage Ⅳ. The preoperative diagnosis of PGML was difficult because the incidence of PGML is low, the symptoms are nonspecific, and the radiologic and fibrogastroscopic character were very similar to those of gastric carcinoma and peptic ulcer disease. The surgical treatment of PGML is disccused.
Objective To investigate the relevance of primary pulmonary non-Hodgkin’s lymphoma ( PPNHL) imaging with pathology features, so as to improve the diagnostic accuracy. Methods Twenty-two patients of PPNHL were scanned by chest computed tomography, and the results of clinical and pathology features were analyzed. Results The resulting pathologic examination showed that all patients in 12 cases of low-grade lymphoma had MALT lymphoma( 54. 5% ) , histologically with slightly atypical small lymphocyte proliferated. The radiological findings indicated unilateral peripheral lesion which extended along mucous membrane in 11 patients ( 91. 7% ) and multilateral lesion in only 1 patients ( 8. 3% ) . CT features were illdefined nodule or mass with halo sign ( n =8, 66. 7%) , patchy infiltrate ( n = 4, 33. 3% ) , and ill-defined consolidations with air-bronchograms ( n =7, 58. 3% ) . The resulting pathologic examination showed that 10 patients were high and middle-grade lymphoma ( 45. 5% ) . The radiological findings indicated unilateral lesion in4 patients ( 40%) and multilateral lesion in 6 patients( 60% ) . CT features were ill-defined noduleor mass ( n =4, 40% ) , patchy infiltrate ( n = 1, 10% ) , mixed manifestation ( n =5, 50% ) , pleural effusion ( n =5, 50% ) , hilar and mediastinal lymph node enlargement ( n =2, 20% ) , atelectasis ( n =3, 30%) , and pulmonary interstitial with interlobular septal thickening ( n=2, 20% ) . Conclusions The imaging features of PPNHL rely on its’ basic pathology. Low-grade lymphoma is characterized by peripheral focal consolidation with air-bronchograms. High and middle-grade lymphoma is characterized by mixed manifestation of interstitial change and nodular focus. Analyzing CT features seriously may be helpful for diagnosis of PPNHL.
Objective To observe the ocular features and analyze the cause of misdiagnosis of intraocular nonHodgkin's lymphoma (IONHL). Methods A retrospective study was performed in 6 patients and related literatures were reviewed. The age of those patients was 46 to 68 yrs with an average of 562 yrs. Four cases were female, two cases were male. Five patients were unilateral and one case was bilateral case. All patients were investigated by Goldmann tonometer, fundus fluorescein angiography (FFA) and ophthalmic Bscan. Pathological samples come from enucleation and vitrectomy, and were analyzed histologically and immunohistochemically. Results Ophthalmological signs of IONHL included decrease visual acuity, red eye, aqueous flare; keratic precipitates (Kp), vitreous opacity, retinal detachment and multiple whiteyellow retinal lesions of different sizes and fuzzy boundaries. IONHL patients were always misdiagnosed as diverse and nonspecific symptoms and signs, two cases were misdiagnosed as retinitis or chorioiditis, one case as intermediate uveitis, one case as secondary glaucoma in uveitis. The duration from onset of symptom and sign to a final diagnosis was from 6 months to 24 months with an average of 13.3 months. Conclusions The clinical manifestation of IONHL was diverse and non-specific，and this disease was unknown to lots of doctors and easily be misdiagnosed.
ObjectiveTo analyze the influencing factors for hepatitis B virus (HBV) infection screening in lymphoma patients prior to chemotherapy with a focus on HBV reactivation after chemotherapy. MethodsThe HBV infection screening data of 449 patients with lymphoma treated by chemotherapy between June 2010 and July 2012 were analyzed retrospectively. ResultsAmong the 449 patients, 387 (86.2%) were screened for HBV before initiation of chemotherapy, and patients with elevated aminotransferase levels were more likely to receive pre-chemotherapy HBV testing (OR=2.509, P=0.040). HBV reactivation was observed in 16.1% (9/56) of the HBsAg-positive patients after chemotherapy, and it was more likely to occur in patients with the use of rituximab (29.2% vs. 6.3%; P=0.030). Prophylactic antiviral therapy can significantly reduce the incidence of chemotherapy-induced HBV reactivation (12.0% vs. 50.0%; P=0.046). Two cases of reactivation occurred in patients who were HBsAg negative and hepatitis B core antibody positive. ConclusionHBV reactivation, especially for people with the use of rituximab, is a common complication in patients with HBV infection. HBV infection testing should be considered for lymphoma patients who were planned for chemotherapy. Prophylactic antiviral therapy can greatly decrease the incidence of HBV reactivation.
ObjectiveTo analyze the characteristics of ultrasound images for soft tissue lymphoma and discuss the diagnostic value of ultrasonography. MethodsBetween January 2008 and August 2014, the ultrasound images of 25 soft tissue lymphomas confirmed by histopathology and immunohistochemistry were retrospectively analyzed. ResultsOf the total 25 patients with soft tissue lymphoma (histological types of non-Hodgkin's lymphoma), there were 10 females and 15 males. Among them, 14 had diffuse large B-cell lymphoma (56%, 14/25). There was a primary lymphoma located in the lower leg, and all the rest 24 cases were secondary lymphoma. Of the 24 secondary cases, 19 presented solitary lesion located respectively in limbs (8 cases), trunk (7 cases) and head & neck (4 cases); the other 5 cases presented multiple lesions located respectively in limbs and trunk. Among all the lesions, 12 were located in muscular layer, presenting weak echo mass with irregular shape growing along the direction of muscular fibers; and 13 were located in skin and subcutaneous soft tissue, among which 4 cases showed diffused thickening of skin and subcutaneous layer with irregular hypoechoic areas on ultrasound examination, and 9 cases showed nodular or hypoechoic irregular shaped lesion, iso-hyperechoic, with heterogeneous internal echogenecity having unclear boundary. ConclusionUnderstanding the characteristics of soft tissue lymphoma on ultrasound images will help to improve diagnostic accuracy.
ObjectiveTo explore the clinical characteristics, diagnosis and treatment methods of pulmonary mucosa-associated lymphoid tissue lymphoma. MethodsClinical manifestations, laboratory examinations, imaging, diagnosis and treatment data of 23 patients with pulmonary mucosa-associated lymphoma were collected and related literatures were reviewed. ResultsAmong the 23 patients, 14 were males and 9 females, aged 22 to 71 years old, with a median age of 58 years old. Seven patients were found in physical examination, 15 patients showed respiratory symptoms, and 1 patient was diagnosed with flatness on percussion. According to the pulmonary CT scan, 10 patients showed large consolidations, 9 patients showed mass shadows with air bronchograms, 10 patients showed nodular shadows, 1 patient showed small reticular shadows, and 1 patient was observed with subcarinal mass in the mediastinum; 1 patient was observed with a decreased lung volume. Immunohistochemistry examination showed CD20 (+), cyclind-1 (-), and Ki-67 index was from 5% to 25%. Ten patients were treated with chemotherapy, 9 patients were treated with surgery, 1 patient was treated with radiotherapy and surgery, and 3 patients were untreated. ConclusionsPulmonary mucosa-associated lymphoid tissue lymphoma is a low-moderate malignant tumor, with insidious clinical onset, and patients usually go for treatment due to physical examination and mild respiratory symptoms. Imaging findings are mainly pulmonary consolidation and mass shadows associated with air bronchograms. Confirmed diagnosis is primarily made by pathology and immunohistochemistry. Currently, there is still some controversy over a variety of treatment options, including observation, surgery, surgery combined with chemotherapy, chemotherapy alone, and radiotherapy. The patients' prognosis and survival time are both excellent.
ObjectiveTo summarize experience of clinical diagnosis and treatment for liver posttransplant lymphoproliferative disorder(PTLD). Method The clinical diagnosis and treatment processes of 3 patients with live PTLD in this hospital were retrospectively analyzed and the relevant literatures were reviewed. ResultsThe EB virus was negative and CD20 was positive for these 3 patients with liver PTLD, the time of onset was 10 to 12 years after liver transplantation, and the tacrolimus was given for anti-immune following liver transplantation. The pathological diagnosis was diffuse large B cell lymphoma for all the patients. ConclusionsWith use of large quantities of immunosuppressive drugs following liver transplantation, incidence of liver PTLD gradually rises. Meanwhile, prognosis is poor and early diagnosis is difficult. Currently, diagnosis and classification is still dependent on pathological examination. EB virus positive patients show earlier onset, while EB negative patients show later onset with a poorer prognosis. Therefore, a long-term follow-up should be conducted for early detection, and rituximab should be administrated to patients with CD20(+).
ObjectiveTo evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL). MethodsRetrospective non-comparative interventional case series. Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study. All patients received examination of Snellen chart visual acuity, fundus color photography and optical coherence tomography (OCT). Among the 24 eyes with recordable visual acuity, 17 eyes has initial visual acuity≥0.1 (0.45±0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement. The vitreous opacities and (or) subretinal yellowish-white lesions and retinal pigment epitheliumuplift were observed in all eyes. All eyes were treated with intravitreal methotrexate (4000 μg/ml, 0.1 ml) injections according to a induction-consolidation-maintenance regimen. For 26 treated eyes, each received an average of (11.5±6.3) injections. Twenty eyes had finished theintraocular chemotherapy, while 6 eyes had not. Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy, 12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months, the mean time was 18 months. The examination of BCVA, fundus color photography and OCT were performed. No tumor cell was defined as clinical remission. Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines). ResultsTwenty eyes achieved clinical remission after (3.5±3.6) injections, 12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8±3.0) injections. The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36±0.23 and 0.56±0.20, respectively. Compared with before treatment, the visual acuity was mild declined in induction phase (t=1.541, P>0.05), but mild improved at the end of treatment (t=2.639, P<0.05). The visual acuity at the end of treatment in 7 eyes with initial visual acuity<0.1 was ranged from no light perception to 0.1. Of 14 patients, 2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma. No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy. ConclusionsPVRL patients can achieve clinical remission after (3.5±3.6) injections by intravitreal chemotherapy of methotrexate, and the visual acuity improved mildly. No ocular recurrence was found during follow-up.
Primary vitreoretinal lymphoma (PVRL) is a rare type of non-Hodgkin's lymphoma with poor prognosis and the optimal treatment has yet to be determined. Its treatment has evolved from enucleation to ocular radiotherapy, systemic chemotherapy and intravitreal chemotherapy. Radiotherapy can effectively eradicate tumor cells but ocular recurrences are common. Systemic chemotherapy has become the mainstream option but there are problems with only-partial response of PVRL and high rate of recurrence. Intravitreal chemotherapy, primarily used as adjunctive to systemic chemotherapy, has achieved high remission rate and low rate of recurrence as well as with limited ocular complications. The tumor cells were cleared and the visual function preserved. However, issues about the drug applied, treatment protocols and goals of intravitreal chemotherapy, whether for visual preservation or survival improvement, are worthy for further study.
ObjectiveTo investigate the clinical characteristics and prognosis of pneumocystis pneumonia (PCP) in patients with lymphoma. MethodsTwenty inpatients who were diagnosed as lymphoma with PCP in PLA 307 Hospital from March 2012 to December 2014 were retrospectively analyzed. ResultsAll patients got non-Hodgkin's lymphoma. Specific genes for Pneumocystis jirovecii were found in the sputum of 5 patients and the bronchoalveolar lavage fluid of the other 15 patients. The major clinical presentations were fever (18/20) and dyspnea (13/20). Arterial blood gas analysis showed that all patients had hypoxaemia. There were 10 patients with respiratory failure (10/20), in which 7 patients needed mechanical ventilation (7/20). Four patients died (4/20). All patients were treated by multiple chemotherapy. Fifteen patients (75%) had leukocytopenia, with an average white blood cell (WBC) count of (3.2±2.8)×109/L. The mean lactate dehydrogenase (LDH) level was (374.6±197.2) U/L. The mean APACHEⅡ score was 12.6±4.4. PCP had no significant manifestations under the bronchoscope. Imaging manifestations were ground-glass opacities expanding to periphery from the hila, but the pleura was less involved. Univariate analysis revealed that there were no significant differences in chemotherapy cycle, WBC count or G test between the survival group and the death group. However, serum LDH, APACHEⅡ score, delay diagnosis, and co-infection were statistically significant between the two groups. ConclusionsThe main clinical presentations of PCP patients with lymphoma are fever and progressive exertional dyspnea. High LDH, high APACHEⅡ score, diagnosis delay and co-infection indicate poor prognosis.