Sinonasal lymphoma: a clinicopathologic analysis of 58 cases from the Massachusetts General Hospital.

Few large series compare lymphomas of the nasal cavity with those of the paranasal sinuses. We studied the cases of 58 patients, 34 males and 24 females, aged 7 to 92 years (mean, 57 years), who had lymphoma involving the nasal cavity or paranasal sinuses. Thirty-three patients had diffuse large B-cell lymphoma (DLBCL). Twenty-three were male and 10 were female, with an age range of 7 to 91 years (mean, 63 years); two were HIV-positive. Only 2 of 11 cases tested (one in an HIV-positive patient and one of lymphomatoid granulomatosis type) were Epstein-Barr virus (EBV)-positive. Thirty (91%) involved paranasal sinuses, 10 with nasal involvement, whereas three cases had nasal, but not sinus, involvement. At last follow-up, 16 (67%) were free of disease 7 to 169 months later (mean, 65 months), and 8 (33%) had died of disease 2 to 166 months later (mean, 45 months). Seventeen patients had nasal-type natural killer (NK)/T-cell lymphoma. There were 10 women and 7 men, aged 27 to 78 years (mean, 48 years). Thirteen of 14 were EBV-positive. Sixteen patients had nasal involvement, eight with sinus involvement. Eleven (73%) of 15 were alive and well 6 to 321 months later (mean, 139 months), three (20%) died of lymphoma 1, 11, and 12 months later, and one (7%) is alive with disease. There was one case each of marginal zone B-cell lymphoma, Burkitt's lymphoma, Burkitt-like lymphoma, peripheral T-cell lymphoma of unspecified type, and adult T-cell lymphoma/leukemia. In an additional three cases, the lymphomas were composed predominantly of large cells, but no immunophenotyping could be performed for subclassification. In 19 cases (17 DLBCLs, 1 Burkitt-like lymphoma, and 1 lymphoma of uncertain lineage), presenting symptoms included complaints related to the eyes. In 16 cases (13 DLBCLs, 1 Burkitt-like lymphoma, 1 nasal NK/T-cell lymphoma, and 1 lymphoma of uncertain lineage), the orbit was invaded by lymphoma. In our series, the most common lymphoma to arise in the sinonasal area is DLBCL, followed by nasal NK/T-cell lymphoma. Comparison of these two types of lymphoma showed that lymphomas involving sinuses without nasal involvement were predominantly DLBCLs (20 of 21), whereas nasal cavity lymphomas without sinus involvement were usually NK/T-cell type (8 of 11) (p = 0.000125). Compared with patients with DLBCL, patients with nasal NK/T-cell lymphoma were overall younger, with a lower male-to-female ratio. Lymphomas of B-cell lineage were more likely to be associated with symptoms related to the eyes (p < 0.0005) and to have extension to the orbit (p < 0.01) than were lymphomas of T- or NK-cell lineage. In contrast to results of Asian studies in which nasal NK/T-cell lymphoma has a very poor prognosis, our nasal NK/T-cell lymphomas had an outcome similar to that of DLBCL.

Prognostic significance of cutaneous depigmentation in Mexican patients with malignant melanoma.

BACKGROUND: The clinical significance of cutaneous depigmentary phenomena in patients with malignant melanoma is not clear. There are two varieties: 1) vitiligo (VIT), and 2) leukoderma acquisitum centrifugum (LAC). METHODS: In order to evaluate the outcome of our patients with malignant melanoma and skin depigmentation (VIT or LAC), the patients in this study with this association were retrospectively reviewed and compared with the total melanoma patients at the Oncology Hospital and the XXI Century National Medical Center of the Mexican Social Security Institute in Mexico City. RESULTS: Nine cases were found from 1985-1995. There were eight women and one man, their mean age was 63 years. Six melanomas were located in the foot, one in the leg, one in the anus and one in the neck. All were Clark's levels III, IV or V, and their mean tumor thickness was 5.7 mm. Four out of nine patients had regional lymph node metastasis. Six melanomas were associated with VIT and three with LAC. Three patients developed the depigmentation after chemo- or chemoimmunotherapy. All nine patients are alive (100%) with a mean follow-up of 55 months (9-141), eight out of nine have no evidence of tumor. CONCLUSIONS: From these data it may be concluded that the study patients with malignant melanoma and VIT or LAC have a higher-than-expected survival according to their prognostic factors. Therefore, the presence of the depigmentation phenomena must be looked for intentionally.