Primary, Bilateral and Diffuse Renal Non-Hodgkin’s Lymphoma in a Young Woman Suffering from Turner Syndrome

Primary renal lymphoma (PRL) is a rare form of non-Hodgkin’s lymphoma (NHL) restricted to and primarily involving one or both kidneys, with no lymph node extension. It accounts for <1% of extranodal lymphomas, and descriptions in the literature are limited. Here, we describe an unprecedented case of bilateral PRL in a 44-year-old woman with Turner syndrome and discuss both diagnostic and therapeutic issues in the light of the available literature in the field. A personalized approach to this rare disease is necessary.

Primary Extranodal Non-Hodgkin Lymphomas: A First Tertiary Care Experience from Punjab, North India

Background Primary extranodal lymphomas are less frequently encountered and difficult to diagnose in routine practice. The histopathological and immunohistochemical studies are essential in addition to clinical details to diagnose. The incidence is varied in different parts of India along with variation in histopathological spectrum. Methodology The clinical features and histopathological findings of patients diagnosed with primary extranodal lymphoma over 3-year period were retrieved from archives of pathology department and analyzed. Results During the 3-year study period, a total of 135 cases of non-Hodgkin lymphomas were evaluated, and of these, 41.4% (56/135) of cases presented with primary extranodal involvement. The mean age of primary extranodal lymphoma presentation was 61.3 ± 17.5 with M:F ratio of 1:1.1 Most common extranodal site involved was gastrointestinal tract 32.1%, 18/56 (small intestine [17.8%, 10 cases] and large intestine [8.9%, 5 cases]). Non-Hodgkin lymphomas of B cell type were the predominant subtype (48/56, 85.7%), while 8/56 (14.2%) cases were of T cell lineage. Of the B cell non-Hodgkin lymphoma diffuse, large B cell lymphoma was the predominant subtype constituting ~83.3% (40/48). Conclusion Primary extranodal lymphomas exhibit varied histomorphological and clinical presentation. The present study is first such analysis from Punjab that intends to compare with studies from other parts of India.

Primary Diffuse Large B-Cell Lymphoma of the Breast: A Rare Case Report and Review of the Literature

BACKGROUND: Breast lymphomas are rare extranodal lymphomas. They constitute a tiny percentage of malignant tumors of the breast and a small subset of extranodal lymphomas. The rarity of breast lymphomas is attributed to the very scanty lymphoid tissue content of the chest wall. AIMS OF STUDY: This case report aims to provide an up-to-date review of the literature on breast lymphomas and clinicians to consider the possibility of this disease entity while treating a breast mass. CASE PRESENTATION: A case is reported of primary mammary non-Hodgkin lymphoma in a 52-year-old man. Fine needle aspiration cytology (FNAC) was inconclusive. Incisional biopsy-confirmed primary breast lymphoma was diagnosed as the diffuse large B-cell type: non – Hodgkin lymphoma. He had complete disease remission in response to chemotherapy – Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone (CHOP). After that, the patient did not require further surgical intervention. He was followed up at two-monthly intervals for eighteen months in the surgical outpatient clinic with no disease recurrence and satisfactory clinical outcome, following which he discontinued follow-up visits. CONCLUSION: While assessing breast masses, clinicians must recognize primary non-Hodgkin lymphoma as a potential differential diagnosis. A core biopsy of breast masses is needed to exclude it, and appropriate treatment must be given if diagnosed.

Impact of Histologic Type on Survival in Primary Parotid Lymphomas

Introduction: Primary extranodal lymphomas of the salivary glands constitute 12% of head and neck lymphomas, and less than 5% of salivary gland neoplasms. Parotid gland is the most commonly involved structure. Mucosa-associated lymphoid tissue (MALT) lymphoma is considered the most common histology in parotid lymphomas and carry a favorable prognosis. In this study, we sought to explore the impact of histologic subtype on survival. Methods: The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients (≥18 years) diagnosed with primary parotid lymphomas between 1975 and 2016. B-cell, T-cell, and Hodgkin's lymphomas were included. Treatment effect (surgery, radiation, chemotherapy) was analyzed when available. Only stage I lymphomas by Ann-Arbor staging system were included to ensure parotid gland as the primary site. Overall survival was estimated using the Kaplan-Meier method, and compared using Log-Rank test. Cox proportional hazards models were used for adjusted survival analyses. Results: A total of 1482 patients were included in the analysis. Median age was 66 years (18-102), and the majority were female (n=904, 61%) and Caucasian (n=1074, 72.5%). MALT was the most common histology (N=681, 46%), followed by follicular lymphoma (FL; N=407, 27.5%), and diffuse large B-cell lymphoma (DLBCL; N=310, 21%). Small lymphocytic lymphoma was the least common histology (CLL/SLL; N=3, 0.8%). A total of 1084 patients (73%) had surgery, 433 (29%) had systemic therapies and 691 (47%) had radiation. Median overall survival was 13 years [12-14.5; 95% CI]. Survival was different by histological type (Figure 1, P<0.001). Compared with MALT, DLBCL was associated with higher mortality (HR 2.05 [1.60-2.63], P <0.001), while FL was not significantly different (HR 1.11 [0.89-1.40], P=0.32); independent of other variables. In a multivariate model; surgery (HR 0.81 [0.66-0.99], P=0.042) and radiation (HR 0.67 [0.56-0.82], P <0.001), but not systemic therapies (HR 0.93 [0.76-1.15], P=0.55) were associated with lower mortality (Figures 2-4). Adjusted mortality decreased by a relative 3% annually (HR 0.97 [0.95-0.99], P=0.03). Conclusion: Primary parotid lymphomas are rare extranodal lymphomas affecting mostly elderly Caucasian women. Using a large population database, MALT was still the most common histology and carried a favorable prognosis with a median overall survival of greater than 10 years despite the high median age at diagnosis. DLBCL histology did significantly worse which highlights the need for potentially more aggressive interventions to improve outcomes. Surgery and radiation were associated with improved outcomes. Disclosures Yazbeck: Gilead Sciences: Research Funding; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees.

A retrospective study of flow cytometric characterization of suspected extranodal lymphomas in dogs

Flow cytometry (FC) is widely applied to characterize and stage nodal lymphomas in dogs because it has a short turnaround time, requires minimally invasive sampling, and allows contemporary evaluation of neoplastic cells in the primary lesion and of blood and marrow involvement. We investigated advantages and limitations of FC in suspected extranodal lymphomas in dogs. The likelihood of obtaining a suitable FC sample was significantly lower for aspirates of extranodal lesions than for lymph node aspirates. However, we noted no differences among different extranodal lesion sites. We also describe FC results for 39 samples compatible with extranodal lymphoma. A dominant population of large cells was easily identified on morphologic FC scattergrams in many cases. Phenotypic aberrancies were frequently present, mainly in T-cell lymphomas. Lymphoma cells were distinguishable from normal residual lymphocytes in >85% of cases, facilitating the quantification of putative blood and marrow involvement by FC. Despite the high percentage of non-diagnostic samples (32 of 73, >40%), we support the inclusion of FC in the diagnostic workup of suspected extranodal lymphomas in dogs, in conjunction with histopathology. Histopathology is the gold standard for diagnosing lymphoma, provides relevant information, including tissue invasion and epitheliotropism, but has a longer turnaround time.