Primary breast lymphoma – a review of the literature and report of three cases

Primary breast lymphoma (PBL) is a rare disease accounting for 0.4-0.5% of all breast malignancies. Diffuse large B-cell lymphoma (DLBCL) is the most common histological diagnosis. The clinical presentation of PBLs is usually no different from that of carcinoma. In this paper we review the literature on the clinical presentation, diagnosis, prognostic factors and treatment options of PBL. In the light of the information gained we discuss three patients with primary breast lymphoma (one with a central nervous system relapse) who were treated in our department in the years 2002-2007. In conclusion: there is no consensus on the question of how to best treat PBL: chemotherapy, radiotherapy or combined therapy. However, the last approach to be the most successful one. Due to high incidence of central nervous system (CNS) involvement in PBL patients, many authors strongly believe that patients with aggressive forms of PBL should receive CNS infiltration prophylaxis, even in the early stages, as this may improve the outcome and significantly reduce the risk of a CNS disease relapse

Zastosowanie bortezomibu u starszego pacjenta ze wznową szpiczaka plazmocytowego po auto-HSCT

We present a case of 69 year-old woman with plasma cell myeloma who relapsed after autologous hematopoietic stem cell transplantation. The patient was treated with the bortezomib based chemotherapy (1 PAD [bortezomib, adriamycin, dexamethasone] course with continued PD [adriamycin, dexamethasone] chemotherapy). Due to the hematological toxicity, mainly thrombocytopenia stage 4 according to World Health Organization, the doses of bortezomib were delayed and gradually reduced from of 1.3 mg/m2 to 1 mg/m2, and then to 0.7 mg/m2. In addition, the patient required a platelet transfusions. The patient achieved a partial response after 8 courses of PD. Bortezomib is safe and effective and it seems to be valuable option for heavily pretreated patients.W pracy przedstawiono przypadek 69-letniej kobiety z rozpoznaniem wznowy szpiczaka plazmocytowego po autologicznym przeszczepieniu krwiotwórczych komórek macierzystych. U pacjentki zastosowano leczenie oparte na bortezomibie (1 kurs wg schematu PAD [bortezomib, adriamycyna, deksametazon] z kontynuacją leczenia wg protokołu PD [adriamycyna, deksametazon]). Ze względu na objawy toksyczności hematologicznej — w tym głównie małopłytkowości 4. stopnia według Światowej Organizacji Zdrowia — leczenie odraczano, a dawki bortezomibu odpowiednio zmodyfikowano z 1,3 mg/m2 do 1 mg/m2, a następnie do 0,7 mg/m2. Ponadto pacjentka wymagała substytucji koncentratu krwinek płytkowych. W ocenie po 8 kursach według schematu PD uzyskano odpowiedź częściową. Bortezomib jest lekiem skutecznym i bezpiecznym przy zachowaniu zasad odpowiedniego monitorowania i stanowi cenną opcję u pacjentów w starszym wieku, którzy uprzednio byli intensywnie leczeni

Autoimmune cytopenias in chronic lymphocytic leukemia: a growing challenge in targeted therapies?

As the world’s population ages, the incidence of chronic lymphocytic leukemia (CLL) will continue to increase. CLL-related autoimmune cytopenias (AICs) are becoming a growing challenge in daily clinical practice. AICs occur in c.10% of CLL patients, and include autoimmune hemolytic anemia, immune thrombocytopenia, pure red cell aplasia, and autoimmune granulocytopenia. The complication can appear at any disease stage, both in treated and previously untreated patients. In some cases, AICs precede the diagnosis of the underlying disease. The diagnostic process of autoimmune complications is often difficult. First of all, however, it requires differentiation from bone marrow infiltration resulting from underlying disease progression. A properly established diagnosis has prognostic and therapeutic implications. Autoimmune cytopenias are more often associated with high-risk CLL (with 17p deletion, 11q deletion, wild-type variant of gene encoding immunoglobulin heavy chain variable region) and show a complex pathogenesis. CLL cells and the surrounding microenvironment are involved in autoimmune mechanisms. Treatment of AICs depends on CLL stage. In the case of isolated symptoms of AICs, without accompanying features of CLL progression, glucocorticosteroids or rituximab are recommended in the first line treatment. No response or a suboptimal response to treatment implies further therapeutic decisions. According to significant advances in the treatment of chronic lymphocytic leukemia, therapeutic strategies for autoimmune cytopenias also need to be optimized. The widespread introduction of ibrutinib, idelalisib, and venetoclax has highlighted the need for understanding the interplay between targeted therapies and AICs

COVID-19 vaccination-related [18F]FDG-avid lymph node in a patient with marginal zone B-cell lymphoma

The [18F]FDG PET/CT is a crucial tool in the diagnostic process and monitoring of neoplastic diseases. Currently, during the global program of vaccination against COVID-19 and the possibility of axillary lymphadenopathy after this injection, the correct interpretation of PET/CT images is vitally significant and may create some difficulties.We present a case of increased uptake of [18F]FDG in an axillary lymph node in a PET/CT scan performed 2 days after the Pfizer BioNTech COVID-19 vaccine in a 48-year-old patient newly diagnosed with marginal zone B-cell lymphoma

Neutropenic enterocolitis and multidrug-resistant bacteria colonization in lymphoma patients undergoing autologous stem cell transplantation

Introduction: There is little iterature data regarding neutropenic enterocolitis (NE) development after autologous hematopoietic cell transplantation (auto-HCT) in non-Hodgkin lymphoma (NHL) patients. The aim of this study was to determine the incidence, risk factors, and clinical outcome of NE after auto-HCT in NHL patients with respect to the impact of multidrug-resistant Gram-negative bacteria (MDRG) and vancomycin-resistant enterococci colonization on the early outcome after auto-HCT. Material and methods: This retrospective single-center analysis included a total of 65 NHL patients who underwent auto-HCT after BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) conditioning (BEAM-auto-HCT). Results: NE was diagnosed in nine (13.8%) patients, a median four days after auto-HCT. In 6/9 (66%) patients, septic shock following NE was diagnosed. In univariate analysis, MDRG colonization before BEAM-auto-HCT was the only factor significant for NE development [odds ratio (OR) 2.4 (1.14–5.0), p = 0.027], although this was not confirmed in multivariate analysis. Additionally, NE [OR 5.2 (1.9–13.9), p = 0.001] and MDRG colonization prior to transplant [OR 2.7 (1.0–7.0), p = 0.041] were independent factors for septic shock development. Conclusions: Our findings suggest that NHL patients presenting with MDRG colonization before transplant should be kept under careful surveillance because of the high risk of the development of early severe infectious complications, including abdominal ones

Rare entitity primary testicular lymphoma: a single-center analysis

Introduction: Primary testicular lymphoma (PTL) is a rare disease, accounting for <5% of all testicular malignancies and 1–2% of non-Hodgkin lymphoma cases. Diffuse large B-cell lymphoma (DLBCL) is the most common histological diagnosis. The literature data concerning PTL is scarce and based mainly on small series or retrospective studies. Methods and results: In this paper, we present six patients with DLBCL-PTL who were treated in the Department of Hematology and Bone Marrow Transplantation at Poznan University of Medical Science, Poland between 2006 and 2022. All the patients obtained complete remission (CR) after six cycles of R-CHOP-21 (cyclophosphamide, doxorubicin, vincristine and rituximab on day 1, and prednisolone on days 1–5, administered every 21 days for a total of eight cycles) as immunochemotherapy. Five of them additionally received prophylaxis of central nervous system involvement with intrathecal methotrexate/arabinoside cytosine. One patient received scrotal radiotherapy, and in another one radiotherapy is planned. Relapse was confirmed in one patient after 72 months in the contralateral testis, and the patient was successfully retreated. After a median follow-up of 146 (range 5–196) months, all patients remain alive and in CR. Conclusion: Despite all interpretative limitations, the current standard DLBCL-PTL therapy seems to be six courses of CHOP-R-21 combined with intrathecal metothrexate and scrotal irradiation

Extraneural relapse of medulloblastoma mimicking acute leukemia: A diagnostic challenge in adult patient

Medulloblastoma is the most frequent malignant tumor of the central nervous system (CNS) in children, but it can rarely occur in adults. Extraneural relapse of medulloblastoma occurs very rarely and it is usually associated with dismal prognosis. We present a case of young adult with relapsed medulloblastoma with extraneural metastases in the bone marrow and expression of terminal deoxynucleotidyl transferase (TdT) on the malignant cells mimicking acute leukemia. To the best of our knowledge, this is the first report of medulloblastoma exhibiting expression of the TdT in adult. We would like to emphasize that in cases like this, differential diagnosis of anemia and thrombocytopenia in adults should include a consideration of primary or secondary bone marrow involvement by medulloblastoma or other rare malignancy