RESUMEN
Marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) of the breast with amyloid deposits is a very rare cause of breast malignancy. Patients who carry a diagnosis of Sjogren's syndrome (SS) have a 5-10% lifetime risk of developing non-Hodgkin lymphoma with MALT lymphoma as the most common histologic subtype. Our case highlights the importance of routine screening mammography in the early detection of such unusual malignancies, and further interventions needed to diagnose and appropriately manage breast MALT lymphoma.
Asunto(s)
Mieloma Múltiple/patología , Células Plasmáticas/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Anticuerpos Monoclonales/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Médula Ósea/patología , Resultado Fatal , Humanos , Cadenas lambda de Inmunoglobulina/inmunología , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Mieloma Múltiple/inmunología , Mieloma Múltiple/terapia , Metástasis de la Neoplasia/diagnóstico por imagen , Metástasis de la Neoplasia/patología , Células Plasmáticas/inmunología , Neoplasias de la Columna Vertebral/diagnóstico por imagen , Neoplasias de la Columna Vertebral/patología , Neoplasias de la Columna Vertebral/radioterapia , Testículo/patologíaRESUMEN
PURPOSE OF REVIEW: Given the median age at diagnosis of 69, multiple myeloma (MM) is commonly identified among elderly individuals. Over-treatment of the frail may lead to unnecessary morbidity, while under-treatment of fit elderly patients may prevent improvement in organ function; both instances reducing quality of life. Here, we summarize assessments of frailty and include considerations in managing newly diagnosed elderly MM patients. RECENT FINDINGS: Eligibility criteria for studies of anti-myeloma agents have traditionally relied on performance status and comorbidities; however, geriatric and myeloma-specific frailty assessments are beginning to be incorporated for more accurate stratification of patients for treatment. The IMWG and R-MCI scores are validated metrics that predict survival in elderly MM patients. In addition, dose-attenuated induction regimens and conditioning before autologous transplant may decrease morbidity in elderly MM patients. Although MM remains incurable, multi-drug regimens have the ability to prolong survival of both untreated and relapsed elderly patients. Older patients require a highly individualized approach since they may have preexisting organ dysfunction, worse frailty scores, and variable goals of care.