Survival of patients living with HIV and cancer in Cali, Colombia

Background: People living with HIV have an increased risk of cancer compared to the general population. However, with the increase in life expectancy and advances in antiretroviral therapy, the survival of patients with cancer and HIV has changed. Objective: To determine the survival of patients living with HIV and cancer in Cali, Colombia Methods: A retrospective cohort study was conducted at the Fundación Valle del Lili, Cali, Colombia. Data from the HIV database was crossed with data from the hospital and population-based cancer registries between 2011-2019. Patients <18 years, limited available clinical information on the diagnosis and treatment of HIV and cancer, and non-oncological tumor diagnosis were excluded. Results: A total of 173 patients were included. The frequencies of AIDS-defining neoplasms were: Non-Hodgkin lymphoma (42.8%), Kaposi sarcoma (27.8%), and cervical cancer (4.6%). Overall survival was 76.4% (95% CI 68.9-82.3) at five years. Poorer survival was found in patients with AIDS-defining infections (56.9% vs. 77.8%, p=0.027) and non-AIDS-defining infections (57.8% vs. 84.2%, p=0.013), while there was better survival in patients who received antiretroviral therapy (65.9% vs. 17.9%, p=0.021) and oncological treatment (66.7% vs. 35.4%, p<0.001). The presence of non-AIDS-defining infections increases the risk of dying (HR = 2.39, 95% CI 1.05-5.46, p=0.038), while oncological treatment decreases it (HR = 0.33, 95% CI 0.14-0.80, p=0.014). Conclusions: In people living with HIV, Non-Hodgkin lymphoma and Kaposi sarcoma are the most common neoplasms. Factors such as AIDS-associated and non-AIDS-associated infections have been identified as determinants of survival. Cancer treatment seems to improve survival.

Antecedentes: Las personas que viven con VIH tienen un riesgo mayor de cáncer en comparación con la población general. Sin embargo, con el aumento de la esperanza de vida y los avances en la terapia antirretroviral, la supervivencia de los pacientes con cáncer y VIH ha cambiado. Objetivo: Determinar la supervivencia de los pacientes que viven con VIH y cáncer en Cali, Colombia. Métodos: Se realizó un estudio de cohorte retrospectivo en la Fundación Valle del Lili, Cali, Colombia. Los datos de la base de datos de VIH se cruzaron con los datos de los registros de cáncer de base hospitalaria y poblacional entre 2011-2019. Se excluyeron los pacientes <18 años, con información clínica limitada disponible sobre el diagnóstico y tratamiento del VIH y el cáncer y los casos con diagnóstico de tumor no oncológico. Resultados: Se incluyeron un total de 173 pacientes. Las frecuencias de neoplasias definitorias de SIDA fueron: linfoma no Hodgkin (42.8%), sarcoma de Kaposi (27.8%) y cáncer cervical (4.6%). La supervivencia global fue del 76.4% (IC 95% 68.9-82.3) a los cinco años. Se encontró una peor supervivencia en pacientes con infecciones definitorias de SIDA (56.9% vs. 77.8%, p=0.027) e infecciones no definitorias de SIDA (57.8% vs. 84.2%, p=0.013), mientras que hubo una mejor supervivencia en pacientes que recibieron terapia antirretroviral (65.9% vs. 17.9%, p=0.021) y tratamiento oncológico (66.7% vs. 35.4%, p<0.001). La presencia de infecciones no definitorias de SIDA aumentó el riesgo de morir (HR = 2.39, IC 95% 1.05-5.46, p=0.038), mientras que el tratamiento oncológico lo disminuyó (HR = 0.33, IC 95% 0.14-0.80, p=0.014). Conclusiones: En las personas que viven con VIH, el linfoma no Hodgkin y el sarcoma de Kaposi son las neoplasias más comunes. Se han identificado factores como las infecciones asociadas al SIDA y las infecciones no asociadas al SIDA como determinantes de la supervivencia. El tratamiento del cáncer parece mejorar la supervivencia.

Linfoma no Hodgkin difuso de células B grande como linfoma primario de ovario. Presentación de caso / Diffuse large B-cell non-Hodgkin's lymphoma as primary ovarian lymphoma. Case presentation

Fundamento: Los linfomas primarios de ovario son poco frecuentes; el 1 % de estos se presenta en ovario y el 1.5 % de los tumores malignos de ovario son linfomas. Los tipos histológicos más frecuentes es el linfoma no Hodgkin difuso de células B grande y el BurKitt; el tratamiento consiste en cirugía combinada con quimioterapia. Objetivo: Reportar un caso de un linfoma no Hodgkin difuso de células B grande primario de ovario. Presentación de caso: Se presentó el caso de una paciente de 39 años de edad, con antecedentes patológicos personales de salud; la cual fue al cuerpo de guardia de ginecología por presentar dolor abdominal difuso que no se aliviaba con analgésicos. En la exploración física presentaba dolor a la palpación superficial y profunda en hipocondrio y fosa ilíaca derecha con masa tumoral palpable. Ecografía hacia proyección anexial derecha se observó una imagen de baja ecogenicidad y en la laparoscopia de urgencia se concluyó como una formación de aspecto tumoral que parecía corresponderse con ovario derecho. Se le realizó una histerectomía con doble anexectomía. El diagnóstico anatomopatológico fue un linfoma no Hodgkin primario de ovario. Conclusiones: La paciente del caso presentado tuvo una clínica oligosintomática y la confirmación de la enfermedad fue a partir de una muestra quirúrgica, lo que expresa que el diagnóstico del linfoma no Hodgkin de células B es difícil y aunque es poco frecuente siempre se debe tener en cuenta en el diagnóstico diferencial de las tumoraciones unilaterales de ovario.

Background: Primary ovarian lymphomas are uncommon, 1% of these malignancies occur in the ovary, and 1.5% of all ovarian malignancies are lymphomas. The most common histologic types are diffuse large B-cell non-Hodgkin's lymphoma and BurKitt's lymphoma; treatment consists of surgery combined with chemotherapy. Objective: To report a case of primary ovarian diffuse large B-cell non-Hodgkin lymphoma. Case presentation: A 39-year-old female case is presented, with a personal pathological history; she went to the gynecology emergency service because she presented diffuse abdominal pain that was not relieved by analgesics. Physical examination revealed superficial and deep pain on palpation in the hypochondrium and right illiac fossa with a palpable tumor mass. Right adnexal ultrasound showed an image of low echogenicity and at the emergency laparoscopy, it was diagnosed as a tumor-like formation that appeared to correspond to the right ovary. She underwent a hysterectomy with double adnexectomy. The anatomopathologic diagnosis was primary ovarian non-Hodgkin's lymphoma. Conclusions: The patient in the presented case had an oligosymptomatic clinical presentation. Confirmation of the disease was obtained from a surgical sample, which means that B-cell non-Hodgkin's lymphoma is difficult to diagnose and although it is uncommon, it should always be considered in the differential diagnosis of unilateral ovarian tumors.

Clinical analysis of 7 cases of pregnancy with non-Hodgkin lymphoma / 中华妇产科杂志

Objective:To investigate the clinicopathological features, diagnosis, treatment and outcomes of pregnancy with non-Hodgkin lymphoma (NHL).Methods:The clinicopathological data of 7 patients of pregnancy with NHL admitted to Nanjing Drum Tower Hospital from January 2010 to May 2022 were reviewed. General information, diagnosis, treatment and maternal and child outcomes were retrospectively analyzed.Results:(1) The median age of the 7 patients was 28 years old (range: 26-33 years); 3 cases complained of abdominal pain (2 cases of huge pelvic or abdominal mass with multiple metastases), 2 cases of cough (1 case with superior vena cava syndrome), 1 case of facial swelling and pain, and 1 case of poor appetite. The median time from the onset of symptoms to initial visit was 30 days (range: 15-188 days). (2) Only 3 cases were diagnosed during pregnancy through biopsy, and the biopsy sites including right nasal vestibular mass, left supraclavicular lymph node and lung respectively. One case was suspected to be splenic marginal zone lymphoma through bone marrow puncture during pregnancy, and confirmed by pathological results observed in splenectomy specimens after termination of pregnancy. Three cases were diagnosed as NHL by pathological results of focus biopsy or partial tumor resection during cesarean section. Pathological types: 5 cases of diffuse large B cell lymphoma, one splenic marginal zone lymphoma and one nasal cavity natural killer (NK)/T cell lymphoma. Stages: 1 case of stage Ⅱ, 6 cases of stage Ⅳ. Pathological examination of placentas was performed for 4 patients after delivery, included one case with tumor metastasis to the placenta. (3) Among the 7 patients, 1 case was induced in the second trimester; 5 cases were terminated by cesarean section in the third trimester, all of which were premature; one case of full-term was delivered with forceps. All 6 neonates survived healthy. Treatments: 5 cases received chemotherapy after termination of pregnancy (included 1 case received autologous hematopoietic stem cell retransfusion therapy after chemotherapy), and 1 case received chemotherapy combined nasopharyngeal radiotherapy, and six cases survived without recurrence (follow-up until October 2022). The other case was a patient with hepatitis B virus infection and congenital heart disease who died of multiple organ failure 18 days after cesarean section.Conclusions:It is difficult to diagnose, necessary to pay attention to the complaints of pregnant women, and to actively carry out related examinations during pregnancy. When the lesion involves multiple organs, the possibility of lymphoma should be considered. Pregnancy with NHL is sensitive to chemotherapy. Even for advanced patients, good outcome could still be obtained after standardized treatment.

Effects of collaborative psychological nursing on quality of life and psychology of non-Hodgkin lymphoma patients and their caregivers / 白血病·淋巴瘤

Objective:To investigate the influence of collaborative psychological nursing on the quality of life and psychology of non-Hodgkin lymphoma (NHL) patients and their caregivers.Methods:Eighty NHL patients and 80 caregivers in the Affiliated Hospital of Inner Mongolia Medical University from February 2018 to February 2019 were selected, and the patients were divided into observation group 1 (40 patients) and control group 1 (40 patients) according to the random number table method, and the caregivers were divided into observation group 2 (40 caregivers) and control group 2 (40 caregivers). Control group 1 was given routine nursing, and observation group 1 was given collaborative psychological nursing on the basis of routine nursing. The World Health Organization Quality of Life (WHOQOL)-BREF was used to compare the quality of life of two groups of patients and two groups of caregivers. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to compare the psychological states of two groups of patients and two groups of caregivers.Results:Compared with control group 1, the observation group 1 had lower SAS and SDS scores after nursing [(40±6) points vs. (44±6) points, t = 5.12, P = 0.014; (46±4) points vs. (52±4) points, t = 3.22, P = 0.031] and higher WHOQOL-BREF scores [(87.2±2.1) points vs. (65.0±2.5) points, t = 8.55, P = 0.018]. Compared with control group 2, the observation group 2 had lower SAS and SDS scores after nursing [(37±4) points vs. (40±4) points, t = 3.21, P = 0.021; (44±4) points vs. (49±3) points, t = 2.37, P = 0.032] and higher WHOQOL-BREF scores [(84.0±2.5) points vs. (79.5±2.7) points, t = 3.28, P=0.015]. Compared with before nursing, SAS and SDS of each group decreased after nursing, while WHOQOL-BREF scores increased, and all differences were statistically significant (all P < 0.05). Conclusions:Collaborative psychological nursing can effectively improve the quality of life and mental resilience score of NHL patients and their caregivers.

Linfoma angioinmunoblástico de células T como imitador de lupus eritematoso sistémico

El linfoma angioinmunoblástico de células T (LAIT) es un linfoma no Hodgkin poco frecuente, puede imitar a enfermedades autoinmunes y es de pobre pronóstico. Se presenta el caso de una mujer de 36 años con 3 años de enfermedad caracterizada por fiebre, artralgias y baja de peso. La paciente fue diagnosticada inicialmente como lupus eritematoso sistémico, pero al no encontrar mejoría con el tratamiento su diagnóstico fue replanteado. En una nueva hospitalización se le identificaron múltiples adenomegalias. Se realizó la biopsia de una de las adenomegalias, la patología fue compatible con LAIT. Se indicó 3 sesiones de quimioterapia, sin embargo, desarrolló falla multiorgánica con desenlace fatal. El LAIT es un reto diagnóstico debido a que puede imitar varias patologías autoinmunes. Es muy importante su sospecha y descarte para iniciar un tratamiento precoz que mejore la sobrevida de los pacientes.

Angioimmunoblastic T-cell lymphoma (LAIT) is a rare non-Hodgkin lymphoma, can mimic autoimmune diseases, and has a poor prognosis. We present the case of a 36-year-old woman with a 3-year illness characterized by fever, arthralgia and weight loss. She was initially diagnosed as systemic lupus erythematosus, but finding no improvement with treatment, her diagnosis was reconsidered. In a new hospitalization, multiple lymph nodes were identified. They performed a biopsy of one of the adenopathies, the pathology was compatible with LAIT. Three chemotherapy sessions were indicated, however, she developed multiple organ failure with a fatal outcome. LAIT is a diagnostic challenge because it can mimic several autoimmune pathologies. Its suspicion and ruling out is very important to initiate early treatment that improves patient survival.

Linfoma del tejido linfoide asociado a las mucosas en paciente con tiroiditis de Hashimoto / Mucosa-associated lymphoid tissue lymphoma in a patient with Hashimoto's thyroiditis

RESUMEN El linfoma del tejido linfoide asociado a las mucosas es una variedad poco común y recientemente descubierta del linfoma no Hodgkin. Suele presentarse en la sexta década de la vida, con un predominio del sexo femenino y en sitios como el tracto digestivo, pulmón, riñón, hígado, piel, y solo en el 2 % de los casos, en la glándula tiroides, donde en muchas ocasiones se asocia a la tiroiditis autoinmune de Hashimoto. Su evolución es favorable cuando se diagnostica en estadios iniciales de la enfermedad. Se presenta una paciente de 22 años, con una historia de trastornos endocrinos, perceptibles desde la adolescencia, a quien se le diagnosticó una tiroiditis de Hashimoto, sobre la que subyacía un linfoma del tejido linfoide asociado a las mucosas, y que evolucionó satisfactoriamente luego del tratamiento quirúrgico.

ABSTRACT Mucosa-associated lymphoid tissue lymphoma is a rare and recently discovered variant of non-Hodgkin's lymphoma. It usually occurs in the sixth decade of life, with a predominance of females and may be observed in sites such as the digestive tract, lung, kidney, liver, skin, and only in 2% of cases, in the thyroid gland, where in many occasions it is associated with Hashimoto's autoimmune thyroiditis. Its evolution is favorable when it is diagnosed in the initial stages of the disease. We present a 22-year-old female patient with a history of perceptible endocrine disorders since adolescence, who was diagnosed with Hashimoto's thyroiditis, underlying mucosa-associated lymphoid tissue lymphoma, and who evolved satisfactorily after surgical treatment.

Methotrexate nephrotoxicity in a patient with preserved renal function. case report

ABSTRACT Introduction: Methotrexate is a drug with chemotherapeutic properties frequently used for the treatment of certain types of cancer. The following is a clinical case which, to the best of the authors' knowledge, is the first report in Colombia on nephrotoxicity caused by this drug and describes the consequences as well as the treatment provided at a quaternary care hospital. Case report: A 71-year-old patient with a diagnosis of non-Hodgkin's lymphoma with normal renal function underwent chemotherapy (high-dose methotrexate intravenously) and developed stage 3 acute renal failure according to the KDIGO guidelines, which was most likely related to methotrexate intake. The patient received treatment with intravenous fluids and sodium bicarbonate as promoters of urine excretion of the toxin, and oral calcium folinate following the institutional protocol. The patient was discharged with recovery of kidney function and improved creatinine and urea nitrogen levels. Conclusion: The treatment given to the patient in this case report shows that although methotrexate nephrotoxicity is a potentially serious entity, it can have a good prognosis if treated promptly.

RESUMEN Introducción. El metotrexato es un fármaco con propiedades quimioterapéuticas usado de forma frecuente para el tratamiento de ciertos tipos de cáncer. A continuación, se presenta un caso clínico que, a conocimiento de los autores, es el primer reporte en Colombia sobre nefrotoxicidad por este medicamento, así como sus consecuencias y el manejo que se le dio en un hospital de cuarto nivel. Presentación del caso. Hombre de 71 años con diagnóstico de linfoma no Hodgkin y función renal normal, quien se sometió a tratamiento quimioterapéutico (metotrexato a altas dosis por vía endovenosa) y desarrolló insuficiencia renal aguda estadio 3 según las guías KDIGO, la cual muy probablemente se relacionaba al consumo de metotrexato. El paciente recibió manejo con líquidos endovenosos y bicarbonato de sodio como promotores de la eliminación renal del tóxico, así como folinato cálcico oral, según el protocolo institucional, con lo cual se logró la recuperación de su función renal y que los niveles de niveles de creatinina y nitrógeno ureico mejoraran. Conclusiones. El manejo del paciente reportado demuestra que aunque la nefrotoxicidad por metotrexato es una entidad potencialmente grave, puede tener un buen pronóstico si se maneja oportunamente.

Linfoma cutâneo difuso de grandes células B, tipo perna: sobre um caso típico / Cutaneous diffuse large B-cell lymphoma, leg type - a typical case

O linfoma cutâneo difuso de grandes células B, tipo perna, compreende uma neoplasia rara, agressiva e de mau prognóstico. Corresponde a 10-20% dos linfomas cutâneos de células B e afeta principalmente membros inferiores de mulheres idosas. Relatamos o caso de mulher de 81 anos, com nódulos e tumorações dolorosos, de crescimento rápido na perna esquerda. Os achados histopatológicos e a imuno-histoquímica, associados à ausência de comprometimento extracutâneo no estadiamento, concluíram o diagnóstico de linfoma cutâneo difuso de grandes células B, tipo perna. A raridade, a clínica e a epidemiologia típicas e a excelente resposta ao tratamento motivaram este relato

Cutaneous diffuse large B-cell lymphoma, leg type, is a rare, aggressive, and poorly prognostic neoplasm. It corresponds to 10-20% of cutaneous B-cell lymphomas and mainly affects the lower limbs of older women. We report the case of an 81-year-old woman with painful, fast-growing nodules and tumors in her left leg. Histopathological and immunohistochemical findings, associated with the absence of extra-cutaneous involvement during staging, concluded the diagnosis of cutaneous diffuse large B-cell lymphoma, leg type. The rarity of this limphoma, its typical clinic and epidemiology, and the excellent response to treatment motivated this report

Tratamento cirúrgico exclusivo de linfoma B primário cutâneo da zona marginal: relato de caso / Exclusive surgical treatment of a primary cutaneous marginal zone lymphoma: a case report

Os linfomas B primários cutâneos (LBPCs) são linfomas não Hodgkin, de acometimento exclusivamente cutâneo, e representam 25% dos linfomas primários cutâneos. São divididos, conforme comportamento clínico, em indolentes e intermediários. O tratamento das formas indolentes inclui a cirurgia, a radioterapia e, em casos extensos, o rituximabe. Relata-se o caso de mulher de 57 anos, com placa única no braço esquerdo, com diagnóstico de LBPC da zona marginal, tratado com excisão com margens de segurança de 5mm, sem recidiva após 36 meses de seguimento. A cirurgia é uma alternativa terapêutica com bom resultado clínico, sem impacto na sobrevida livre da doença.

Primary cutaneous B-cell lymphomas are non-Hodgkin lymphomas presenting only in the skin and represent 25% of all primary cutaneous lymphomas. Based on their clinical behavior, they are classified into indolent and intermediate forms. Treatment of indolent forms includes surgery, radiotherapy, and, in extensive disease, rituximab. We report a case of a 57-year-old woman with a single nodule in the left arm treated with surgical excision with 5-mm security margins, without relapse after 36 months. Surgery is a therapeutic option in these lymphomas without compromising disease-free survival.

Mucormicosis orbitorrinocerebral: el manejo más allá de la cirugía. Informe de caso clínico y revisión de la literatura / Rhino-orbital-cerebral mucormycosis: management beyond surgery. Clinical case report and literature review

Introducción: se presenta el caso clínico de un paciente con mucormicosis orbitorrinocerebral y revisión de la literatura. Caso clínico: se trata de hombre de 45 años que consultó por síntomas nasosinusales manejado ambulatoriamente con múltiples antibióticos sin mejoría, por lo cual se realizó manejo quirúrgico con toma de muestras que revelaron hifas compatibles con mucormicosis. Cuando acudió a la institución presentaba extensión de la infección a todas las cavidades nasales y parte de la base del cráneo. En la búsqueda de la inmunosupresión, se encontró una diabetes de novo de difícil control. Discusión: la mucormicosis orbitorrinocerebral es una enfermedad altamente invasiva que requiere un manejo multidisciplinario, cirugías seriadas y extendidas, antimicóticos tópicos y sistémicos. El pronóstico mejora y la evolución puede ser favorable cuando se logra controlar la causa de la inmunosupresión, en este caso la diabetes. Conclusiones: es requisito fundamental realizar un tratamiento multidisciplinario en el abordaje de estos pacientes, tanto en la especialidad clínica como en la quirúrgica, psicosocial, nutricional y de rehabilitación.

Introduction: It is the clinical case of a patient with rhino-orbital-cerebral mucormycosis and the review of the literature. Clinical case: We present the case of a previously healthy young man who started with sinonasal symptoms and hyphae compatible with mucormycosis were found in the initial samples of outpatient care. When he came to the institution, the infection had spread to all the nasal cavities and part of the skull base. Discussion: Searching for baseline immunosuppression, only difficult-to-control diabetes and de novo diagnosis were found. It required multidisciplinary management, serial and extended surgeries, topical, venous and oral antifungals. The prognosis improved and the evolution became favorable when glycemic control was achieved. Conclusion: It is a fundamental requirement to carry out a multidisciplinary work for the approach to these patients, both in the clinical, surgical, psychosocial, nutritional and rehabilitation specialties.

Atypical magnetic resonance imaging findings, misdiagnosis analysis and functional imaging value of primary central nervous system lymphoma / 中国医师杂志

Objective:To observe and analyze the atypical magnetic resonance imaging (MRI) findings and misdiagnosis reasons of primary central nervous system lymphoma (PCNSL), and to explore the value of conventional MRI signs combined with minimum apparent diffusion coefficient value (ADCmin) and imaging features of magnetic resonance spectroscopy (MRS) in the diagnosis and differentiation of atypical PCNSL.Methods:The clinical and imaging data of 15 patients with atypical PCNSL confirmed by clinical and pathological findings from Lianyungang Second People′s Hospital and the Affiliated Hospital of Xuzhou Medical University from January 2015 to December 2020 was collected. All cases were examined by plain MRI, enhanced and diffusion weighted imaging (DWI), and 3 cases were examined by MRS. The conventional MRI features, DWI signal features and MRS imaging features of 15 cases of atypical PCNSL were observed and analyzed, and the MRI findings of atypical PCNSL and the causes of misdiagnosis were summarized and analyzed. The ADCmin of tumor parenchyma, the mean ADC values of proximal peritumor, distal peritumor and contralateral white matter were detected and compared to explore the variation rules of ADC values in different regions.Results:Of the 15 cases of PCNSL, 14 cases were single and 1 case was multiple, with a total of 21 lesions. (1) Single lesions in rare sites: 4 cases in the superficial part of the brain, 1 case in the bridge arm, 1 case in the cerebellar hemisphere, 1 case in the suprasellar saddle, and 1 case in the third ventricle. (2) Atypical MRI findings: cystic degeneration or necrosis in 5 lesions (5/21), accompanied by hemorrhage in 1 lesion (1/21); There were 3 isosensitive lesions on DWI, and isosensitive lesions on ADC false color images. There were 5 ring enhancement lesions and 3 sheet enhancement lesions. (3) Multi-center growth pattern: 1 case with a total of 7 lesions, located in the right thalamus, basal ganglia and corona radiata, showing multiple nodules and ring enhancement. 1H-MRS examination showed that choline (Cho) peak increased, creatine (Cr) peak decreased, N-acetyl aspartate (NAA) peak decreased, and obvious Lip peak appeared in all the 3 cases with single lesions. 2 cases showed high Lip peak as the first peak. The ADCmin values of tumor parenchyma, proximal peritumor, distal peritumor and contralateral white matter showed a parabola pattern of first rise and then decline, as follows: (0.54±0.06)×10 -3 mm 2/s, (1.55±0.10)×10 -3 mm 2/s, (1.45±0.09)×10 -3 mm 2/s, (0.85±0.03)×10 -3 mm 2/s, overall difference was statistically significant ( F=630.570, P<0.001). The pairwise comparison was statistically significant (all P<0.05). Conclusions:Atypical PCNSL is easy to be misdiagnosed. Conventional MRI feature analysis combined with DWI and MRS imaging features and comparison of ADC values in different tumor areas are helpful for the diagnosis and differentiation of PCNSL and are expected to improve diagnostic accuracy.

Research advance in primary ovarian Burkitt lymphoma / 中国基层医药

Among all non-Hodgkin's lymphoma, primary ovarian Burkitt lymphoma (POBL) is a rare disease. Tumors can occur in one or both ovaries. The main symptoms of POBL are abdominal pain or a large abdominal mass. The differential diagnosis of POBL based on imaging characteristics and histopathological examination is the basis for further treatment of ovarian tumors from different sources. Although most patients with POBL have undergone surgical treatment after the discovery of ovarian masses, chemotherapy rather than surgery should be the main treatment method for them. Active chemotherapy combined with preventive central nervous system therapy leads to good prognosis. A variety of treatment schemes have been adopted, which greatly increase the survival rate of patients with POBL. In this review, we retrieved related literature and retrospectively reviewed the epidemiology, clinical manifestation, diagnosis and treatment of POBL. The purpose of this review is to draw clinicians' attention to the possibility of POBL when performing differential diagnosis of ovarian tumors.

Research progress of metformin in non-Hodgkin lymphoma / 国际肿瘤学杂志

Preclinical studies have shown that metformin, an activator of AMP-activated protein kinase (AMPK) , can inhibit the growth of lymphoma cells without affecting the function of normal lymphocytes, promote the apoptosis of lymphoma cells and improve the tumor immune environment. Clinical studies have shown that metformin can improve the efficacy of chemotherapy and prognosis of non-Hodgkin lymphoma (NHL) . Through the influence on glucose metabolism, it can improve blood glucose level and reduce the incidence of steroid diabetes. The main molecular mechanisms of metformin against NHL include activating AMPK in tumor cells, inhibiting mammalian target of rapamycin signal, inhibiting key cholesterol synthesis, improving glucose metabolism, enhancing highly cytotoxic T lymphocyte (CTL) activity and so on. Current research shows that metformin may become a new strategy for the treatment of NHL.

Comparison of efficacy and safety of obinutuzumab-based regimen versus rituximab-based regimen in treatment of B-cell non-Hodgkin lymphoma: a Meta-analysis / 白血病·淋巴瘤

Objective:To systematically evaluate the efficacy and safety of obinutuzumab-based regimen versus rituximab-based regimen in treatment of B-cell non-Hodgkin lymphoma (B-NHL).Methods:The Cochrane clinical controlled trials database, PubMed, Embase, American Society of Hematology meeting proceedings, American Society of Clinical Oncology annual meeting proceedings and ClinicalTrails database were searched for studies on the use of regimens containing obinutuzumab or rituximab for the treatment of B-NHL. Patients were divided into obinutuzumab group and rituximab group according to their medication status. Review Manager 5.3 software was used to compare the efficacy and safety of the two groups.Results:A total of 7 randomized controlled trials were selected, including 4 235 patients (1 430 cases of follicular lymphoma, 2 102 cases of diffuse large B-cell lymphoma, and 703 cases of other B-NHL); 2 121 cases were in the obinutuzumab group and 2 114 cases were in the rituximab group. Among 4 162 patients who could be evaluated, the objective response rate (ORR) in the obinutuzumab group was higher than that in the rituximab group [75.1% (1 565/2 083) vs. 72.7% (1 512/2 079); OR = 1.19, 95% CI 1.01-1.41, P = 0.03]. Progression-free survival (PFS) in the obinutuzumab group was better than that in the rituximab group ( HR = 0.86, 95% CI 0.75-0.99, P = 0.03). Among 3 542 patients who could be evaluated for adverse reactions, the incidence of grade 3-4 adverse reactions in the otuzumab group was higher than that in the rituximab group [61.8% (1 098/ 1 776) vs. 54.2% (958/1 766); OR = 1.50, 95% CI 1.29-1.74, P < 0.001], the incidence of grade 3-4 infusive-related adverse reactions [7.5% (158/1 776) vs. 3.1% (65/1 766); OR = 2.56, 95% CI 1.91-3.45, P < 0.001] and neutropenia [34.1% (597/1 749) vs. 29.4% (511/1 738); OR = 1.27, 95% CI 1.09-1.47, P = 0.002] in the obinutuzumab group were higher than those in the rituximab group. Conclusions:The ORR and PFS of B-NHL patients treated with obinutuzumab-based regimen are better than those treated with rituximab-based regimen, but the influence of adverse reactions should be considered when selecting the regimen.

Primary central nervous system T-cell lymphoma: a case report / 中华神经科杂志

Primary central nervous system T-cell lymphomas (PCNSTL) are rare, the clinical symptoms and radiographic imaging of which are unspecific, and the pathological morphology is antypical, leading to misdiagnosis and delays in treatment. A 45-year-old male patient with diplopia accompanied by numbness and dysarthria was reported in this paper, which was considered as "lymphoma or lymphoproliferative lesions" on magnetic resonance imaging (MRI) while no typical tumor cells in brain biopsy. The clinical symptoms worsened one month later and the reexamined MRI showed that the scope of the lesion was enlarged and the enhancement was more obvious than before, which was still considered as lymphoma or lymphoproliferative lesion. The second biopsy was performed and still no typical tumor lymphocytes were seen. Finally, gene rearrangement was carried out and showed the β and γ chains both present positive mutations in T cell receptor (TCR) gene rearrangement. Combined with cell morphology, immunophenotype and TCR gene rearrangement results, the patient was finally diagnosed as PCNSTL. This article reviewed the clinical symptoms, imaging features, laboratory examinations, pathological characteristics, diagnosis and differential diagnosis of PCNSTL, so as to improve the understanding of this rare disease.

Linfoma difuso de células grandes B CD5 positivo con compromiso prostático: una recurrencia inusual / CD5 positive Diffuse large B cell lymphoma with prostate involvement: An unusual recurrenc

Introducción: El Linfoma de células grandes B CD5 positivo (LDCGB CD5+) constituye una patología rara y agresiva con pobre respuesta a la quimioinmunoterapia. Objetivo: Describir un caso con diagnóstico de LDCGB CD5+ con recurrencia inusual prostática. Caso clínico: Paciente varón de 61 años con sintomatología de dolor abdominal y síntomas B. Los estudios de imagen mostraron adenopatías mediastinales y retroperitoneales. El informe patológico fue compatible LDCGB CD5+, recibiendo terapia de primera línea con R-CHOP logrando remisión completa, con recaída precoz prostática confirmada por inmunohistoquímica. Posteriormente, inicia terapia de rescate con R-ICE, con pobre respuesta y deterioro del estado funcional. Conclusiones: El LDCGB CD5 + representa una patología infrecuente y agresiva, siendo la recaída en próstata un evento muy inusual, es por ello que los exámenes clínicos exhaustivos y anatomo-patológico son esenciales para un diagnóstico certero. A la fecha, la respuesta a terapias estándar o de mayor intensidad son desalentadoras, por lo que es necesario un mayor número de estudios a futuro(AU)

Introduction: CD5 positive Large B-cell Lymphoma (CD5 + DLBCL) constitutes a rare and aggressive pathology with poor response to chemoimmunotherapy. Objective: To describe a case with a diagnosis of CD5 + DLBCL with an unusual recurrence in the prostate. Clinical case: A 61-year-old male presented abdominal pain and B symptoms. Imaging studies showed mediastinal and retroperitoneal lymphadenopathy. The pathology informed a CD5+ DLBCL diagnosis, receiving first-line R-CHOP treatment and achieving complete remission, with prostatic early relapse confirmed by immunohistochemistry. Therefore, he received R-ICE as rescue treatment with poor response and performance status decline. Conclusions: CD5 + LDCGB represents a rare and aggressive disease, being the prostate relapse a very unusual event, in which the exhaustive clinical and pathological workup is essential for an accurate diagnosis. To date, the response to standard or higher-intensity therapies is disappointing, so more studies are needed in the future(AU)

Linfoma con morfología en anillo de sello: patología con distintivos diagnósticos diferenciales / Lymphoma with signet ring morphology: pathology with distinctive differential diagnoses

Introducción: el linfoma con células en anillo de sello es una entidad poco frecuente y simuladora de neoplasias epiteliales, sarcomas y condiciones reactivas de histiocitos. Representa una variante morfológica de distintos linfomas no Hodgkin, por lo que su diagnóstico puede representar un desafío y debe ser considerado al realizar estudios complementarios. Objetivo: mostrar un caso con una morfología muy poco frecuente y recalcar la importancia de conocer esta entidad para no cometer errores en su diagnóstico. Caso clínico: se documenta el caso de un hombre de 67 años que desarrolló crecimientos ganglionares en axila derecha, cuello, ingle derecha, y región submandibular, con aparente afección en pulmones y bazo, que fue diagnosticado como linfoma B difuso de células grandes con morfología en anillo de sello, originado en el centro germinal. Se realizó estudio de microscopía electrónica de transmisión para una mejor caracterización de la morfología. Desafortunadamente el paciente no regresó a consulta de seguimiento, por lo que no inició tratamiento, falleció a los 6 meses posteriores al diagnóstico. Conclusiones: el linfoma con fenotipo en anillo de sello es poco frecuente, y puede presentarse en cualquier tipo de linfomas no Hodgkin; sin embargo, esta morfología es más comúnmente asociada a carcinomas y, en menor frecuencia, a sarcomas, melanomas o histiocitos reactivos, por lo que el considerar esta entidad junto con el uso adecuado de estudios complementarios es de gran importancia para su adecuado diagnóstico.

Background: Signet-ring cell lymphoma is a rare entity that simulates epithelial neoplasms, sarcomas and reactive histiocytes conditions. It represents a morphological variant of non-Hodgkin's lymphomas, its diagnosis can represent a challenge, therefore it should be considered in complementary studies. Objective: The aim of this work is to show a case with a very rare morphology and to emphasize the importance of awareness this entity and avoid mistakes in its diagnosis. Clinical case: We present a case of a 67-year-old man, who developed lymph node growths in the right armpit, neck, right groin, and submandibular region, with apparent involvement of the lungs and spleen; was diagnosed as diffuse large B cell lymphoma with signet-ring morphology, originated in the germinal center. Transmission electron microscopy study was carried out for a more precise characterization of the morphology. Unfortunately, the patient did not return for a follow-up consultation, so he did not start treatment and died 6 months after diagnosis. Conclusions: Lymphoma with the signet-ring phenotype is rare, and can occur in any type of non-Hodgkin lymphoma; however, this morphology is more commonly associated with carcinomas and, less frequently, with sarcomas, melanomas or reactive histiocytes conditions, therefore should be considered this entity together with the appropriate use of complementary studies for proper diagnosis.

Esplenectomía laparoscópica en esplenomegalia masiva por linfoma no Hodgkin de zona marginal / Massive laparoscopic splenectomy for marginal zone non-Hodgkin lymphoma / Esplenectomia laparoscópica em esplenomegalia maciça devido a linfoma não-Hodgkin de zona marginal

Resumen: Introducción: si bien la esplenectomía laparoscópica en esplenomegalias masivas y supramasivas constituye un desafío técnico, su realización es factible y segura en centros con equipos con experiencia en cirugía laparoscópica. Objetivo: presentar el primer caso de esplenectomía laparoscópica en esplenomegalia masiva realizada en Uruguay. Caso clínico: se trata de una paciente de 70 años portadora de una pancitopenia periférica, esplenomegalia masiva y diagnóstico realizado por punción de médula ósea de neoplasia linfoproliferativa tipo B de bajo grado, a quien se le indicó la esplenectomía con fines diagnósticos y terapéuticos. La paciente se operó en decúbito lateral derecho a 15 grados, los trócares se colocaron bajo visión directa adaptados al tamaño del bazo que se extendía desde el diafragma hasta el estrecho superior de la pelvis. Se realizó la esplenectomía en un tiempo de 220 minutos, extrayéndose la pieza íntegra y sin haberla colocado en bolsa a través de un hemi Pfannenstiel, protegiendo la pared con un retractor de heridas quirúrgicas. No presentó complicaciones, fue dada de alta a las 48 horas. El hemograma realizado a las 24 horas demostró un aumento de las cifras de todas las series celulares y el informe anatomopatológico diagnosticó un linfoma no Hodgkin de zona marginal. Discusión: la esplenectomía laparoscópica en esplenomegalias masivas requiere de un mayor tiempo quirúrgico, aunque las pérdidas sanguíneas y la estadía hospitalaria son menores en comparación a los procedimientos convencionales, presentando una morbilidad similar. En la experiencia inicial de los equipos quirúrgicos se reporta un porcentaje de conversiones y reingresos cercanos al 30%.

Abstract: Introduction: despite the fact that laparoscopic splenectomy for massive and supramassive splenomegaly constitutes a technical challenge, it is a feasible and safe procedure in the context of institutions with experienced teams in laparoscopic surgery. Objective: to present the first case of laparoscopic splenectomy for massive splenomegaly in Uruguay. Clinical case: the study presents the case of a 70-year-old patient carrier of peripheral pancytopenia, massive splenomegaly and a diagnosis of type B lymphoproliferative neoplasm based on bone marrow aspiration and biopsy, who underwent diagnostic and therapeutic splenectomy. The patient was operated in supine position with a 15-degree tilt, the trocars were placed under direct view, adapted to the size of the spleen which went from the diaphragm until the superior pelvic outlet. Splenectomy was performed in 220 minutes, the entire piece was removed through a hemi Pfannenstiel incision, without placing it in a bag, the wall being protected with a surgical wound retractor. There were no complications and the patient was discharged from hospital 48 hours. The blood count performed after 24 hours evidenced increase in all cell series and the pathology report confirmed diagnosis of marginal zone non- Hodgkin lymphoma. Discussion: laparoscoppic splenectomy in massive splenomegaly requires of a greater surgical time, although blood loss and hospital star are lower when compared to conventional procedures and evidence similar morbility. The initial experience of surgical teams reports 30% of conversions and readmissions.

Resumo: Introdução: embora a esplenectomia laparoscópica em esplenomegalias massivas e supremassivas seja um desafio técnico, sua realização é viável e segura em centros com equipes com experiência em cirurgia laparoscópica. Objetivo: apresentar o primeiro caso de esplenectomia laparoscópica em esplenomegalia maciça realizada no Uruguai. Caso clínico: paciente de 70 anos com pancitopenia periférica, esplenomegalia maciça e diagnóstico feito por punção de medula óssea de neoplasia linfoproliferativa tipo B de baixo grau, com indicação de esplenectomia para fins diagnósticos e terapêuticos. A paciente foi operada em decúbito lateral direito a 15 graus, os trocartes foram colocados sob visão direta adaptados ao tamanho do baço que se estendia do diafragma ao estreito superior da pelve. A esplenectomia foi realizada em um tempo de 220 minutos, retirando-se toda a peça e sem colocá-la em bolsa por meio de uma hemi Pfannenstiel, protegendo a parede com afastador de ferida operatória. Sem apresentar complicações a paciente teve alta após 48 horas. O hemograma realizado 24 horas depois da cirurgia mostrou um aumento no número de todas as séries de células e o laudo anatomopatológico diagnosticou linfoma não Hodgkin de zona marginal. Discussão: a esplenectomia laparoscópica nas esplenomegalias maciças requer um tempo cirúrgico maior, embora as perdas sanguíneas e a permanência hospitalar sejam menores em comparação aos procedimentos convencionais, apresentando morbidade semelhante. Na experiência inicial das equipes cirúrgicas, é relatado um percentual de conversões e readmissões próximo a 30%.

Pérdida de agudeza visual progresiva en paciente con proptosis. Caso clínico y revisión de la literatura / Progressive visual impairment in a patient with proptosis. Case report and review of the literature.

Introducción: a raíz del siguiente reporte de caso clínico se pretende repensar el diagnóstico diferencial de los tumores orbitales y revisar la literatura existente al respecto. Caso: paciente de 54 años, fumadora, acude a nuestro centro por una pérdida de agudeza visual progresiva de dos años de evolución en el ojo derecho, que se acompañaba de proptosis. Las pruebas de imagen basadas en resonancia magnética y tomografía por emisión de positrones ­ tomografía computarizada (PET-TC) realizadas describían una lesión intraconal derecha de morfología indefinida, que rodeaba el nervio óptico. El estudio inmunohistoquímico y molecular anatomopatológico confirmó la sospecha de síndrome linfoproliferativo extranodal de bajo grado. Discusión: el manejo endoscópico de estas lesiones puede resultar en una menor comorbilidad en comparación con el abordaje externo tradicional. El papel de la cirugía radica en la obtención de una muestra de la lesión que permita un correcto diagnóstico. Conclusiones: el abordaje multidisciplinar con oftalmólogos, hematólogos y expertos en radioterapia permite obtener buenos resultados quirúrgicos y clínicos en la inmensa mayoría de casos.

Introduction: as result of the following clinical case report, we intend to review the differential diagnosis of orbital tumors and review the existing literature in this regard. Case report: a 54-year-old smoking patient, consulted to our department due to a progressive visual impairment over the last two years in her right eye. She presented proptosis in her clinical examination. Imaging studies based on MRI and PET-CT described a right intraconal lesion with an undefined morphology surrounding the optic nerve. Orbital tumors differential diagnosis is delicate. Nevertheless, Non-Hodgkin lymphomas followed by metastasis are the two most common found in this location. The immunohistochemistry and molecular studies, confirmed the suspected diagnosis of extranodal low-grade lymphoproliferative syndrome. Discussion: endoscopic management of these lesions may result in a lower comorbidity compared to traditional external approaches. Role of surgery lays in obtainment of a quality sample which allows a proper diagnosis. Conclusions: multidisciplinary approach with ophthalmologists, hematologists and radiotherapy experts enhance good surgical and clinical results in the vast majority of cases.

Intravascular large B-cell lymphoma presenting with fever and refractory acidosis

Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse large B-cell lymphoma, characterized by malignant B-cells primarily localized to the lumina of small- and medium-sized blood vessels without lymphadenopathy. Two patients initially presented with fever of unknown origin and persistent lactic acidosis without evidence of tissue hypoxia. Neither patient had an identifiable source of infection and both underwent peripheral blood smear demonstrating leukocytosis with a neutrophilic predominance and thrombocytopenia without evidence of hematologic malignancy. One had previously had a bone marrow biopsy which was unremarkable. Both patients' condition deteriorated rapidly, progressing to multiorgan failure requiring pressors and mechanical ventilation, which ultimately resulted in cardiopulmonary arrest. At autopsy, each patient demonstrated malignant lymphocytoid cells, staining positive for CD20, localized to the lumina of small- and medium-sized vessels in multiple organs, including the lungs, liver, spleen, and kidneys, among others, allowing for the diagnosis of IVLBCL. IVLBCL is exceedingly rare, which in combination with significant variability in presentation, can make identification and diagnosis challenging. Diagnosis requires biopsy, therefore a high index of suspicion is needed to obtain an adequate tissue sample, whether pre- or postmortem. In the presented cases, both patients exhibited type B lactic acidosis with an unknown etiology that was ultimately determined at autopsy.