An unusual case of late recurrent Hodgkin lymphoma presenting with soft tissue masses

Hodgkin lymphoma remains primarily a nodal disease. Extranodal involvement in Hodgkin lymphoma is less common than that seen in non-Hodgkin lymphoma. In particular, extranodal Hodgkin lymphoma involving soft tissues is extremely rare. We report a case of extranodal Hodgkin lymphoma involving breast and thigh tissues in a 72 year-old female. CAT scan showed a complex mass like area centered around the distal aspect of the vastus medialis. Ultrasound showed an ovoid solid and cystic mass in the right breast. This case illustrates that, while rare, Hodgkin lymphoma can manifest as soft tissue masses

Clinico-pathological features and PD-1/PD-L1 Expression in Primary Mediastinal Large B Cell Lymphoma

Primary Mediastinal Large B Cell Lymphoma (PMBCL) is a distinct subtype of Diffuse Large B Cell Lymphoma (DLBCL) that has been historically reported to have a worse prognosis than DLBCL. Occasional studies have reported PD-L1 expression in PMBCL, which can emerge as an important target for immune-check point therapy. This study aimed to evaluate clinico-pathological features and characterize the expression of PD-1 and PD-L1 in a single cohort of 15 patients with PMBCL. A total of 15 cases of PMBCL were retrieved from records of the department of Pathology; eleven of these had tissue available for additional immunohistochemistry, specifically, PD-L1 (clone SP142) and PD-1 (clone NAT105). A cut-off of ≥30% was used for PD-1 and PDL-1 expression in tumor cells, and ≥20% for tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs). The median age was 42 years (23-83 years), and 9 of 15 (60%) patients were females. Of the 8 patients with clinical data, three (38%) received aggressive R-EPOCH therapy and responded. Tumor cells showed positive PD-L1 expression in only 1 case (9%), and TAMs showed positive PDL-1 expression in seven cases (64%). None of the cases analyzed showed positive PD-1 expression in TCs, while four cases (36%) showed positive PD-1 expression in TILs

Is Myeloproliferative Neoplasm with Splanchnic Vein Thrombosis a Distinct Clinical Entity?

Clinical History: A 29 year-old previously healthy female presented with sub-acute symptoms of weight loss, right upper quadrant pain and nausea. CBC results: WBC-11.7, Hb- 12.5, Platelet- 286, MCV- 90, MCV- 26.8, RDW- 18%. Imaging: Ultrasound and MRI of the abdomen were suggestive of Budd-Chiari syndrome that was supported by a liver biopsy showing features of hepatic outflow obstruction(Figure 1). There was no clinical or radiological evidence of splenomegaly. The hypercoagulable work-up was negative. An underlying Myeloproliferative Neoplasm (MPN) was suspected

Therapy related acute myeloid leukemia with t(10:16): a rare entity

Treatment related myelodysplastic syndrome (t-MDS) and acute myeloid leukemia (t-AML) are well known complications after chemotherapy for various hematologic and non-hematologic malignancies. Alkylating agents and Topoisomerase inhibitors are most widely studied in this regard. There is growing concern about occurrence of t-MDS, t-MDS/AML and t-AML in patients of CLL treated with nucleoside analogues especially in combination with alkylating agents. Exact incidence and pathogenesis of nucleoside analogue related MDS/AML is not clear at this time. We hereby report a case of t-AML in a patient treated with Fludarabine, Cyclophosphamide and Rituximab (FCR) for CLL. The cytogenetic studies revealed a unique translocation t (10:16), that has been reported in very few cases of therapy related AML and pediatric AML

Increasing the rate of excisional lymph node biopsies at easily accessible sites when ruling out lymphoma

The aim of this study is to increase the rate of excisional lymph node biopsies from 78% to 95% in patients presenting to the Center City campus with lymphadenopathy at easily accessible sites by September 2021

Assessment of the Diagnostic Accuracy of Core Needle Biopsy in the Diagnosis of Lymphoma

Introduction: Excisional biopsy (EB) of lymph nodes is the gold standard for diagnosing lymphoma. Recent literature suggests that diagnostic techniques such as immunohistochemistry, flow cytometry and FISH/Cytogenetics yield similar diagnostic adequacy rates when paired with less invasive procedures, like Core Needle Biopsy (CNB). We were interested in comparing the diagnostic odds ratio and adequacy of patients suspected of lymphoma who underwent CNB to EB at Thomas Jefferson University Hospital (TJUH). Methods: We performed a retrospective cohort study on biopsies collected from 01/01/2016 and 12/31/2019 at TJUH. Specimens were considered diagnostically inadequate if there was not enough lesional tissue for diagnosis or the disease process was unable to be fully characterized. The diagnostic odds ratio and confidence intervals were calculated using the Baptista-Pike method. Adequacy of the specimens was then compared for statistical significance using a chi-squared test. Results: A total of 457 biopsy samples were included in the final analysis, consisting of 339 EB samples and 118 CNB samples. EBs had adequate tissue to make a diagnosis 96.8% (328) of the time, while CNB’s had adequate tissue 56.8% (67) of the time. The diagnostic odds ratio of CNB was determined to be 0.03583, [95% confidence interval {CI}: 0.01695 to 0.07532] (Baptista-Pike), p\u3c0.0001 (Chi square). Discussion: TJUH has begun moving away from EBs in recent years, but our results indicate that EB should remain the standard of care. Additional research is needed to understand the reason for this recent trend as well as how ancillary studies could enhance CNB diagnostic accuracy

Assessment of the Diagnostic Accuracy of Core Needle Biopsies in the Diagnosis of Lymphoma

Introduction: Excisional biopsy remains the gold standard in the diagnosis of lymphomas. However, recent studies have shown that core needle biopsy (CNB) may have similar accuracy. CNB offers several advantages over excisional biopsy, including reduced cost and morbidity, thus we set out to determine the diagnostic accuracy of CNB at Thomas Jefferson University Hospital (TJUH) to understand if this approach should be utilized more in our system. Methods: We performed a retrospective chart review of all suspected new diagnosis of lymphoma at TJUH from January 1st, 2016 to December 31st, 2019. All CNB and excisional biopsies were reviewed. Samples were deemed inadequate if they 1. Did not provide enough tissue for a diagnosis or 2. Were too limited to fully characterize the disease. We determined the accuracy of each biopsy type, as well as their diagnostic odds ratio using a Baptista-Pike model. Results: Excisional biopsy was found to be adequate 97% (328/339) of the time, while CNB was adequate 57% (67/122) of the time. The diagnostic odds ratio for CNB was found to be 0.03583 [95% confidence interval {CI}: 0.01695 to 0.07532] (Baptista-Pike), p \u3c0.0001 (Chi square). Discussion: Our results indicate that excisional biopsy should remain the standard of care in the diagnosis of lymphoma for most cases at TJUH. Based on this research, a quality improvement initiative is being implemented to increase the number of excisional biopsies done at TJUH, especially in easily accessible areas

MiR-200c Reprograms Fibroblasts to Recapitulate the Phenotype of CAFs in Breast Cancer Progression

Mesenchymal-epithelial plasticity driving cancer progression in cancer-associated fibroblasts (CAFs) is undetermined. This work identifies a subgroup of CAFs in human breast cancer exhibiting mesenchymal-to-epithelial transition (MET) or epithelial-like profile with high miR-200c expression. MiR-200c overexpression in fibroblasts is sufficient to drive breast cancer aggressiveness. Oxidative stress in the tumor microenvironment induces miR-200c by DNA demethylation. Proteomics, RNA-seq and functional analyses reveal that miR-200c is a novel positive regulator of NFκB-HIF signaling via COMMD1 downregulation and stimulates pro-tumorigenic inflammation and glycolysis. Reprogramming fibroblasts toward MET via miR-200c reduces stemness and induces a senescent phenotype. This pro-tumorigenic profile in CAFs fosters carcinoma cell resistance to apoptosis, proliferation and immunosuppression, leading to primary tumor growth, metastases, and resistance to immuno-chemotherapy. Conversely, miR-200c inhibition in fibroblasts restrains tumor growth with abated oxidative stress and an anti-tumorigenic immune environment. This work determines the mechanisms by which MET in CAFs via miR-200c transcriptional enrichment with DNA demethylation triggered by oxidative stress promotes cancer progression. CAFs undergoing MET trans-differentiation and senescence coordinate heterotypic signaling that may be targeted as an anti-cancer strategy

An unusual case of a microscopic alveolar adenoma coexisting with lung carcinoma: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Alveolar adenomas are extremely rare, benign, primary lung tumors of unknown histogenesis that are characterized by proliferative type II alveolar epithelium and septal mesenchyma. Mostly incidental, they are clinically important as they can imitate benign primary and secondary malignant tumors and at times are difficult to differentiate from early-stage lung cancer. We describe the case of a 59-year-old man with an incidental microscopic alveolar adenoma coexisting with poorly differentiated lung carcinoma.</p> <p>Case presentation</p> <p>A 59-year-old Caucasian man with a medical history of smoking and chronic obstructive pulmonary disease was incidentally found to have a right upper lobe mass while undergoing a computed tomographic chest scan as part of a chronic obstructive pulmonary disease clinical trial. Our patient underwent a right upper lobectomy after a bronchoscopic biopsy of the mass revealed the mass to be a carcinoma. A pathological examination revealed an incidental, small, 0.2 cm, well circumscribed lesion on the staple line margin of the lobectomy in addition to the carcinoma. Histopathological and immunohistochemical examinations revealed the lesion to be an alveolar adenoma.</p> <p>Conclusions</p> <p>We report the rare presentation of a microscopic alveolar adenoma coexisting with lung carcinoma. Alveolar adenoma is an entirely benign incidental neoplasm that can be precisely diagnosed using immunohistochemical analysis in addition to its unique histopathological characteristics.</p