RESUMO
This study reports a case of a 49-year-old woman having B-cell acute lymphoblastic leukemia with glycophorin A, a representative erythroid marker, expression. According to the WHO criteria for mixed phenotype acute leukemia (MPAL), erythroid lineage is not defined, and to the best of our knowledge, only one other case with erythroid/B-cell biphenotypic acute leukemia has been reported previously. To establish the disease entity and clarify the pathophysiology of erythroid/lymphoid MPAL, additional cases need to be analyzed.
Assuntos
Leucemia Aguda Bifenotípica , Leucemia-Linfoma Linfoblástico de Células Precursoras , Doença Aguda , Linfócitos B , Feminino , Glicoforinas , Humanos , Imunofenotipagem , Pessoa de Meia-IdadeRESUMO
Rabbit antithymocyte globulin (ATG) is an effective immunosuppressive therapy for patients with aplastic anemia (AA). However, Epstein-Barr virus-associated lymphoproliferative disorder (EBV-LPD) is a rare but serious complication of the therapy. An 81-year-old man was diagnosed with severe AA on the occasion of melena. Because cyclosporine monotherapy did not improve his condition, rabbit ATG was additionally administered. Thirty-one days after the administration of rabbit ATG, the patient presented with fever and general malaise. His liver and renal function tests showed rapid decline, and the patient went into shock. Although atypical lymphocytes in the peripheral blood, hepatosplenomegaly, and lymphadenopathy were not detected, the peripheral blood EBV-DNA load and serum ferritin levels were high, and his bone marrow aspiration specimen revealed hemophagocytic findings, leading to a diagnosis of EBV-LPD. He was treated with rituximab and recovered immediately. A total of 480 days have passed since the patient was administered the rabbit ATG, and he remains in AA remission without EBV-LPD relapse. This case suggests that rituximab is an effective therapy for EBV-LPD manifesting as EBV-associated hemophagocytic lymphohistiocytosis and indicates that monitoring the EBV-DNA load contributes to the diagnosis.
Assuntos
Soro Antilinfocitário/efeitos adversos , Infecções por Vírus Epstein-Barr/complicações , Linfo-Histiocitose Hemofagocítica/tratamento farmacológico , Rituximab/uso terapêutico , Idoso de 80 Anos ou mais , Anemia Aplástica/terapia , Animais , Soro Antilinfocitário/uso terapêutico , Herpesvirus Humano 4 , Humanos , Linfo-Histiocitose Hemofagocítica/etiologia , Transtornos Linfoproliferativos , Masculino , CoelhosAssuntos
Antirreumáticos/efeitos adversos , Cromonas/efeitos adversos , Imunossupressores/efeitos adversos , Transtornos Linfoproliferativos/induzido quimicamente , Metotrexato/efeitos adversos , Sulfonamidas/efeitos adversos , Idoso , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Cromonas/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Metotrexato/uso terapêutico , Recidiva , Sulfonamidas/uso terapêuticoAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Cromossomos Humanos Par 14/genética , Cromossomos Humanos Par 19/genética , Doença Relacionada a Imunoglobulina G4 , Linfoma Difuso de Grandes Células B , Tomografia por Emissão de Pósitrons , Translocação Genética , Idoso , Carboplatina/administração & dosagem , Dexametasona/administração & dosagem , Etoposídeo/administração & dosagem , Feminino , Humanos , Ifosfamida/administração & dosagem , Doença Relacionada a Imunoglobulina G4/diagnóstico por imagem , Doença Relacionada a Imunoglobulina G4/tratamento farmacológico , Doença Relacionada a Imunoglobulina G4/genética , Doença Relacionada a Imunoglobulina G4/metabolismo , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/genética , Linfoma Difuso de Grandes Células B/metabolismo , Rituximab/administração & dosagem , Terapia de SalvaçãoAssuntos
Neoplasias do Íleo/terapia , Íleo/patologia , Linfoma Difuso de Grandes Células B/terapia , Bexiga Urinária/patologia , Derivação Urinária , Idoso , Evolução Fatal , Humanos , Neoplasias do Íleo/metabolismo , Neoplasias do Íleo/patologia , Íleo/cirurgia , Antígeno Ki-1/metabolismo , Linfoma Difuso de Grandes Células B/metabolismo , Linfoma Difuso de Grandes Células B/patologia , Masculino , Falha de Tratamento , Bexiga Urinária/cirurgiaRESUMO
We herein report the rare case of a 72-year-old female who presented with paraneoplastic pemphigus (PNP) and bronchiolitis obliterans (BO) associated with follicular lymphoma (FL), who was successfully treated with obinutuzumab (GA101; G) and bendamustine (B). The patient had severe erosive stomatitis and bilateral conjunctival hyperemia that persisted for more than 6 months. A huge mass was found in the abdominal cavity, and a biopsy revealed grade 1 FL (stage IV). Based on a lip biopsy result, the patient was diagnosed with PNP associated FL. The patient received bendamustine and obinutuzumab (BG) chemotherapy and FL and PNP responded very well, but BO was additionally associated during the course of BG. BO progressed without exacerbation as BG therapy progressed to a 2 year maintenance therapy with G, and combination of azithromycin, inhaled bronchodilator therapy, and corticosteroid. She was followed up at the outpatient department with no pulmonary function decline or FL and PNP recurrence. Our case suggests that BG could be a promising treatment option for PNP and BO.
Assuntos
Bronquiolite Obliterante , Linfoma Folicular , Síndromes Paraneoplásicas , Pênfigo , Idoso , Anticorpos Monoclonais Humanizados , Cloridrato de Bendamustina/uso terapêutico , Bronquiolite Obliterante/complicações , Bronquiolite Obliterante/tratamento farmacológico , Feminino , Humanos , Linfoma Folicular/complicações , Linfoma Folicular/diagnóstico , Linfoma Folicular/tratamento farmacológico , Síndromes Paraneoplásicas/complicações , Síndromes Paraneoplásicas/etiologia , Pênfigo/complicações , Pênfigo/tratamento farmacológicoRESUMO
INTRODUCTION: Complications such as severe infection may occur during the chemotherapy of malignant lymphoma. Phlegmonous gastritis (PG) is a rare acute bacterial infection associated with high mortality, requiring early diagnosis, and prompt management. In addition, Guillain-Barré syndrome (GBS) occasionally requires early treatment and intensive care management due to the occurrence of severe neuropathy and respiratory failure. PATIENT CONCERNS: A 70-year-old male was diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) after the detection of several polypoid tumors with ulcers. The patient underwent chemotherapy for DLBCL and exhibited adverse effects (i.e., fever, vomiting, epigastric pain, and neutropenia). Computed tomography indicated widespread thickening in the gastric wall. Furthermore, approximately 2 weeks later, the patient presented with gradual symmetric lower extremity weakness and respiratory failure due to paralysis of the respiratory muscle. DIAGNOSES: DLBCL was diagnosed through a gastric tumor biopsy. On the basis of the computed tomography findings, a culture of gastric juice, nerve conduction studies, and clinical symptoms, this case of gastric lymphoma was complicated with PG and GBS. INTERVENTIONS: The patient was treated with antimicrobial therapy and administration of granulocyte colony-stimulating factor for PG, and with intravenous immunoglobulin and intensive care management for GBS. OUTCOMES: Despite the aggressive progress of the condition, the patient improved without relapse of DLBCL. CONCLUSION: PG was regarded as a precedent infection of GBS. In this article, we present the first reported case of gastric lymphoma complicated with PG and GBS.
Assuntos
Gastrite/complicações , Síndrome de Guillain-Barré/complicações , Linfoma não Hodgkin/complicações , Infecções por Pseudomonas/complicações , Neoplasias Gástricas/complicações , Idoso , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Gastrite/tratamento farmacológico , Gastrite/microbiologia , Humanos , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/patologia , Masculino , Condução Nervosa , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologiaRESUMO
Expression of intragenic exon rearrangements (IERs) has reportedly been detected in both normal and cancer cells. However, there have been few reports of occurrence of these rearrangements specific to neoplasms including malignant lymphoma. In this study, we detected IERs of ten genes (NBPF8, SOBP, AUTS2, RAB21, SPATA13, ABCC4, WDR7, PHLPP1, NFATC1 and MAGED1) in non-Hodgkin B cell lymphoma (B-NHL) cell line KPUM-UH1 using a high-resolution single nucleotide polymorphism array and reverse transcription polymerase chain reaction using reversely directed divergent primers within exons involved in genomic intragenic gains followed by sequencing analysis. Among them, the IERs involved in SOBP (6q21) exon 2 and 3 and AUTS2 (7q11.22) exon 2-4 were the molecular lesions specific to tumors and were frequently detected in B-NHL samples. These IERs constitute novel genetic alterations of B-NHL, which might be associated with tumorigenesis and be useful as genetic biological markers.
Assuntos
Proteínas de Transporte/genética , Proteínas do Citoesqueleto/genética , Éxons/genética , Linfoma de Células B/genética , Linfoma não Hodgkin/genética , Proteínas Nucleares/genética , Fatores de Transcrição/genética , Biomarcadores Tumorais/genética , Proteínas de Transporte/metabolismo , Linhagem Celular Tumoral , Proteínas do Citoesqueleto/metabolismo , Humanos , Leucócitos Mononucleares/metabolismo , Linfoma de Células B/patologia , Linfoma não Hodgkin/patologia , Proteínas de Neoplasias/genética , Proteínas Nucleares/metabolismo , Reação em Cadeia da Polimerase , Polimorfismo de Nucleotídeo Único , Fatores de Transcrição/metabolismoRESUMO
Delayed platelet engraftment (DPE) is occasionally observed despite prompt neutrophil engraftment after autologous peripheral blood stem cell transplantation (auto-PBSCT). To identify risk factors for DPE and to develop a simple and clinically applicable system for predicting the time required for platelet recovery, we conducted a multi-institutional retrospective study in 144 patients with B-cell non-Hodgkin lymphoma who underwent auto-PBSCT. In a median observation period of 930 days (range: 25-5272 days), 139 patients successfully achieved platelet engraftment (≥50.0 × 109/L). The median duration for platelet engraftment was 19 days, and 130 patients had platelet engraftment within 40 days after auto-PBSCT; however, the other 14 patients failed to achieve platelet engraftment within 60 days. These 14 patients with DPE required a significantly greater number of apheresis procedures and had a lower pre-apheresis absolute lymphocyte count (PA-ALC) compared to those without DPE. Importantly, multivariate analysis revealed that the number of transplanted CD34+ cells (≤2.0 × 106/kg), number of required apheresis procedures (≥3 days), and PA-ALC (≤1.0 × 109/L) were independently associated with a longer time for platelet engraftment after auto-PBSCT. By incorporating these three independent factors as variables, we generated a new scoring system for prediction of the time and probability for platelet engraftment after auto-PBSCT.
Assuntos
Linfócitos B/patologia , Plaquetas/citologia , Transplante de Células-Tronco Hematopoéticas/métodos , Linfoma de Células B/terapia , Transfusão de Plaquetas/estatística & dados numéricos , Trombopoese , Adulto , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Linfoma de Células B/sangue , Linfoma de Células B/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Condicionamento Pré-Transplante , Transplante AutólogoRESUMO
The patient, a 70-year-old woman with diffuse large B-cell lymphoma (DLBCL), developed haemorrhagic cystitis associated with the BK virus (BKV) and adenovirus type 11. Moreover, chest computed tomography showed ground-glass opacity (GGO) in the bilateral upper lobe, and we performed bronchoalveolar lavage (BAL). The BKV DNA load was elevated not only in blood but also in BAL fluid (BALF), leading to the diagnosis of BKV pneumonia. After administering cidofovir, the respiratory symptoms and GGO abated. Therefore, detection of BKV DNA in BALF is useful for diagnosing BKV pneumonia. The patient with DLBCL developed BKV pneumonia. We performed BAL, and BKV DNA load was elevated on BALF. The detection of BKV DNA in BALF is useful for diagnosing BKV pneumonia.