1/8. Progressive external ophthalmoplegia: a paraneoplastic manifestation of lymphoma.PURPOSE: Paraneoplastic neurological syndromes are well-known sequelae of some malignancies. To our knowledge, a syndrome mimicking progressive external ophthalmoplegia had never been reported preceding the diagnosis of a lymphoma. CASE REPORT: A 63-year-old man developed progressive external ophthalmoplegia, without any other neurological symptoms, as the initial manifestation of a follicular lymphoma grade III. The ophthalmoplegia resolved after two cycles of combination chemotherapy. CONCLUSIONS: The ophthalmologist, when confronted with a progressive external ophthalmoplegia, should consider a neurological paraneoplastic syndrome associated with a tumor as a possible diagnosis.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
2/8. Re-entry of tumour B cells into the cycle of somatic mutation and isotype switching in follicular lymphoma.Sequencing of the immunoglobulin (Ig) gene transcripts of the tumour B cells in lymph node (LN) and bone marrow (BM) from a follicular lymphoma (FL) patient associated with multiple myeloma identified two dominant clones. One of the clones, present in both LN and BM, had somatic mutations and extensive clonal diversity. Among the diversified clones, two dominant populations of identical sequences (group I and II) were present. Group II was a descendant population of group I and had nine more somatic mutations. Group I contained micro-, delta-, gamma- and alpha-expressing clones. Group II clones contained mainly micro- and delta-expressing clones. These findings showed that somatic mutation and isotype switching occurred repeatedly in this patient.- - - - - - - - - - ranking = 4keywords = cycle (Clic here for more details about this article) |
3/8. retreatment with rituximab alone induces sustained remission in a patient with follicular lymphoma with multiple extranodal sites of involvement, relapsing soon after primary treatment with fludarabine-rituximab.Two recent studies have shown that retreatment of patients with relapsed indolent NHL with rituximab (RI) can be as effective as primary treatment, provided the lymphoma was initially responsive to primary RI therapy. From the available data, it remains unknown as to whether this approach is also effective for extranodal relapse. Here, we describe a 47-year-old male with stage 4B follicular lymphoma (FL), initially also involving skin, who achieved complete remission (CR) after a combination of fludarabine, cyclophosphamide and RI that lasted only 5 months. He soon relapsed with systemic disease and a number of extranodal sites including liver, lungs and bone marrow. After retreatment with RI alone (four cycles, 375 mg/m(2)), the patient achieved a second CR. Another four infusions of RI were given 6 months later as maintenance therapy. The duration of CR is already 18 months longer than the first CR. This case illustrates the fact that even in relapsed advanced FL, with multiple sites of extranodal disease, RI given as a single agent may be extremely effective in achieving an additional meaningful complete response.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
4/8. acetaminophen-induced anion gap metabolic acidosis and 5-oxoprolinuria (pyroglutamic aciduria) acquired in hospital.A rare cause of high anion gap acidosis is 5-oxoproline (pyroglutamic acid), an organic acid intermediate of the gamma-glutamyl cycle. acetaminophen and several other drugs have been implicated in the development of transient 5-oxoprolinemia in adults. We report the case of a patient with lymphoma who was admitted for salvage chemotherapy. The patient subsequently developed fever and neutropenia and was administered 20.8 g of acetaminophen during 10 days. During this time, anion gap increased from 14 to 30 mEq/L (14 to 30 mmol/L) and altered mental status developed. After usual causes of high anion gap acidosis were ruled out, a screen for urine organic acids showed 5-oxoproline levels elevated at 58-fold greater than normal values. Predisposing factors in this case included renal dysfunction and sepsis. Clinicians need to be aware of this unusual cause of anion gap acidosis because it may be more common than expected, early discontinuation of the offending agent is therapeutic, and administration of N -acetylcysteine could be beneficial.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
5/8. Multiple osteolytic lesions and testicular involvement at first relapse of follicular lymphoma grade 1 in transformation.A 62-year-old man was initially diagnosed with stage IA follicular lymphoma grade 1 of the left tonsil. Shortly after radiotherapy he rapidly developed multiple painful acroosteolytic lesions and testicular involvement. The histological examination revealed a transformed lymphoma in the testis (DLCL) and follicular lymphoma in the acroosteolytic lesions. The clonal identity of lymphoma cells within the primary biopsy as well as in the two sites at relapse was shown by PCR and nucleotide sequence analysis of the lymphoma clone specific B-cell receptor rearrangement. Chemotherapy with six cycles of CHOP followed by high dose chemotherapy and autologous blood stem cell transplantation led to a complete clinical remission with disappearance of all osteolytic lesions.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
6/8. Follicular non Hodgkin's lymphoma in adenolymphoma: report of a case.A case of centroblastic centrocytic follicular lymphoma arising within a bilateral adenolymphoma of the parotid glands with involvement of the adjacent lymph nodes is reported. The patient was treated with combination chemotherapy and three years after the first cycle of therapy there was no evidence of disease. The occurrence of primary malignant lymphomas in the lymphoid stroma of an adenolymphoma has seldom been discussed in literature. All cases reported of follicular centre cell type were characterized by an indolent clinical course.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
7/8. Malignant lymphoma with a high content of epithelioid histiocytes: report of T-cell variant of so-called Lennert lymphoma and review of the literature.The present report describes the first case of well-differentiated nodular lymphocytic lymphoma evolving into Lennert lymphoma of T-cell origin. A 58-year-old white female developed malignant lymphoma, well-differentiated, lymphocytic type, nodular, with focal bone marrow involvement (stage IV) in May 1975. She received 16 cycles of cyclophosphamide and prednisone combination chemotherapy which was completed in October 1976. A complete remission was achieved. In December 1976, she relapsed and was treated with cyclophosphamide, vincristine, bleomycin, and prednisone until May 1977. Lymphadenopathy decreased until August 1978, but then increased again. biopsy of an axillary lymph node was interpreted as Lennert lymphoma. She received methotrexate, cyclophosphamide, vincristine, adriamycin, and prednisone beginning in September 1978. When last seen in November 1979, she was in partial remission. Lymphoid cells obtained from lymph node which was involved with Lennert lymphoma consisted of 93% standard E-rosettes and 83% gravity E-rosettes. Cytoplasmic immunoglobulin on frozen sections was negative, but acid phosphatase (ACP) and alpha-naphthyl acetate esterase reactions were strongly positive. These findings support a T-cell proliferation in Lennert lymphoma. A review of the literature reveals only four cases of Lennert lymphoma of T-cell origin.- - - - - - - - - - ranking = 1keywords = cycle (Clic here for more details about this article) |
8/8. Testicular cancer and hodgkin disease in the same patient.BACKGROUND. Although testicular cancer and hodgkin disease are the neoplasms with the highest incidence in young men, only 13 cases of metachronous and 2 cases of synchronous occurrence in the same person were reported before 1991. methods. A 30-year-old man is described, in whom, 2 years after radiation therapy for Stage IIIA hodgkin disease, a testicular nonseminomatous germ cell tumor developed with metastatic spread to the retroperitoneal lymph nodes, lung, and left supraclavicular fossa. The second case report describes a 31-year-old man in whom a metastasizing nonseminomatous testicular cancer, with elevation of levels of the serum tumor markers alpha-fetoprotein and human chorionic gonadotropin, developed simultaneously with axillary lymphadenopathy that was histologically confirmed hodgkin disease. RESULTS. After five cycles of cisplatin-based chemotherapy and secondary retroperitoneal lymphadenectomy, the patient with metachronous disease has remained in complete remission for 8 years. The patient with synchronous occurrence has been disease-free for 14 months after five cycles of chemotherapy consisting of cisplatin, etoposide, and doxorubicin (Adriamycin, Adria laboratories, Columbus, OH). CONCLUSIONS. The metachronous and synchronous occurrence of testicular cancer and hodgkin disease is a rare association of two curable neoplasms. The presence of both malignant neoplasms should be taken into consideration in young male patients, especially if disease distribution diverges from a regular pattern.- - - - - - - - - - ranking = 2keywords = cycle (Clic here for more details about this article) |