Staging for CLL-type non-Hodgkin's lymphoma reveals a gastrointestinal stromal tumour.

We report a 73-year-old man presenting with fatigue, lymphadenopathy and weight loss. He had no abdominal pain, fever or night sweats. Physical examination revealed a palpable 1.4-cm hard nontender lymph node behind the left sternocleidomastoid muscle and a palpable 2-cm lymph node in the left axilla. Bone marrow examination and excisional biopsy of the lymph node behind the left sterno-cleidomastoid muscle showed a CLL-type non-Hodgkin's lymphoma (CLL-type NHL). Staging by CT scanning revealed, besides axillary and mediastinal adenopathy, an unexpected mass in the stomach. Gastroscopy and pathological evaluation showed a gastrointestinal stromal tumour (GIST) with immunohistochemical staining for CD 34 and CD 117. The patient was treated with imatinib. CLL-type NHL and GIST both tend to occur in middle-aged and older patients. A double-tumour consisting of both these tumours is rare: the incidence is estimated to be 3 per 10 billion people.

High-dose dexamethasone as a first- and second-line treatment of idiopathic thrombocytopenic purpura in adults.

The current first-line choice of treatment of idiopathic thrombocytopenic purpura (ITP) in adults, prednisone, is effective but has many side effects. Furthermore, reduction of the dose leads to a relapse of ITP in a majority of cases. Courses of high-dose dexamethasone (HD) aim to avoid these problems. We treated 36 patients with newly diagnosed or recurrent ITP with an 8-day course of HD, with a peak dose of 40 mg/day. The courses were repeated up to a maximum of six courses, with a 28-day interval. Acute and chronic effects of HD on platelet counts were observed, as well as side effects. HD led to an acute response (rise of platelet count to a level above 50 x 10(9)/l) in 83%. When HD was given as a first-line treatment, 59% of patients were still in remission after 31 months. When HD was given as a second-line treatment, 50% of patients were in remission after 5 months, declining to 25% after 54 months. Side effects were frequent but rarely dangerous. In conclusion, acute effects of HD were excellent. Long-term effects of HD as a first-line therapy of ITP were good, but its long-term effects as a second-line therapy were much poorer.

Rituximab in the treatment of relapsing idiopathic thrombocytopenic purpura.

About 25 to 30% of patients with idiopathic thrombocytopenic purpura (ITP) are resistant to standard treatment with steroids and splenectomy. In these patients with chronic refractory ITP, there is no proven algorithm for standard care. Recently, the chimeric anti-CD20 monoclonal antibody rituximab was considered as an alternative treatment option in this patient group. We present a patient with frequently relapsing ITP after treatment with prednisone, splenectomy and high-dose dexamethasone. Since he experienced increasing side effects due to the steroids, he was treated with rituximab 375 mg/m2, once weekly for four weeks, resulting in a complete long-lasting response (follow-up seven months).

Inhibition of emotional expression in breast cancer patients.

To obtain a better understanding of the inhibited emotional expression often reported in breast cancer patients, the authors compared 48 breast cancer patients and 49 healthy women with respect to disturbed emotional processes (alexithymia), emotional disclosure, emotional expression, assertiveness, repression, and distress. The patient group showed significantly more ambivalence over emotional expression, more restraint, and more anxiety than the healthy controls. No differences were found between the 2 groups in alexithymia, expressing emotions in general, or willingness to talk with others about emotions. The image of the breast cancer patient that emerged in the study was that of a person who has conflicting feelings with regard to expressing emotions, is reserved and anxious, is self-effacing, and represses aggression and impulsiveness. These findings suggest that cancer patients' inhibited behavior is a reaction to the disease rather than a reflection of a personality characteristic predisposing an individual to (breast) cancer.

The impact of 5-FU-based bolus chemotherapy on survival in patients with advanced colorectal cancer.

BACKGROUND: An analysis was performed to evaluate whether bolus chemotherapy with 5-fluorouracil (5-FU) and leucovorin (LV) improves survival for patients with advanced colorectal cancer (ACC). PATIENTS AND METHODS: Two groups of patients were selected from a database which included all patients with colorectal cancer treated in our hospital since 1984. The first group consisted of all patients with irresectable metastases diagnosed between January 1984 and December 1989, who had a performance status of 0 or 1, and were younger than 76 years old. The second group consisted of all patients with irresectable metastases--younger than 76 years old and with a performance status of 0 or 1--who were started on chemotherapy between January 1994 and December 1997. In the first period chemotherapy was never given and in the second period chemotherapy was given to all motivated patients. None of the patients had received a previous metastasectomy or isolated liver perfusion. For chemotherapy, age, location of the metastases, type of surgical intervention for the primary tumor, Hemoglobin, Lactate Dehydrogenase and Carcinoembryonic Antigen concentration we evaluated the relationship with survival. Variables which showed a significant relation with survival in the univariant analysis (logrank test, p < 0.05) were entered into a proportional hazards regression analysis. RESULTS: In the univariant analysis chemotherapy and location of metastases showed a significant relation with survival. The median survival was 11 months for patients who had received chemotherapy and 8 months for untreated patients (p = 0.009). Chemotherapy and location of metastases both retained their significance in a proportional hazards regression analysis. CONCLUSION: In our study group chemotherapy added 3 months to the median life expectancy for patients with ACC.

A patient with fatal cold haemagglutinins.

We describe a patient with an acute fatal autoimmune haemolytic anaemia (AIHA) due to idiopathic cold haemagglutinins. According to the literature the dramatic course of this cold haemagglutinin disease is uncommon.

Regional enteritis complicating malignant lymphoma.

We describe a patient presenting with palpable lymph nodes due to non-Hodgkin's lymphoma. Chemotherapy induced complete remission. One year later he complained of cramping abdominal pain, diarrhoea and bloody stools all due to Crohn's disease of the colon. There are only a few more patients described with a combination of inflammatory bowel disease and malignant lymphoma. So far there is no explanation for the co-incidence of the two diseases.

Acute renal failure as first presentation of acute lymphoblastic leukaemia.

A 26-year-old man presented with acute renal failure, which appeared to be due to uric acid nephropathy occurring as a metabolic complication of acute lymphoblastic leukaemia with T-cell immunophenotype. At presentation there were neither other manifestations of leukaemic disease nor signs of a large leukaemic cell burden, which is very uncommon.

Rounded atelectasis of the lung, just a benign disorder.

Three patients with rounded atelectases are described. One of them developed a malignant non-Hodgkin lymphoma 6 months after presentation with rounded atelectasis. His rounded atelectasis could be followed during 20 months and was unrelated to the appearance, complete remission after chemotherapy and relapse of a malignant non-Hodgkin lymphoma. Rounded atelectasis of the lung is a little-known form of peripheral pulmonary collapse which may mimic a neoplastic tumour. It might be formed either because of a folding in a basal lung segment caused by temporarily pleural effusion, or because of initial damage to the pleura which leads to fibrosis and thus to challenge to the clinician, it should be emphasized that the benign nature of rounded atelectasis should be recognized by radiological techniques.

EORTC study of non-Hodgkin's lymphoma: phase III study comparing CHVmP-VB and ProMACE-MOPP in patients with stage II, III, and IV intermediate- and high-grade lymphoma.

In the EORTC lymphoma cooperative group, a randomized phase III study was done for patients with stage II, III, IV intermediate- and high-grade lymphoma. Eight courses of CHVmP-VB were compared to eight courses of ProMACE-MOPP. Response was evaluated after 8 courses. Of 430 patients entered, 346 were eligible for this first analysis. Additional radiotherapy was given at initial large masses or residual disease after three courses. Response rate was higher in the CHVmP-VB arm in comparison to the ProMACE-MOPP arm, 82% vs. 65% (p < 0.0005). In the ProMACE-MOPP arm, treatment had to be interrupted because of patient refusal in 7% of the patients. So far there has been no significant difference in freedom from progression at 5 years (49% vs. 47%), relapse-free survival (59% vs. 59%), or overall survival (55% vs. 49%). Patients with early response at 4 courses showed no better RFS in comparison with late responders between 4 and 8 courses. The International Index, based on age, stage, SLDH, performance status, and number of extranodal localizations showed a good prognostic significance in this series of patients.

Lymph node histology simulating T-cell lymphoma in adult-onset Still's disease.

A patient with adult-onset Still's disease (AOSD) underwent lymph node biopsy as part of initial evaluation for fever of unknown origin. The lymph node histology showed a massive, diffuse immunoblastic hyperplasia, simulating T-cell lymphoma. This nodal histology differs from rheumatoid arthritis, where mostly a follicular B-cell reaction predominates. Evaluating fever of unknown origin when one is unacquainted with this massive immunoblastic hyperplasia can lead to the wrong diagnosis of T-cell lymphoma in patients with AOSD.

Primary malignant lymphoma of the uterine cervix associated with cold-reacting autoantibody-mediated hemolytic anemia.

A 66-year-old woman presented with autoimmune hemolytic anemia of the cold antibody type as one of the first symptoms of a non-Hodgkin lymphoma (NHL) localized primarily in the uterine cervix. Cold-reacting autoantibody-mediated hemolytic anemia is a rare complication of NHL. Its occurrence as one of the presenting symptoms of NHL is even more unusual. The incidence of a primary malignant lymphoma in the genital tract is low. The combination of these phenomena in one patient make this case unique in the English literature.