Successful treatment of refractory chylous ascites due to follicular lymphoma with very low-dose radiotherapy.

Chylous ascites is an extremely rare complication of lymphoma. Here, we discuss the case of a patient presenting with refractory chylous ascites due to a massive retroperitoneal follicular lymphoma, staged as IVB. The patient was unresponsive to chemoimmunotherapy, which prompted us to consider alternative treatment strategies. Low-dose radiotherapy was initiated and resulted in a marked decrease of the lymphadenopathy and complete regression of the peritoneal fluid. Low-dose radiotherapy represents a well-tolerated, highly effective treatment and should remain an important modality in cases of follicular lymphoma-associated chylous ascites.

Mechanisms underlying the association between obesity and Hodgkin lymphoma.

A solid body of knowledge indicates that overweight and obese subjects are prone to develop cancer, aggressive disease, and death more than their lean counterparts. While obesity has been causally associated with various cancers, only a limited number of studies beheld the link with classical Hodgkin lymphoma (HL). Contemporary meta-analysis and prospective studies confirmed the association of body mass index with HL. Besides epidemiological evidence, excess adiposity is known to influence tumor behavior through adipokines, adipose-derived stem cell migration, and metabolism regulation, and by modulating immunoinflammatory response. Nevertheless, the obesity paradox has been described in few cancers. Considering that adipose tissue is an immunomodulatory organ, and that inflammation is the cornerstone of HL pathophysiology, the rationale for being causally related due to endocrine/paracrine interactions cannot be negligible. In this hypothesis-generating review, we explore the biologically plausible links between excess adiposity and HL in light of recent basic and clinical data, in order to create a basis for understanding the underlying mechanisms and foster applied research. The establishment of an association of excess adiposity with HL will determine public health preventive measures to fight obesity and eventually novel therapeutic approaches in HL patients.

Should a patient with systemic mastocytosis be vaccinated against COVID-19? / Deve um doente com mastocitose sistêmica ser vacinado contra a COVID-19?

A 26-year-old woman was referred to the allergy department for two episodes of anaphylaxis after intake of non-steroidal antiinflammatory drugs. In both episodes she was evaluated at the emergency department, and her levels of tryptase were 141 ug/L and 117 ug/L, respectively. Baseline tryptase was 92 ug/L. Bone marrow biopsy, myelogram, and immunophenotypic study were performed, confirming systemic mastocytosis. In patients with mast cell disorders, the risk of anaphylaxis after mRNA vaccine against COVID-19 has been under debate. Considering the occupational risk of COVID-19, the risk of anaphylaxis upon exposure to the vaccine was discussed with the patient and, after consent, Pfizer/BioNTech® BNT162B2 was administered under allergist supervision. No premedication was administered and both vaccine inoculations occurred without eliciting mast cell symptoms.

Mulher de 26 anos enviada à consulta de imunoalergologia após dois episódios de anafilaxia no contexto de ingestão de antiinflamatórios. Em ambos os episódios foi observada no Serviço de Urgência. Os valores de triptase nos episódios foram 141 ug/L e 117 ug/L, respetivamente. A triptase basal 92 ug/L. Realizou biópsia de medula óssea, mielograma e estudo imunofenotípico que confirmaram mastocitose sistêmica. Nos doentes com doença mastocitária, o risco de anafilaxia após administração de vacinas mRNA contra a COVID-19 tem sido debatido. Considerando o risco de exposição à COVID-19, o risco de anafilaxia após administração da vacina foi discutido com a doente e, após consentimento, a vacina Pfizer/BioNTech® BNT162B2 foi administrada sob vigilância de um alergologista. Não foi administrada pré-medicação, e a doente recebeu as duas doses da vacina sem evidenciar sintomatologia relacionada com ativação mastocitária.