A case of diffuse large B-cell lymphoma in association with paraesophageal leiomyoma: highlighting false-positivity of PET scan and importance of tissue diagnosis.

PET scan and PET/CT scans are being widely used for staging of diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma. They are sensitive and specific imaging techniques available for lymphoma. However, practicing hematologists must be aware of false-positive tests, which can upgrade the stage of the lymphoma significantly and may alter the treatment paradigm for an individual patient. This report describes a case of DLBCL that was upgraded with PET/CT scan to stage IVA from stage IA. Pursuit of tissue biopsy with minimally invasive surgery eventually confirmed it to be stage IA DLBCL and paraesophageal leiomyoma. This case highlights the potential pitfalls of modern imaging techniques and the need for histologic diagnosis.

Examining racial differences in diffuse large B-cell lymphoma presentation and survival.

We performed a retrospective cohort analysis of 701 (533 white and 144 black) patients with diffuse large B-cell lymphoma (DLBCL) treated at two referral centers in southern United States between 1981 and 2010. Median age of diagnosis for blacks was 50 years vs. 57 years for whites (p < 0.001). A greater percentage of blacks presented with elevated lactate dehydrogenase levels, B-symptoms and performance status ≥ 2. More whites (8%) than blacks (3%) had a positive family history of lymphoma (p = 0.048). There were no racial differences in the use of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; 52% black vs. 47% white, p = 0.73). While black race predicted worse survival among patients treated with CHOP (hazard ratio [HR] 1.8, p < 0.001), treatment with R-CHOP was associated with improved survival irrespective of race (HR 0.61, p = 0.01). Future studies should examine biological differences that may underlie the observed racial differences in presentation and outcome.