Caracterización epidemiológica del Linfoma de Hodgkin en pacientes atendidos en el hospital de SOLCA - Guayaqui / Epidemiological characterization of Hodgkin lymphoma in patients treated at the SOLCA - Guayaquil

Introducción: El linfoma de Hodgkin es una enfermedad en la que se forman células malignas en el sistema linfático y que en los últimos años ha venido aumentando su presencia en la población. Objetivo: Caracterizar epidemiológicamente los linfomas de Hodgkin atendidos en el hospital de SOLCA - Guayaquil durante el periodo 2010-2021. Materiales y métodos: Se realizó un estudio de datos abiertos de diseño observacional, descriptivo, de corte transversal, de casos nuevos atendidos con linfoma de Hodgkin diagnosticados en el hospital de SOLCA Guayaquil, entre 2010 y 2021. Resultados: Las atenciones del linfoma de Hodgkin en el hospital de SOLCA Guayaquil fueron del 4 % en el 2010 y del 12 % en el 2021. Se tuvo sobre todo el linfoma de Hodgkin con esclerosis nodular, en hombres; los grupos etarios más frecuentes fueron hombres entre 0 y 19 años (37,7 %) y mujeres entre 20 y 29 años (45,3 %), procedentes de la provincia del Guayas. Conclusiones: Durante este periodo incrementaron las atenciones por linfoma de Hodgkin, en las que se observó más la esclerosis nodular en los pacientes, en hombres de 0 a 19 años y en mujeres de 20 a 39 años, similar al estándar de comportamiento de esta enfermedad

Introduction: Hodgkin lymphoma is a disease in which malignant cells form in the lymphatic system; its presence in the population has been increasing in recent years. Objective: Epidemiological characterization of the Hodgkin lymphomas treated at the SOLCA - Guayaquil hospital during the period 2010­2021. Material and methods: A study was carried out with open data from a cross-sectional observational descriptive design of the new cases of Hodgkin Lymphoma diagnosed and treated at the SOLCA - Guayaquil hospital between 2010 and 2021. Results: Hodgkin lymphoma care at the SOLCA - Guayaquil Hospital went from 4% in 2010 to 12% in 2021. Hodgkin lymphoma with nodular sclerosis was mostly observed in men; however, by age group, it was more frequent in men between 0 and 19 years old (37.7%) and in women between 20 and 29 years old (45.3%) from the Guayas province. Conclusions: During this period, Hodgkin lymphoma has garnered more attention due to an increase in nodular sclerosis cases observed in men aged 0 to 19 and women aged 20 to 39, which aligns with the standard behavior of this disease

Experiencia clínica de uso de Brentuximab-vedotin como terapia de linfoma de Hodgkin recaído o refractario en Hospital Guillermo Grant Benavente, Concepción, Chile / Clinical experience of using brentuximab-vedotin as therapy in relapsed/refractory Hodgkin's lymphoma at Hospital Guillermo Grant Benavente, Concepción, Chile

INTRODUCCIÓN: El linfoma de Hodgkin es una neoplasia de células B de buen pronóstico, pero con mala respuesta a quimioterapia en casos refractarios o recaídas. Brentuximab vedotin es un anticuerpo monoclonal antiCD30 aprobado para su uso en estos casos. El presente trabajo tiene como objetivo describir la experiencia clínica de los pacientes tratados con brentuximab vedotin bajo la modalidad de acceso expandido. MATERIAL Y MÉTODOS: Estudio retrospectivo sobre información clínica de pacientes diagnosticados de linfoma de Hodgkin refractario o en recaída y tratados con brentuximab-vedotin en el Hospital Regional de Concepción en el período 2015-2021. RESULTADOS: Se identificaron 7 pacientes, 5/7 de sexo masculino, con una mediana de edad de 35 años (21-50). Cinco casos fueron celularidad mixta y 2 esclerosis nodular. Cuatro estaban en etapa II, 1/7 en etapa III y 3/7 en etapa IV. La mediana de líneas de tratamiento previas fue 4 (3-5) y en 2 casos la recaída fue postrasplante. En 6/7 casos se empleó como inducción y en un caso se empleó como mantención postransplante autólogo de médula ósea. La administración fue ambulatoria por vía periférica con una mediana de dosis 150 mg y 10 ciclos. En un caso se necesitó ajuste de dosis por toxicidad. Tres de 6 pacientes lograron remisión completa y fueron a trasplante autólogo de médula ósea. CONCLUSIONES: brentuximab vedotin es un medicamento ambulatorio de baja toxicidad que puede optimizar el tratamiento de pacientes con linfoma de Hodgkin recaído-refractario.

INTRODUCTION: Hodgkin's lymphoma is a B-cell neoplasm with a good prognosis but a poor response to chemotherapy in refractory or relapsed cases. Brentuximab-vedotin is an anti-CD30 monoclonal antibody approved for use in these cases. This study aims to describe the clinical experience of patients treated with brentuximab-vedotin through expanded access modality. MATERIALS AND METHODS: A retrospective study on clinical information of patients diagnosed with refractory or relapsed Hodgkin's lymphoma treated with brentuximab-vedotin at the Regional Hospital of Concepción in the period 2015-2021. RESULTS: 7 patients were identified, 5/7 male, with a median age of 35 years (21-50). Five cases were mixed cellularity, and two were nodular sclerosis. Four were in stage II, 1/7 in stage III, and 3/7 in stage IV. The median number of previous treatment lines was 4 (3-5), and the relapse was post-transplantation in two cases. In 6/7 cases, brentuximab-vedotin was used as induction, and in one case, it was used as post-autologous bone marrow transplant maintenance. The administration was outpatient via a peripheral route with a median dose of 150 mg and ten cycles. In one case, dose adjustment was required due to toxicity. Three out of 6 patients achieved complete remission and underwent autologous stem cell transplantation. CONCLUSION: brentuximab-vedotin is an outpatient medication with low toxicity that can optimize the treatment of patients with relapsed-refractory Hodgkin's lymphoma.

Toxicidad pulmonar secundaria a bleomicina. Reporte de un caso / Pulmonary Toxicity Secondary to Bleomycin. A Case Report

La toxicidad pulmonar por antineoplásicos es muy variable dependiente del grupo far-macológico; la bleomicina es uno de los medicamentos en los que se ha reportado este evento. Este citostático puede lesionar el endotelio pulmonar y el epitelio alveolar para llevar a un proceso inflamatorio y fibrótico del intersticio con repercusiones potencial-mente fatales.A continuación, se presenta un caso de enfermedad intersticial tipo neumonía organi-zada asociada a bleomicina en un paciente de 68 años con diagnóstico linfoma Hodg-kin clásico de tipo esclerosis nodular, con estudio imagenológico normal previo al tratamiento

Antineoplastic pulmonary toxicity is highly variable depending on the pharmacological group; bleomycin is one of the drugs in which this event has been reported. This cyto-static can injure the pulmonary endothelium and the alveolar epithelium to lead to an in-flammatory and fibrotic process of the interstitium with potentially fatal repercussions. The following is a case of interstitial disease type organizing pneumonia associated with bleomycin in a 68-year-old patient diagnosed with classical Hodgkin lymphoma of nodular sclerosis type, with imaging study prior to normal treatment

Análisis del manejo del linfoma de Hodgkin clásico durante 10 años en el Hospital Clínico Red Salud UC-Christus con énfasis en el uso del PET CT / Decade of Hodgkin lymphoma: PET CT vs biopsy in single Academic Chilean Center

INTRODUCCIÓN: El Linfoma de Hodgkin (LH) es una causa prevalente de morbilidad por Cáncer Hematológico en el mundo y también en nuestro entorno. OBJETIVOS: Mostrar la experiencia de diez años tratando el LH en un centro docente chileno. Adicionalmente, exponer el rendimiento de diagnóstico del PET CT y la Biopsia de Médula Ósea. MATERIAL Y MÉTODOS: Se realiza un estudio de Cohorte retrospectivo para recopilar datos y resultados de los pacientes tratados en nuestro centro. RESULTADOS: Se analizaron 82 pacientes (edad promedio 35 años. Razón entre hombres y mujeres de 1,9:1). La sobrevida libre de progresión de 88,6% y 66,4% para estadios localizados y avanzados respectivamente. El PET como estrategia de etapificación tuvo mejor sensibilidad al comparar con la Biopsia de Médula. CONCLUSIONES: El resultado clínico de los pacientes tratados en este centro docente chileno fueron comparables a la literatura internacional. Adicionalmente, el PET CT evidenció ser una herramienta superior en el diagnóstico y etapificación superior a la biopsia en nuestros pacientes.

INTRODUCTION: Hodgkin Lymphoma (HL) is a prevalent hematological cancer in the world and Chile. OBJECTIVES: Show the experience of 10 years treating HL in a Chilean academic center. Additionally, it exposes the diagnostic performance of PET CT and Bone Marrow Biopsy. MATERIAL AND METHODS: We conducted a retrospective cohort study to collect data and outcomes of patients treated in our center. RESULTS: 82 patients were analyzed (Average age, 35 years old; the ratio between men and women was 1.9:1). Progression-free survival was 88.6% and 66.4% for localized and advanced stages, respectively. PET as a staging strategy had better sensitivity than Marrow Biopsy. CONCLUSIONS: The clinical results of the patients treated in this Chilean teaching center were comparable to the international literature. Additionally, PET CT proved to be a superior tool in diagnosis and staging compared to biopsy in our patients.

Vírus Epstein-Barr associado ao Linfoma de Hodgkin clássico: um estudo de casos / Epstein-Barr virus associated with classical Hodgkin lymphoma: a case study

Introdução: A expressão da positividade do vírus Epstein-Barr nas células de Reed-Sternberg/Hodgkin e o impacto dessa relação na sobrevida do Linfoma de Hodgkin clássico (LHc) permanecem controversos. Objetivo: Avaliar a presença de Epstein Baar Vírus (EBV) em pacientes com LHc, associando com características anatomopatológicas e clínicas. Materiais e Métodos: Para determinar a presença de EBV, a partir de um material de biópsia de tecidual foi realizada analise por hibridização para RNA codificado para EBV (EBER) e imuno-histoquímica para proteína de membrana latente viral (LMP-1) de uma amostra de demanda de pacientes com diagnóstico entre janeiro de 2009 e janeiro de 2015. As características clínicas avaliadas foram as que compõem o Escore Prognóstico Internacional para estadiamento avançado e os fatores de risco desfavoráveis instituídos pelo Grupo Alemão de Estudos em Hodgkin para estadiamento limitado. Posteriormente, tais características foram relacionadas com a situação do vírus nas células tumorais. Resultados: Foram avaliadas as lâminas de biópsia de 29 pacientes com diagnóstico de Linfoma de Hodgkin. Em relação as características histológicas, o subtipo histológico de celularidade mista apresentou associação estatística com EBV positivo (p= 0,02). Além disso, a presença de EBV foi mais comum em pacientes com 45 anos ou mais (p= 0,07). Embora sem significância estatística, houve uma tendência de melhor sobrevida livre de eventos (p= 0,07), para os pacientes EBV positivo. Conclusão: O subtipo histológico de celularidade mista, apresentou uma relação estatisticamente significativa com a presença de EBV nas células tumorais, em conformidade com a literatura. São necessários estudo com maior número de casos para que se possa entender melhor a relação entre a presença de EBV e o prognóstico do LHc em nosso meio.

Introduction: The expression of Epstein-Barr virus positivity in Reed-Sternberg/Hodgkin cells and the impact of this relationship on survival in classical Hodgkin Lymphoma (cHL) remain controversial. Objective: To evaluate the presence of Epstein Baar Virus (EBV) in patients with cHL, associating it with anatomopathological and clinical characteristics.Materials and Methods: To determine the presence of EBV, analysis was carried out using a tissue biopsy material by hybridization for EBV-encoded RNA (EBER) and immunohistochemistry for viral latent membrane protein (LMP-1) from a demand sample of patients diagnosed between January 2009 and January 2015. The clinical characteristics evaluated were those that make up the International Prognostic Score for advanced stage and the unfavorable risk factors established by the German Hodgkin Study Group for limited stage. Subsequently, these characteristics were related to the status of the virus in tumor cells. Results: Biopsy slides from 29 patients diagnosed with Hodgkin's Lymphoma were evaluated. Regarding histological characteristics, the histological subtype of mixed cellularity showed a statistical association with positive EBV (p= 0.02). Furthermore, the presence of EBV was more common in patients aged 45 years or older (p= 0.07). Although not statistically significant, there was a trend towards better event-free survival (p= 0.07) for EBV positive patients. Conclusion: The histological subtype of mixed cellularity showed a statistically significant relationship with the presence of EBV in tumor cells, in accordance with the literature. Studies with a larger number of cases are needed to better understand the relationship between the presence of EBV and the prognosis of cHL in our country.

Progressively transformed germinal center-like follicular T-cell lymphoma:a clinicopathological analysis of 14 cases / 中华病理学杂志

Objective: To investigate the clinicopathologic features of progressively transformed germinal center-like follicular T-cell lymphoma (PTGC-like FTCL). Methods: The clinicopathologic data of 14 PTGC-like FTCL cases that were diagnosed at the Beijing Friendship Hospital Affiliated to the Capital Medical University from January 2017 to January 2022 were retrospectively collected. Clinicopathological features, immunophenotype, and Epstein-Barr virus (EBV) infection status were analyzed in these cases. Polymerase chain reaction (PCR) was performed to detect the clonal gene rearrangements of T cell receptor (TCR) and the immunoglobulin (Ig) in 10 and 8 cases, respectively. Results: The male to female ratio was 5∶2. The median age was 61 years (range 32-70 years). All patients had lymphadenopathy at the time of diagnosis. By using the Ann Arbor system staging, seven cases were classified as stage Ⅰ-Ⅱ, and seven cases as stage Ⅲ-Ⅳ. Seven cases had B symptoms, four cases had splenomegaly, and two cases had skin rash and pruritus. Previously, three cases were diagnosed as classic Hodgkin's lymphoma, three cases as small B-cell lymphoma, two cases as atypical lymphoid hyperplasia unable to exclude angioimmunoblastic T-cell lymphoma (AITL), one case as EBV-associated lymphoproliferative disorder, and one case as peripheral T-cell lymphoma (PTCL) associated with the proliferation of B cells. All the 14 cases showed that the large nodules were composed of mature CD20+, IgD+B lymphocytes admixed with small aggregates of neoplastic cells with pale to clear cytoplasm. Moreover, hyperplastic germinal centers (GCs) and Hodgkin/Reed-Sternberg-like (HRS-like) cells were seen within these nodules in two and five cases, respectively. The neoplastic cells expressed CD3 (14/14), CD4 (14/14), PD1 (14/14), ICOS (14/14), CD10 (9/14), bcl-6 (12/14), CXCL13 (10/14), and CD30 (10/14). The HRS-like cells in five cases expressed CD20 (2/5), PAX5 (5/5), CD30 (5/5), CD15 (2/5), LCA (0/5), OCT2 (5/5) and BOB1 (2/5). Moreover, neoplastic T cells formed rosettes around HRS-like cells. EBV-encoded RNA (EBER) in situ hybridization showed scattered, small, positive bystander B lymphocytes in 8/14 cases, including 3/5 cases containing HRS-like cells. All tested cases (including five with HRS-like cells) showed monoclonal TCR gene rearrangement and polyclonal Ig gene rearrangement. Conclusions: PTGC-like FTCL is a rare tumor originated from T-follicular helper cells. It could be distinguished from angioimmunoblastic T-cell lymphoma by the formation of follicular structure, and lack of follicular dendritic cell proliferation outside the follicles and the polymorphous inflammatory background. In addition, it should be differentiated from lymphocyte-rich classical Hodgkin's lymphoma and low-grade B cell lymphoma.

A case of laryngeal carcinoma complicated with Hodgkin's lymphoma / 临床耳鼻咽喉头颈外科杂志

A case of laryngeal cancer complicated with Hodgkin's lymphoma treated in the Department of Otolaryngology Head and neck surgery of the First Hospital of Jilin University was reported. Under general anesthesia, right vertical partial laryngectomy, bilateral neck lymph node functional dissection and temporary tracheotomy were performed. No recurrence was found in laryngoscope and color Doppler ultrasound of neck lymph nodes 3 and 5 months after operation.

Linfoma de Hodgkin clásico: diferentes caras, una misma entidad / Classic Hodgkin lymphoma: different faces, same entity

El linfoma de Hodgkin clásico es una neoplasia linfoide maligna derivada de las células B del centro germinal, que corresponde aproximadamente al 85 % de los casos de linfoma de Hodgkin. Esta entidad afecta principalmente a pacientes jóvenes, y cuenta con un excelente pronóstico gracias a los avances en los métodos diagnósticos para su estadificación y tratamiento. Su enfoque diagnóstico correcto y completo requiere de una historia clínica exhaustiva y una biopsia de ganglio linfático adecuada para el análisis e identificación de los hallazgos histopatológicos e inmunohistoquímicos característicos, ya que a diferencia de otros linfomas donde las células neoplásicas son una población importante o dominante, las células de Hodgkin y Reed-Sternberg generalmente representan menos del 10 % de la lesión tumoral. Aunque todavía falta mucho por entender sobre la naturaleza biológica de este linfoma y sus diferentes subtipos, en los últimos años se ha avanzado considerablemente en la comprensión de su linfomagénesis, especialmente cuando está relacionada con la infección por el virus de Epstein-Barr. Su alta heterogeneidad y posible superposición morfológica, obligan a continuar su estudio para poder identificarlo, al igual que a sus posibles diagnósticos diferenciales en aquellos casos donde se presente con una variante o patrón infrecuente. Este artículo pretende ofrecer una descripción integral resumida y actualizada sobre la fisiopatología, la clínica, el diagnóstico histopatológico con énfasis en aquellos patrones raros que podrían llegar a ser factores distractores y de confusión, y el pronóstico del linfoma de Hodgkin clásico, buscando lograr una mejor comprensión de la enfermedad

Classic Hodgkin lymphoma is a malignant lymphoid neoplasm derived from B cells in the germinal center, and accounts for approximately 85% of all Hodgkin lymphoma cases. This disease mainly affects young patients and has an excellent prognosis due to advances in diagnostic methods for staging and treatment. A correct and complete diagnostic approach requires a thorough clinical history and an adequate lymph node biopsy for the analysis and identification of characteristic histopathological and immunohistochemical findings. Unlike other lymphomas where neoplastic cells are an important or dominant population, Reed-Sternberg/ Hodgkin cells generally represent less than 10% of the tumor lesion. Although much remains to be understood about the biological nature of this lymphoma and its different subtypes, considerable progress has been made in understanding its lymphomagenesis in recent years, especially when it is related to Epstein-Barr virus infection. Its high heterogeneity and possible morphological overlap require ongoing study to identify it and its possible differential diagnoses in cases where it presents with a rare variant or pattern. This article aims to provide a comprehensive updated summary on the pathophysiology, clinical presentation, histopathological diagnosis, with emphasis on rare patterns that could become distracting and confusing factors, and prognosis of classic Hodgkin lymphoma, seeking to achieve a better understanding of the disease

Virus de Epstein-Barr: más que una mononucleosis infecciosa / Epstein-Barr virus: more than infectious mononucleosis

El virus de Epstein-Barr (VEB) fue el primer virus asociado a neoplasias en humanos. Infecta el 95 % de la población mundial, y aunque usualmente es asintomático, puede causar mononucleosis infecciosa y se relaciona con más de 200.000 casos de neoplasias al año. De igual forma, se asocia con esclerosis múltiple y otras enfermedades autoinmunes. A pesar de ser catalogado como un virus oncogénico, solo un pequeño porcentaje de los individuos infectados desarrollan neoplasias asociadas a VEB. Su persistencia involucra la capacidad de alternar entre una serie de programas de latencia, y de reactivarse cuando tiene la necesidad de colonizar nuevas células B de memoria, con el fin de sostener una infección de por vida y poder transmitirse a nuevos hospederos. En esta revisión se presentan las generalidades del VEB, además de su asociación con varios tipos de neoplasias, como son el carcinoma nasofaríngeo, el carcinoma gástrico, el linfoma de Hodgkin y el linfoma de Burkitt, y la esclerosis múltiple. Adicionalmente, se describen los mecanismos fisiopatológicos de las diferentes entidades, algunos de ellos no completamente dilucidados

Epstein-Barr virus (EBV) was the first virus associated with human cancer. It infects 95% of the world's population, and although it is usually asymptomatic, it causes infectious mononucleosis. It is related to more than 200,000 cases of cancer per year, and is also associated with multiple sclerosis and other autoimmune diseases. Despite being classified as an oncogenic virus, only a small percentage of infected individuals develop EBV-associated cancer. Its persistence involves the ability to alternate between a series of latency programs, and the ability to reactivate itself when it needs to colonize new memory B cells, in order to sustain a lifelong infection and be able to transmit to new hosts. In this review, the general characteristics of EBV are presented, in addition to its association with various types of cancers, such as nasopharyngeal carcinoma, gastric carcinoma, Hodgkin's lymphoma and Burkitt's lymphoma, and multiple sclerosis. Additionally, the pathophysiological mechanisms of the different entities are described, some of them not completely elucidated yet

Overall survival in Chilean patients with lymphoma and human immunodeficiency virus: A retrospective cohort study

ABSTRACT Introduction: People living with human immunodeficiency virus (PLWH) still face high morbidity and mortality resulting from lymphoma. Aim: To describe a population of PLWH and lymphoma in a Chilean public hospital and compare the overall survival (OS) with a previously reported cohort from the same institution. Methods: Retrospective single-center cohort study. All the patients diagnosed between 2010 and 2017 were included. Demographic and clinical variables were obtained from medical records. The overall survival (OS) was estimated in treated patients from diagnosis until death or October 2020. The OS was then compared with a cohort of patients diagnosed between 1992 and 2008. Main Results: Eighty-four patients were included. The most common histological types were Burkitt's lymphoma (BL), diffuse large B-cell lymphoma (DLBCL), Hodgkin's lymphoma (HL) and plasmablastic lymphoma (PBL) at 31%, 27%, 21% and 14%, respectively. The three-year OS for the whole cohort of BL, DLBCL, HL and PBL was 58.9%, 65.2%, 47.4%, 76.4% and 50%, respectively. Compared to the cohort of 1992 to 2008, a global increase in the OS was found after excluding HL and adjusting for age and clinical stage (HR 0.38, p = 0.002). However, when the main types were analyzed individually, the increase in the OS was statistically significant only in DLBCL (HR 0.29, p = 0.007). Most patients with DLBCL received CHOP chemotherapy, as in the previous cohort. Conclusion: The OS has improved in this population, despite no major changes in chemotherapy regimens, mainly due to the universal access to antiretroviral therapy.

Aspectos clínicos do câncer durante o período gestacional: desafios diagnósticos e terapêuticos / Clinical aspects of cancer during the gestational period: diagnostic and therapeutic challenges

O câncer é uma das maiores causas de morte em mulheres na idade reprodutiva e ocorre em aproximadamente 0,05% a 0,1% das gestações. Os cânceres ginecológicos, de mama, tireoide e hematológicos são os mais comuns na gravidez. O obstetra é o principal médico para investigar sintomas que podem estar relacionados à malignidade. O diagnóstico pode ser dificultado devido à sobreposição de sintomas da gravidez, como náusea, vômitos, aumento do útero e das mamas, dor abdominal, além da limitação para uso de exames de imagem e alterações comuns em exames laboratoriais. O risco e o benefício do diagnóstico e o tratamento para o bem-estar materno e fetal devem ser avaliados com cuidado pelos profissionais envolvidos. Este artigo tem como objetivo realizar uma revisão sobre quando suspeitar e como investigar os principais cânceres na gestação.(AU)

Cancer is the major cause of death in women on reproductive age and occurs in approximately 0.05% to 0.1% of pregnancies. Gynecological, breast, thyroid and hema- tological cancers are the most common in pregnancy. The obstetrician is the primary physician to investigate symptoms that may be related to malignancy. The diagnosis can be difficult due to the overlap of pregnancy symptoms, such as nausea, vomiting, enlargement of the uterus and breasts, abdominal pain, in addition to the limitation for the use of imaging tests and common changes in laboratory tests. The risk and be- nefit of diagnosis and treatment for maternal and fetal well-being should be carefully assessed by the professionals involved. This article aims to conduct a review on when to suspect and how to investigate the main cancers in pregnancy.(AU)

Caracterización y supervivencia de pacientes con linfoma de Hodgkin. Un reporte de 7años de un centro único / Characterization and survival of patients with Hodg-kin lymphoma. A 7-Year single-center study

Introducción: El Linfoma de Hodgkin (LH), es una neoplasia hematológica poco frecuente, donde las células neoplásicas forman una minoría del tumor y están rodeados por un medio inflamatorio reactivo que incluye linfocitos, eosinófilos, neutrófilos, histiocitos y células plasmáticas. El objetivo del presente estudio fue describir una población con esta patología y su supervivencia en 7 años de seguimiento. Metodología Este estudio longitudinal, se realizó en el Hospital Carlos Andrade Marín, de Quito, Ecuador, del período 2013-2019, con una muestra no probabilística, de pacientes con LH. Se registraron variables demográficas, clínicas, de laboratorio, clasificación Ann Arbor, clasificación histológica, tratamiento y respuesta, mortalidad y tiempo de supervivencia. Se utiliza estadística descriptiva; bivariado y un análisis de supervivencia. Resultados: Se analizan 73 casos, 43 hombres (58.9 %). El grupo de 61 a 70 años fue el más prevalente con 19 casos (26%). 1 caso (4.1 %) con VIH, 7 casos (9.6%) con inmunosupresores. Síntomas B en 49 casos (67.1%). Adenomegalias en 15 casos (20.5 %). Masa Bulky 5 casos (6.8 %). Fallecieron 22 casos (30.1 %). Supervivencia de 52.8 meses, el 83.6% de recibieron Adriamicina, Bleomicina, Vincristina y Dacarbazina como 1ra línea de tratamiento, con remisión completa en el 61.7%. El estadio IV de Ann Arbor con Hazard Ratio (HR): 3.47,(IC95%: 1.20 ­6.11, P= 0.04), depleción linfocitaria HR: 4.98 (IC95%: 1.31 ­9.47, P= 0.04).Hemoglobina < 10.5 g/dL HR: 2.40,(IC95%: 1.47­5.94, P= 0.03), Albúmina < 4 g/dL HR: 4.02, IC95%: 1.94­7.26, P= 0.01) y linfocitos < 600 células/µL HR: 4.57, (IC95%: 1.85 ­11.28, P= 0.001)Conclusión: La prevalencia de LH fue ligeramente mayor en hombres, con una relación de 1.1: 1. LA incidencia fue bimodal, entre 31-40 años y entre 61-70 años, con síntomas B y adenomegalias. Los estadios II y III (Ann Arbor) fueron los más frecuentes. La Hemoglobina y albúmina fue menor en los fallecidos. El tratamiento de primera línea tuvo remisión completa en el 61.7% de los casos. La ausencia de síntomas B, se relacionó con una mayor supervivencia; los estadios avanzados se relacionaron con peor supervivencia; la supervivencia fue mayor en pacientes que obtuvieron remisión completa con la primera línea de tratamiento; la supervivencia general fue menor a la encontrada en países desarrollados

In troduction: Hodgkin's Lymphoma (HL) is a rare hematological neoplasm where neoplastic cells form a minority of the tumor and are surrounded by a reactive inflammatory medium that includes lympho-cytes eosinophils, neutrophils, histiocytes, and plasma cells. The objective of the present study was to describe a population with this pathology and its survival in 7 years of follow-up.Met hodology: This longitudinal study was carried out at the Carlos Andrade Marín Hospital, in Quito, Ec-uador, from 2013-2019, with a non-probabilistic sample of patients with HL. Demographic, clinical, labor-atory variables, Ann Arbor classification, histological classification, treatment and response, mortality, and survival time were recorded. Descriptive statistics are used; bivariate and survival analysis.R esults: 73 cases were analyzed, 43 men (58.9%). The group of 61 to 70 years was the most prevalent, with 19 cases (26%). 1 case (4.1%) with AIDS and 7 cases (9.6%) with immunosuppressants. B symp-toms in 49 cases (67.1%). Enlarged lymph nodes in 15 cases (20.5%). Bulky mass 5 cases (6.8%). 22 cases died (30.1%). Survival of 52.8 months, 83.6% received Adriamycin, Bleomycin, Vincristine, and Dacarbazine as1st line of treatment, with complete remission in 61.7%. Ann Arbor stage IV with Hazard Ratio (HR): 3.47, (95% CI: 1.20 ­6.11, P= 0.04), lymphocyte depletion HR: 4.98 (95% CI: 1.31 ­9.47, P= 0.04). Hemoglobin < 10.5 g/dL HR: 2.40, (95% CI: 1.47 ­5.94, P= 0.03), Albumin < 4 g/dL HR: 4.02, 95% CI: 1.94 ­7.26, P= 0.01) and lymphocytes < 600 cells/ µL HR: 4.57, (95% CI: 1.85 ­11.28, P= 0.001).C o nclusion: The prevalence of HL was slightly higher in men, with a ratio of 1.1: 1. The incidence was bimodal, between 31-40 years and between 61-70 years, with B symptoms and enlarged lymph nodes. Stages II and III (Ann Arbor) were the most frequent. Hemoglobin and albumin were lower in the de-ceased. First-line treatment had complete remission in 61.7% of cases. The absence of B symptoms was related to more remarkable survival; advanced stages were related to worse survival; survival was higher in patients who achieved complete remission with the first line of treatment; overall survival was lower than that found indeveloped countries

Reactivación de brucelosis en paciente receptor de trasplante hematopoyético autólogo: reporte de caso / Reactivation of brucellosis in an autologous hematopoietic transplant recipient: a case report

Introducción: La brucelosis es la zoonosis más frecuente, producida por el género brucella, que afecta a varias especies de mamíferos y dentro de ellos a los humanos. Se transmite al hombre por contacto directo con los animales infectados, por sus excretas o por la ingestión de productos no pasteurizados. En los últimos años se ha descrito un incremento de la enfermedad en los pacientes inmunocomprometidos. Objetivo: Describir la reactivación de la brucelosis en paciente receptor de un trasplante hematopoyético, su curso y manejo. Presentación de caso: Se presenta una paciente con linfoma de Hodgkin y antecedentes de brucelosis que recibió un trasplante hematopoyético autólogo mieloablativo. Después de la recuperación hematológica, inició con cuadro de fiebre, diaforesis, dolores articulares y hepato-esplenomegalia. Se le diagnosticó brucelosis, por lo que se inició tratamiento con doxiciclina y rifampicina, con lo que se logró la eliminación de los síntomas y la negativización de las pruebas evolutivas. Conclusiones: La brucelosis puede mantenerse meses o años asintomática y reactivarse después de la inmunosupresión en los pacientes trasplantados. Su sospecha y rápido tratamiento puede lograr la curación y evitar complicaciones(AU)

Introduction: Brucellosis is the most frequent zoonosis, produced by the genus brucella, which affects several species of mammals, including human beings. It is transmitted to persons by direct contact with infected animals, by their excreta or by ingestion of unpasteurized products. In recent years, an increase has been described in immunocompromised patients. Objectives: To describe the reactivation of brucellosis in a hematopoietic transplant recipient patient, its course and management. Case presentation: A patient with Hodgkin's lymphoma and a history of brucellosis is presented; that she received a myeloablative autologous hematopoietic transplant. After haematological recovery, she started with symptoms of fever, diaphoresis, joint pain and hepato-splenomegaly. She was diagnosed with brucellosis, so treatment with doxycycline and rifampin was started, which eliminated the symptoms and made the evolutionary tests negative. Conclusions: Brucellosis can be asymptomatic for months or years and after immunosuppression it can be reactivated in transplanted patients. Suspicion and prompt treatment can bring about a cure and avoid complications(AU)

Overview of lymphoma diagnosis in Brazilian public health system patients: Open data analysis for health care planning

Abstract Introduction Knowing the information regarding the panorama of lymphoma diagnosis in patients treated in the Brazilian Public Unified Health System from the last 10 years is a challenge for Strategic Health Planning. Objective To characterize the Brazilian population with lymphoma treated in the Brazilian Public Unified Health System between 2008 and 2017 regarding staging, sex, residence site and mortality. Material and methods A descriptive, retrospective, and longitudinal trial with secondary data from DataSUS (SIA/SUS and SIM/SUS) obtained from patients with ICD-10 C81-85. Results There were 70,850 lymphoma cases between 2008 and 2017, of which 55% were male, the median age was 51 years, and 27% had Hodgkin Lymphoma. Most patients (56%) were treated outside the residence city. São Paulo State accounted for 25% of patients. Treatment initiation took more than 60 days in 27% of cases. A total of 45,601 deaths were due to lymphoma (12% Hodgkin Lymphoma and 88% Non-Hodgkin Lymphoma), with a median age 63 years, and were mainly males (55%). Staging data were inadequate in 23% of patients, and analysis was performed only on the valid records. Advanced disease was diagnosed in 58% of patients (60% male; 57% female) and was more common in Non-Hodgkin Lymphoma (62%) versus Hodgkin Lymphoma (49%). Discussion Late diagnosis interferes with mortality rates. Health promotion and cancer prevention campaigns, especially targeting the male public, and training for early diagnosis and early treatment are needed. Conclusion Effective measures for early diagnosis and treatment are urgently needed for lymphoma control.

Pathological characteristics and clinical prognosis of nodular sclerosis grade 2 of classic Hodgkin's lymphoma / 中华肿瘤杂志

Objective: To investigate the pathological characteristics and clinical prognosis of nodular sclerosis grade 2 of classic Hodgkin's lymphoma (cHL-NS2) in our cancer center. Methods: A retrospective collection of 23 cases of cHL-NS2 admitted in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from July 2008 to April 2019 was performed. Fifty-five cases of nodular sclerosis grade 1 of classical Hodgkin's lymphoma (cHL-NS1) during the same period were selected as control group. Survival curves were plotted using the Kaplan-Meier method, and Cox regression model was used to analyze the influencing factors for survival. Results: The median age of 23 cases of cHL-NS2 was 30 years old. Five cases had extra nodal invasion, and 19 cases were Ⅰ-Ⅱ stage based on Ann Arbor system. The pathological morphology of cHL-NS2 showed that the lymph node structure was completely destroyed and was divided into nodules by thick collagen. The tumor cells in the nodules were abundant and proliferated in sheets. The boundaries between the tumor cells were not clear. The incidence of tumor necrosis in cHL-NS2 was 43.5% (10/23), which was significantly higher than 18.2% (10/55) in cHL-NS1 (P=0.040). The 3-year progression-free survival (PFS) rate of patients in the cHL-NS2 group was 58.1%, which was significantly lower than 89.7% in the cHL-NS1 group (P=0.002). In all of 78 cases, the 3-year PFS rate of patients who did not obtain complete response (CR) was 67.1%, which was significantly lower than 92.2% in patients who achieved CR (P=0.030). Multivariate Cox regression analysis demonstrated that both cHL-NS2 and failure to obtain CR by first-line treatment were independent indicators for short PFS time (P<0.05). Conclusions: In cHL-NS2, the morphology of tumor cells are diverse, and tumor necrosis can be easily found. Under the current first-line treatments of doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) or bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP), cHL-NS2 is an independent indicator for worse PFS.

A Terapêutica Cirúrgica e o Protocolo DH-II-90 no Tratamento da Doença de Hodgkin em Jovens e Adultos: um Estudo Ecológico / Surgical Therapy and DH-II-90 Protocol in the Treatment of Hodgkin Disease in Young Adults: an Ecological Study / La Terapia Quirúrgica y el Protocolo DH-II-90 en el Tratamiento del Linfoma de Hodgkin en Jóvenes y Adultos: un Estudio Ecológico

Introdução: A doença de Hodgkin (DH) é uma patologia que se inicia nos linfonodos, desenvolve-se nos tecidos neoplásicos e manifesta- -se, majoritariamente, em jovens adultos. Objetivo: Correlacionar os resultados da terapêutica cirúrgica e do protocolo DH-II-90 em jovens adultos acometidos pela DH, e associá-los ao perfil epidemiológico, aos dados de mortalidade pela doença e à distribuição de recursos físicos no Brasil. Método: Estudo ecológico exploratório, com informações coletadas do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Instituto Nacional de Câncer José Alencar Gomes da Silva (INCA), do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), entre 2013 e 2021. O estudo, portanto, compara os resultados da terapêutica cirúrgica e do protocolo DH-II-90 associados a dados epidemiológicos, sendo o protocolo considerado o método mais eficiente, por apresentar melhores resultados quando comparado a métodos mais invasivos. Resultados: A Região Sudeste concentra maior número de leitos e procedimentos com números mais expressivos de pacientes diagnosticados de 0 a 29 anos. Em resumo, as taxas de mortalidade bruta por DH reduziram-se a partir de 1990, período no qual o protocolo DH-II-90 foi aplicado. Conclusão: O presente estudo fornece uma visão relevante sobre o perfil epidemiológico da DH e contribui para a comparação entre a terapêutica cirúrgica e o protocolo DH-II-90, sendo possível concluir que, após a aplicação do protocolo, houve redução da taxa de mortalidade por DH no Brasil e no mundo

Introduction: Hodgkin disease (HD) is a pathology that starts in the lymph nodes, develops in the neoplastic tissues and manifests, mainly, in young adults. Objective: To correlate the results of the surgical therapy and the DH- II-90 protocol in young adults affected by HD, and to associate them with the epidemiological profile, the mortality data by the disease and the distribution of physical resources in Brazil. Method: Exploratory ecological study with information collected from the Informatics Department of the National Health System (DATASUS), the National Cancer Institute José Alencar Gomes da Silva (INCA), the National Registry of Health Establishments (CNES) and the SUS Outpatient Information System (SIA/ SUS) between 2013 and 2021. The study, therefore, compares the results of surgical therapy and the DH-II-90 protocol associated with epidemiological data, and the protocol is considered the most efficient method, as it produces better results when compared to more invasive methods. Results: The Southeast Region concentrates high number of beds and procedures and stands out due to more expressive numbers of patients diagnosed from 0 to 29 years. In short, crude mortality rates per HD decreased from 1990, the period where the DH-II-90 protocol was applied. Conclusion: This study provides a relevant view on the epidemiological profile of HD and contributes for the comparison between surgical therapy and the DH-II-90 protocol, being possible to conclude that after the application of the protocol, there was a reduction of the mortality rate by HD in Brazil and worldwide

Introducción: El linfoma de Hodgkin (LH) es una patología que inicia en los ganglios linfáticos, se desarrolla en los tejidos neoplásicos y se manifiesta mayoritariamente en adultos jóvenes. Objetivo: Correlacionar los resultados de la terapéutica quirúrgica y del protocolo DH-II-90 en jóvenes adultos acometidos por el LH, y asociarlos al perfil epidemiológico, a los datos de mortalidad por la enfermedad y a la distribución de recursos físicos en Brasil. Método: Estudio ecológico exploratorio, con información recolectada del Departamento de Informática del Sistema Único de Salud (DATASUS), del Instituto Nacional de Cáncer José Alencar Gomes da Silva (INCA), del Registro Nacional de Establecimientos de Salud (CNES) y del Sistema de Informaciones Ambulatorias del SUS (SIA/SUS), entre 2013 y 2021. El estudio, por lo tanto, compara los resultados de la terapéutica quirúrgica y del protocolo DH-II-90, asociados a datos epidemiológicos, siendo el Protocolo considerado el método más eficiente, por presentar mejores resultados cuando comparado a métodos más invasivos. Resultados: La Región Sudeste tiene más camas y procedimientos y presenta mayores números de pacientes diagnosticados de 0 a 29 años. En resumen, las tasas de mortalidad bruta por LH disminuyeron a partir de 1990, período en el que se incorporó el protocolo DH-II-90. Conclusión: El presente estudio proporciona una visión relevante sobre el perfil epidemiológico del LH y contribuye a la comparación entre terapéutica quirúrgica y el protocolo DH-II-90, concluyendo que, tras la inserción del protocolo, hubo reducción de la tasa de mortalidad por LH en Brasil y en el mundo

Incidence des cancers chez les personnes vivant avec le VIH suivies à Casablanca / Incidence of cancer among people living with HIV at Casablanca

Objectif. Décrireles aspects épidémiologiques des cancers chez les personnes vivant avec le VIH à Casablanca. Patients et méthodes. Il s'agissait d'une étude rétrospective sur 13 ans dans le service des maladies infectieuses du CHU Ibn Rochd de Casablanca. Ont été inclus tous les patients infectés par le VIH et présentant un cancer documenté histologiquement. Les données ont été colligées à partir du Nadis. L'analyse des données a été faite sur le logiciel épi info. Une valeur de p< 0,05 était considérée significative. Résultats. Nous avons inclus 139 patients qui présentaient des pathologies cancéreuses soit un taux d'incidence de 3,7patients pour 1000 patients année. L'âge moyen était de 37ans. Le sexe ratio était de 1,72 (88H/51F). Les cancers classant sida ont représenté 84% (117 cas) contre 16 % (22 cas) de cancers non classant sida. Le sarcome de Kaposi a été le plus fréquent (58,99%). Le cancer non classant sida le plus fréquent était le lymphome de Hodgkin (6,47%)(9 cas). Les Lymphomes malins non hodgkiniens et le sarcome de Kaposi étaient corrélés au sexe masculin (p=0,002, p=0,0006). Nous avons enregistré 39 décès (28%) et 34 perdus de vue (24,48%). Conclusion. Les pathologies cancéreuses restent fréquentes au cours du VIH avec une morbi-mortalité importante. Les cancers classant sida demeurent les plus fréquents dans notre contexte.

Objective. To describe the epidemiology of malignancies in people living with HIV at Casablanca. Patients and methods. It was a 13-year retrospective study in the Infectious Diseases Department of Ibn Rochd University Hospital in Casablanca. Included were all HIV-infected patients with histologically documented cancer. Data was collected from Nadis. Data analysis was done on the software epi info. A value of p <0.05 was considered significant. Results. 139 patients had cancerous diseases, an incidence rate of 3.7 patients per 1000 patients' year. The average age was 37 years old. The sex ratio was 1.72 (88H / 51F). Cancer classifying AIDS represented 84% (117 cases) against 16% (22 cases) of non-AIDS-defining cancers. Kaposi's sarcoma was the most common with 58.99%. The most common non-classifying AIDS cancer was Hodgkin's lymphoma with 6.47% (9 cases). Non-Hodgkin's malignant lymphoma and Kaposi's sarcoma were correlated with male sex (p = 0.002, p = 0.0006). We recorded 39 deaths (28%) and 34 lost to follow-up (24.48%). Conclusion. Cancerous pathologies remain frequent during HIV with significant morbidity and mortality. Cancer classifying AIDS remains the most common in our context.

Linfoma de Hodgkin anal primario y tumor neuroendocrino intestinal sincrónicos: a propósito de un caso y revisión de la literatura / Primary rectal Hodgkin's lymphoma and synchronous small bowel neuroendocrine tumor: Case report and literature review

Resumen La localización extranodal gastrointestinal del linfoma de Hodgkin comprende el 5% de todos los linfomas. Dentro de este grupo, el linfoma anal primario representa menos del 0,05%, siendo por tanto una entidad extremadamente rara. Por otro lado, los tumores neuroendocrinos son un grupo heterogéneo de neoplasias relativamente poco frecuentes, pero de localización fundamentalmente digestiva. La asociación entre un linfoma de Hodgkin de localización anal y un tumor neuroendocrino intestinal no ha sido descrita previamente en la literatura, pero no es en absoluto raro que los tumores neuroendocrinos puedan coexistir con otro tipo de neoplasias. Los autores presentan el caso infrecuente de presentación de linfoma Hodgkin de localización anal asociado a un tumor neuroendocrino intestinal en una paciente mujer de 74 años, describiéndose la clínica, resultados de pruebas complementarias y tratamiento recibido.

Abstract Extranodal gastrointestinal Hodgkin's lymphoma comprises 5% of all lymphomas. In this group, primary rectal lymphoma represents less than 0.05%; thus, it is an extremely rare entity. On the other hand, neuroendocrine tumors are a heterogeneous group of infrequent neoplasms, mainly of digestive location. The association between a rectal Hodgkin's lymphoma and an intestinal neuroendocrine tumor has not been previously described in the literature, but it is not at all uncommon for neuroendocrine tumors to coexist with other types of neoplasms. The authors present a rare case of rectal Hodgkin's lymphoma associated with an intestinal neuroendocrine tumor in a 74-year-old female patient, describing the symptoms, complementary test results, and treatment.