Diffuse large B-cell lymphoma associated with chronic inflammation as an incidental finding and new clinical scenarios.

Diffuse large B-cell lymphoma that develops in the setting of long-standing chronic inflammation is typically associated with Epstein-Barr virus, and usually presents as tumor mass involving body cavities, as in pyothorax-associated lymphoma. It is listed as a distinct entity in the latest World Health Organization lymphoma classification. We report four cases that were incidentally discovered on histologic examination, one each in a splenic false cyst, a long-standing hydrocele, an atrial myxoma, and metallic-implant wear debris. Microscopic foci of atypical (neoplastic) large lymphoid cells were found within the contents of the cysts or curettage material, or within the stroma of the atrial myxoma. Despite the diverse clinical scenarios, all cases showed a homogeneous phenotype: positivity for B-lineage markers (CD20+, CD79a+, PAX5+), non-germinal center immunophenotype (CD10-, BCL6-/+, MUM-1+), and positivity for Epstein-Barr virus with type III latency (LMP1+, EBNA2+). The last feature supports the hypothesis that the lymphoma has arisen in a setting of 'local immunodeficiency' as a result of long-standing chronic inflammation in an enclosed space, a characteristic pathogenetic mechanism of diffuse large B-cell lymphoma associated with chronic inflammation. These cases therefore expand the spectrum of this entity to include new clinical scenarios for the development of this lymphoma type.

Extent of margin involvement, lymphovascular invasion, and extensive intraductal component predict for residual disease after wide local excision for breast cancer.

UNLABELLED: In the present study, we identified predictors of residual disease after an inadequate wide local excision. Residual tumor was more likely when tumor was present at the inked margin, when more than a single radial margin was affected, and in tumors associated with lymphovascular invasion and an extensive intraductal component. BACKGROUND: Positive margins after wide local excision (WLE) increase the probability of residual disease, and additional surgery is often recommended. However, residual tumor will be found in only two thirds of cases, suggesting that additional surgery can be avoided in many instances. In the present study, we sought to establish the frequency of residual tumor when the surgical margins are inadequate and to identify factors that predict for residual tumor. MATERIALS AND METHODS: A retrospective review was performed of 720 consecutive patients who had undergone WLE for ductal carcinoma in situ and nonmetastatic breast cancer at a single unit from January 1, 2004 to December 31, 2010. RESULTS: At least a single radial margin was affected (either involved or close, defined as tumor < 1 mm from the margin) in 244 patients who had undergone WLE, and either the anterior or posterior margin was affected in another 103 patients. Reoperation was performed in 215 patients with affected radial margins and 9 others with affected anterior or posterior margins. Residual disease was found in 98 of 224 patients (43.8%) and was more likely when tumor was present at the inked margin, when > 1 radial margin was affected, and when lymphovascular invasion (LVI) or an extensive intraductal component (EIC) was present. The association with tumor size was of borderline significance. No association was found with tumor histologic type or patient age. CONCLUSION: Additional evaluation is needed to determine whether additional surgery can be safely omitted in women with tumors without LVI or EIC when a single radial margin has been deemed to be close.