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1.
Medicine (Baltimore) ; 99(9): e18601, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118703

RESUMO

INTRODUCTION: Primary immunodeficiency diseases (PIDs), a rare group of gene defects with different manifestations, are at great risk of malignancy. The incidence of diffuse large B-cell lymphoma in the sinusoidal tract is quite rare with nasal congestion, stuffiness, and pain in maxillary sinus manifestation. Human serine-threonine kinase 4 (STK4) deficiency affects the immune system with recurrent bacterial and viral infections, mucocutaneous candidiasis, cutaneous warts, skin abscesses, T- and B-cell lymphopenia, and neutropenia. PATIENT CONCERN: In this study we describe the infrequent incidence and successful treatment of sinusoidal diffuse large B-cell lymphoma in a STK4 deficient patient with clinical manifestation of severe intractable headaches, unilateral swelling of her face, nasal congestion, stuffiness, and pain in maxillary. DIAGNOSIS: Clinical data including headaches, unilateral swelling of face, nasal congestion, stuffiness and pain in maxillary sinus with confirmed histopathology and magnetic resonance imaging finding confirmed sinusoidal diffuse large B cell lymphoma in a STK4 deficient patient. INTERVENTION: Six cycles of R-CHOP (rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisolone) were administered and after each cycle, G-CSF support was used. Chemotherapeutic drugs were administered with standard dose and no dose reduction was done during the treatment. IVIG treatment continued during the courses of chemotherapy. OUTCOME: The index patient achieved complete response at the end of chemotherapy courses and was in remission for about 8 months afterward, prior to the date of the present report. CONCLUSION: PID patient are often at increased risk of malignancies. Sinusoidal diffuse large B-cell lymphoma is quite rare and prognosis is variable. Early attention to patient's manifestation, suitable treatment, and monitoring manifestations caused by PID are critical.


Assuntos
Linfoma Difuso de Grandes Células B/etiologia , Neoplasias do Seio Maxilar/etiologia , Proteínas Serina-Treonina Quinases/deficiência , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica , Ciclofosfamida , Doxorrubicina , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Imagem por Ressonância Magnética , Neoplasias do Seio Maxilar/diagnóstico por imagem , Neoplasias do Seio Maxilar/tratamento farmacológico , Prednisona , Rituximab , Vincristina
2.
Medicine (Baltimore) ; 99(5): e18980, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000430

RESUMO

RATIONALE: Primary hepatic lymphoma (PHL) is an extremely rare manifestation of extranodal non-Hodgkin lymphoma. There were few cases about PHL in recent years, while cases using positron emission tomography (PET) modalities for both diagnosis and follow-up were even rare. PATIENT CONCERNS: A 29-year-old man complaining of dull epigastric pain for 2 weeks. DIAGNOSIS: The features of liver biopsy and immunohistochemistry were consistent with diffuse large B cell lymphoma. Since there were no other foci of lymphoma on the F-fluoro-2-deoxy-D-glucose (F-FDG) PET/computed tomography (CT) images, the patient was further diagnosed with PHL. INTERVENTIONS: Since the lesions were mainly confined to the right lobe of liver, partial hepatectomy and radiofrequency ablation were performed. Subsequently, 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, dexamethasone regimen were performed. OUTCOMES: The patient recovered well postoperatively and was discharged 1 week after surgery. Fortunately, the follow-up F-FDG PET/CT scan 36 months later revealed no abnormal FDG uptake, indicating the absence of relapse. LESSONS: As the superiority in excluding other organ involvement, F-FDG PET/CT should be considered as the preferable imaging modality for the diagnosis and follow-up of PHL. Besides chemotherapy, surgical resection should be considered initially. If radical R0 resection could not be done, partial hepatectomy with radiofrequency ablation may also offer an appropriate alternative treatment.


Assuntos
Neoplasias Hepáticas/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ablação por Cateter , Fluordesoxiglucose F18 , Hepatectomia , Humanos , Neoplasias Hepáticas/terapia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Compostos Radiofarmacêuticos
3.
Medicine (Baltimore) ; 99(6): e18590, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028388

RESUMO

RATIONALE: The specific pathogenesis of the diffuse large B-cell lymphoma(DLBCL)is still indefinite and argumentative. It is known that DLBCL is the most common type of non-Hodgkin's lymphomas (NHL). A lot of cases of DLBCL such as primary gastric diffuse large B-cell lymphoma(PG-DLBCL) are reported. However, primary intestinal diffuse large B-cell lymphoma(PI-DLBCL) is unusual. PATIENT CONCERNS: We present a case of a 57-year-old male diagnosed in the Gastroenterology Department, which presented a bleeding duodenal ulcer with irregular borders. DIAGNOSES: The immunohistochemical staining showed: CD20(+++), CD10(+) and Ki-67>40%. INTERVENTIONS: The patient was successfully treated by Poly-chemotherapy with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vindesine and prednisolone). OUTCOMES: After 6 courses of chemotherapy treatment, the duodenal ulcer was completely healed by reviewing the UGIE. LESSONS: Our report might give further strength to avoiding the erroneous and missed diagnosis for PI-DLBCL which is different from common duodenal ulcer.


Assuntos
Úlcera Duodenal/etiologia , Neoplasias Intestinais/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Humanos , Imuno-Histoquímica , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico por imagem , Neoplasias Intestinais/tratamento farmacológico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Vincristina/uso terapêutico
5.
Medicine (Baltimore) ; 99(4): e18807, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977874

RESUMO

RATIONALE: Primary lymphoma of the bones (PLB) is a rare extranodal non-Hodgkin lymphoma (NHL) that is particularly rare in children. The clinical presentation and radiological features of PLB are often nonspecific, making clinical diagnosis challenging and misdiagnosis frequent. Here, we report 2 children with PLB focusing on clinical presentation, differential diagnosis, and treatment outcomes. PATIENTS CONCERNS: A 9-year-old boy presented with left knee swelling and pain for 4 months after a fall. He was previously misdiagnosed with traumatic soft tissue injury. The second patient was an 11-year-old boy with a 6-month history of intermittent left knee pain. He was previously misdiagnosed with bone tuberculosis and chronic osteomyelitis. DIAGNOSES: A 9-year-old boy showed an abnormal signal of the left tibia metaphysis, diaphysis, and epiphysis, and tibia with periosteal reactions and surrounding soft tissue swelling. Tumor biopsy and immunohistochemistry confirmed a diagnosis of B-cell lymphoblastic lymphoma.An 11-year-old boy showed a permeative lesion in the metaphysis and diaphysis of the left proximal tibia. Tumor biopsy and immunohistochemistry confirmed the diagnosis of diffuse large B-cell lymphoma. INTERVENTIONS: Both patients were treated with 6 courses of NHL-Berlin-Frankfurt-Münster-95. OUTCOMES: Both patients are in complete clinical remission with a follow-up of 27 and 18months after treatment, respectively. LESSONS: PLB is a rare malignancy that is difficult to diagnose, particularly in children. Clinicians should increase the awareness of the disease and consider a differential diagnosis of bone lesions. Chemotherapy combined with radiotherapy is a favorable treatment for children with PLB. Early diagnosis and active treatment can improve patient prognosis.


Assuntos
Linfoma Difuso de Grandes Células B/patologia , Linfoma não Hodgkin/patologia , Tíbia/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Asparaginase/uso terapêutico , Criança , Ciclofosfamida/uso terapêutico , Citarabina/uso terapêutico , Dexametasona/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/tratamento farmacológico , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Indução de Remissão , Tioguanina/uso terapêutico , Tíbia/diagnóstico por imagem , Vincristina/uso terapêutico
6.
Ann Hematol ; 99(3): 557-570, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31989249

RESUMO

In 27% of diffuse large B cell lymphoma (DLBCL) cases, bone marrow (BM), assessed by BM biopsy, is involved. BM involvement, an extranodal site involvement, affects the International Prognostic Index (IPI) score adversely. However, chromosomal abnormalities are neither included as a prognostic factor nor are they considered in the IPI risk classification category. We retrospectively analyzed 600 DLBCL patients at diagnosis for BM involvement (by both BM biopsy immunohistochemistry [BMI] with karyotyping and 18-fluorodeoxyglucose-positron emission tomography [FDG-PET] high uptake [BMP]). The BM-involved DLBCL patients identified by both BMI and BMP showed significantly inferior survival outcomes. Chromosomal abnormalities, especially complex karyotype (CK) of the involved BM, are related to much worse survival outcomes due to the inadequate treatment response including frontline auto-hematopoietic stem cell transplantation (HSCT). Therefore, CK population should either be considered for more aggressive treatment modalities, such as frontline allo-HSCT, or those further clinical trials are explored for alternative or novel treatment approaches. Furthermore, if the FDG-PET shows high possibility of marrow involvement, bilateral BM biopsy with cytogenetic evaluation should be incorporated into the routine workup for newly diagnosed DLBCL patients. This is to look for other markers of poor-risk factors, such as CK or further genetic mutations.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Medula Óssea/diagnóstico por imagem , Aberrações Cromossômicas , Transplante de Células-Tronco Hematopoéticas , Linfoma Difuso de Grandes Células B , Tomografia por Emissão de Pósitrons , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Autoenxertos , Ciclofosfamida/administração & dosagem , Intervalo Livre de Doença , Doxorrubicina/administração & dosagem , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/genética , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Prednisona/administração & dosagem , Rituximab/administração & dosagem , Taxa de Sobrevida , Vincristina/administração & dosagem
7.
Mayo Clin Proc ; 95(1): 157-163, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31902411

RESUMO

With improvement in the cure rates for diffuse large B cell lymphoma, the question of surveillance imaging in patients who achieve complete remission after the initial therapy has become relevant. Some of the clinical practice guidelines recommend surveillance scanning. However, several studies have reported no benefit in overall survival with scans. Moreover, studies have highlighted an increased risk for developing secondary malignancies because of exposure to ionizing radiation from the scans. Different international societies have contrasting guidelines for the role of surveillance computerized tomography scans in patients who achieve complete remission after first-line therapy. Any benefit of surveillance imaging must be balanced by the costs, risk of radiation exposure, and lack of survival benefit. The PubMed platform was searched using relevant keywords for English-language articles with no date restrictions. Search terms were cross-referenced with review articles, and additional articles were identified by manually searching reference lists. Results were reviewed by the authors and selected for inclusion based on relevance. We present a review of this current data available for surveillance imaging in patients with diffuse large B cell lymphoma.


Assuntos
Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Humanos , Linfoma Difuso de Grandes Células B/terapia , Tomografia por Emissão de Pósitrons/efeitos adversos , Tomografia por Emissão de Pósitrons/métodos , Prognóstico , Indução de Remissão/métodos , Medição de Risco , Tomografia Computadorizada por Raios X/efeitos adversos , Tomografia Computadorizada por Raios X/métodos
8.
BMC Cancer ; 20(1): 15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906982

RESUMO

BACKGROUND: Patients with lymphoma are at risk for developing pulmonary opportunistic infections due to immunocompromise. However, clinical reports of concurrent lymphoma and opportunistic infection at presentation are rare and often confined to single cases. A delayed diagnosis of either opportunistic infection or lymphoma usually occurs in this complex situation. Here, we report such a case and analyse 18 similar cases searched in the PubMed database to deepen clinicians' understanding. CASE PRESENTATION: A 48-year-old man presented with a 3-month history of fever, cough and emaciation. High-resolution computed tomography revealed bilateral cavitating lesions of different sizes. Aspergillus fumigatus complex was identified from a bronchoalveolar lavage fluid culture. However, antifungal treatment combined with multiple rounds of antibacterial therapy was unsuccessful, and the patient's lung lesions continued to deteriorate. Multiple puncture biopsies finally confirmed the coexistence of diffuse large B-cell lymphoma. Despite the initiation of combination chemotherapy, the patient died of progressive respiratory failure. CONCLUSIONS: Synchronous pulmonary lymphoma and simultaneous opportunistic infection is rare and usually lacks specific clinical and imaging manifestations. Lymphoma should be considered as part of the differential diagnosis of patients with an opportunistic infection when treatment fails or other symptoms are present that could be considered "atypical" for the condition. Tissue biopsy is the gold standard, and multiple biopsies are essential for making the final diagnosis and should be performed upon early suspicion.


Assuntos
Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico , Aspergillus fumigatus/patogenicidade , Biópsia , Diagnóstico Diferencial , Humanos , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/microbiologia , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Pulmão/patologia , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/complicações , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/patologia , Tomografia Computadorizada por Raios X
9.
BMJ Case Rep ; 13(1)2020 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-31900300

RESUMO

A 28-year-old primigravida was evaluated for complaints of difficulty urinating and pelvic pain of 6-weeks duration. She denied fever, night sweats, weight loss or fatigue. Pelvic ultrasonography revealed a single fetal pole with cardiac activity and a 7 cm mass in the anterior vagina which encased the urethra. The diagnosis of diffuse large B-cell lymphoma germinal centre type was made on analysis of biopsied pelvic mass. Whole body MRI revealed the disease was limited to the vagina. The patient received six cycles of Rituximab-cyclophosphamide, doxorubicin, vincristine and prednisone with significant improvement in her symptoms. Serial ultrasounds over the subsequent months showed appropriate development of the fetus. Whole body MRI after treatment showed decreased size and decreased signal of the primary pelvic mass compatible with favourable treatment response. Challenges in the management of this rare presentation of lymphoma are discussed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Neoplasias Vaginais/tratamento farmacológico , Adulto , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Disuria , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Imagem por Ressonância Magnética , Dor Pélvica , Prednisona/uso terapêutico , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico por imagem , Rituximab/uso terapêutico , Ultrassonografia , Neoplasias Vaginais/diagnóstico por imagem , Vincristina/uso terapêutico
10.
World Neurosurg ; 133: 10-13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550543

RESUMO

BACKGROUND: Epstein-Barr virus (EBV)-positive diffuse large B-cell lymphoma (DLBCL) in an immunocompromised patient with organ transplantation demonstrated unusual brain magnetic resonance imaging (MRI) findings. Recognition of EBV-positive DLBCL by radiologists on MRI may prevent unnecessary neurosurgical resection, and it could be important to obtain viable cells for accurate diagnosis on stereotactic biopsy because of extensive necrosis. CASE DESCRIPTION: A 62-year-old woman presented to the emergency department with left hemiparesis grade III and dysarthria lasting for 3 weeks. She underwent kidney transplantation in 2007 and was taking immunosuppressants and had hypothyroidism. Brain MRI showed a 3.8-cm peripheral enhancing lesion with extensive central necrosis in association with marked perilesional edema. The irregular ringlike enhancing lesion showed diffusion restriction and mildly increased regional cerebral blood volume in the rim portion of the mass. 11C-Methionine positron emission tomography revealed slightly increased uptake in the peripheral lesion. The provisional diagnosis was a high-grade glioma. Stereotactic multiple biopsies were performed for the central necrotic area and peripheral enhancing lesion. The nonenhancing areas showed only necrotic material, without viable cells, and the enhancing portion showed viable cells for an accurate diagnosis in a frozen biopsy specimen. The pathologic diagnosis was EBV-positive DLBCL with extensive necrosis. Positron emission tomography of the chest, abdomen, pelvis, and neck soft tissues ruled out systemic diseases. She underwent whole-brain radiotherapy at a dose of 30.6 Gy. Eight months later, her neurologic symptoms had improved, with a stable brain lesion and improved perilesional edema. CONCLUSIONS: We report an immunocompromised patient with EBV-positive DLBCL, which showed atypical MRI findings, including extensive necrosis. Multiple biopsies were required for final diagnosis.


Assuntos
Encéfalo/patologia , Infecções por Vírus Epstein-Barr/patologia , Linfoma Difuso de Grandes Células B/patologia , Biópsia , Encéfalo/diagnóstico por imagem , Encéfalo/virologia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico por imagem , Feminino , Humanos , Hospedeiro Imunocomprometido , Transplante de Rim , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Necrose/diagnóstico por imagem , Necrose/patologia , Necrose/virologia , Transplantados
13.
Clin Nucl Med ; 45(2): 156-158, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31833937

RESUMO

Primary ventricular lymphoma is a rare form of non-Hodgkin lymphoma confined to the central nervous system. A 51-year-old woman presented with a 4-month history of unsteady gait and progressive decline in memory. An outside brain MRI showed multiple space-occupying lesions in the ventricles, which suggested malignancy. Staging with FDG PET/CT demonstrated not only hypermetabolic masses in the lateral, third, and fourth ventricles but also a hypermetabolic lesion in the spinal cord. A biopsy of the right lateral ventricle tumor confirmed diffuse large B-cell lymphoma.


Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos
14.
Clin Nucl Med ; 45(2): 139-140, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876814

RESUMO

A 66-year-old woman with a known history of diffuse large B-cell lymphoma presented with left lower limb swelling following recent long-distance air travel. Ultrasound Doppler showed no evidence of deep vein thrombosis. In view of her medical history, an F-FDG PET/CT was ordered that found a soft tissue mass following the course of the femoral neurovascular bundle along the anteromedial aspect of the left thigh down to the popliteal fossa and the lateral calf muscle. This was confirmed to be tumor recurrence.


Assuntos
Edema/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Compostos Radiofarmacêuticos , Coxa da Perna/diagnóstico por imagem
15.
Clin Nucl Med ; 45(3): e174-e175, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31876835

RESUMO

T-cell/histiocyte-rich B-cell lymphoma accounts for approximately 1% to 3% of all cases of diffuse large B-cell lymphoma, and involvement of the kidneys comprises a mere 1% of the total primary extranodal lymphomas. We present a case of T-cell/histiocyte-rich B-cell lymphoma who had acute renal failure at initial presentation with bilateral lymphomatous infiltration depicted on FDG PET/CT scan. Four months after the treatment, a repeat FDG PET/CT scan revealed complete resolution of the renal lesions, indicative of the complete remission for kidneys.


Assuntos
Lesão Renal Aguda/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Lesão Renal Aguda/etiologia , Adulto , Fluordesoxiglucose F18 , Histiócitos/patologia , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Masculino , Compostos Radiofarmacêuticos , Linfócitos T/patologia
16.
Medicina (B Aires) ; 79(6): 506-508, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829954

RESUMO

The arteriovenous extracorporeal membrane is used in patients with hemodynamic and respiratory failure, unresponsive to conventional treatment. It provides transitory hemodynamic support, oxygenation and removal of CO2, allowing pulmonary rest. Moreover it offers the possibility of ultraprotective ventilation and avoids generation of VILI (Ventilation-Induced Lung Injury). It is not frequently used in patients with hemodynamic failure secondary to obstructive shock due to mediastinal compromise. We present the case of a patient with obstructive shock, mediastinal mass of lymphoproliferative origin that was treated with extracorporeal arteriovenous circulation membrane.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Linfoma Difuso de Grandes Células B/complicações , Insuficiência Respiratória/terapia , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Adulto , Angiografia por Tomografia Computadorizada/métodos , Feminino , Hemodinâmica , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/patologia , Choque Cardiogênico/diagnóstico por imagem , Tomografia por Raios X/métodos , Resultado do Tratamento
17.
Am J Case Rep ; 20: 1821-1825, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31809493

RESUMO

BACKGROUND Primary mediastinal diffuse large B cell lymphoma (DLBCL) presenting as a large intracardiac tumor is extremely rare and has not been significantly reported in the literature. Cardiac lymphoma consists of 2 subtypes: mediastinal DLBCL invading the heart and primary cardiac lymphoma. Both subtypes have a poor prognosis and are treated similarly. Mediastinal DLBCL is a life-threatening condition that, if diagnosed early, has a better survival rate. This is a rare case of a mediastinal DLBCL invading the right atrium as a large intracardiac mass, causing partial obstruction of the tricuspid valve without hemodynamic compromise. CASE REPORT A 57-year-old female presented with unintentional weight loss, fatigue, exertional dyspnea, and cough for 8 weeks. Transesophageal echocardiogram showed a mass (3.5×3.5 cm) in the posterior wall of the right atrium partially obstructing the tricuspid valve. Biopsy revealed DLBCL. Given new-onset lymphoma, a human immunodeficiency virus (HIV) test was done and came back positive. CD4 count was 100 cells/mm³. Chemotherapy was initiated with rituximab, cyclophosphamide, epirubicin, vincristine, and prednisone (R-CHOP). Highly active anti-retroviral (HAART) therapy was started for HIV. After treatment with R-CHOP and HAART, the patient had complete resolution of the mass and symptoms on follow-up imaging and evaluation at 6 months. CONCLUSIONS Mediastinal DLBCL invading the heart is a life-threatening form of non-Hodgkin's lymphoma (NHL) and early diagnosis and treatment is critical as prognosis is poor especially if diagnosed in later stages of the disease. Testing for HIV is important as 5% of HIV patients are susceptible to developing NHL.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/tratamento farmacológico , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica , Terapia Antirretroviral de Alta Atividade , Tosse , Ciclofosfamida , Diagnóstico Diferencial , Doxorrubicina , Dispneia , Ecocardiografia Transesofagiana , Fadiga , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Prednisona , Rituximab , Tomógrafos Computadorizados , Vincristina , Perda de Peso
19.
Ann Hematol ; 98(12): 2739-2748, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31712879

RESUMO

The aim of this study was to evaluate the prognostic relevance of early risk stratification in diffuse large B-cell lymphoma (DLBCL) using interim Deauville score on positron emission tomography-computed tomography (PET-CT) scan and baseline International Prognostic Index (IPI). This retrospective study included 220 patients (median age, 64 years; men, 60%) diagnosed with DLBCL between 2007 and 2016 at our institution, treated with rituximab-based chemotherapy. Interim PET-CT was performed after three cycles of immuno-chemotherapy. Interim Deauville score was assessed as 4 or 5 in 49 patients (22.3%), and 94 patients (42.7%) had high-intermediate or high-risk IPI scores. In multivariate analysis, interim Deauville score (1-3 and 4-5) and baseline IPI (low/low-intermediate and high-intermediate/high) were independently associated with progression-free survival (for Deauville score, hazard ratio [HR], 1.00 vs. 2.96 [95% confidence interval (CI), 1.83-4.78], P < 0.001; for IPI, HR, 1.00 vs. 4.84 [95% CI, 2.84-8.24], P < 0.001). We stratified patients into three groups: low-risk (interim Deauville scores 1-3 and low/low-intermediate IPI), intermediate-risk (Deauville scores 1-3 with high-intermediate/high IPI or Deauville scores 4-5 with low/low-intermediate IPI), and high-risk (Deauville scores 4-5 and high-intermediate/high IPI). This early risk stratification showed a strong association with progression-free survival (HR, 1.00 vs. 3.98 [95% CI 2.10-7.54] vs. 13.97 [95% CI 7.02-27.83], P < 0.001). Early risk stratification using interim Deauville score and baseline IPI predicts the risk of disease progression or death in patients with DLBCL. Our results provide guidance with interim PET-driven treatment intensification strategies.


Assuntos
Linfoma Difuso de Grandes Células B , Tomografia por Emissão de Pósitrons , Rituximab/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Taxa de Sobrevida
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