Development of diffuse large B-cell lymphoma from duodenal type follicular lymphoma: a retrospective study of 23 cases
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ORIGINAL ARTICLE
Development of diffuse large B‑cell lymphoma from duodenal type follicular lymphoma: a retrospective study of 23 cases Masuho Saburi1,2 · Yoshiyuki Kondo3 · Masao Ogata4 · Yasuhiro Soga5 · Miyuki Abe1 · Kuniko Takano4 · Kazuhiro Kohno1 · Takayuki Nagai6 · Toshiyuki Nakayama1 Received: 13 March 2020 / Revised: 16 July 2020 / Accepted: 21 July 2020 © Japanese Society of Hematology 2020
Abstract The incidence and clinical characteristics of histological transformation (HT) from duodenal type follicular lymphoma (DFL) are unclear. A retrospective analysis was conducted to identify the incidence and clinical features of HT from DFL in 23 cases with DFL. The median follow-up duration was 4.6 years (range, 0.8–20 years). HT to diffuse large B-cell lymphoma was observed in 2 of 23 cases during follow-up (8.7%). One of two cases transformed at 21 months later with increased serum lactate dehydrogenase (LDH; 1655 U/L) and abdominal lymphadenopathy. Partial response was achieved after R-THP (pirarubicin)-COP therapy, but the disease progressed. The other case transformed at 8.3 years with an increase of serum LDH (4022 U/L), abdominal lymphadenopathy, and bone marrow involvement. The disease was refractory to DA-EPOCH-R and a high-dose methotrexate/cytarabine regimen. The patient received allogenic peripheral blood stem cell transplantation and finally achieved complete response. Both cases developed HT at nodal or other intestinal lesions with no progression of the primary duodenal lesion. No significant factors for the occurrence of HT were identified. Although the incidence is low, HT could occur in DFL with aggressive clinical manifestations. Keywords Duodenal type · Follicular lymphoma · Histological transformation · Diffuse large B-cell lymphoma
Introduction Follicular lymphoma (FL) is a mature B-cell neoplasm characterized by follicular proliferation of germinal centerderived B-cells, and it develops as extranodal lesions in various locations, including the gastrointestinal tract [1]. * Masuho Saburi masuho‑saburi@oita‑u.ac.jp 1
Department of Medical Oncology and Hematology, Faculty of Medicine, Oita University, 1‑1 Hasama Idaigaoka, Yuhu City, Oita 879‑5593, Japan
2
Department of Medical Oncology and Hematology, Faculty of Medicine, Oita University, Oita, Japan
3
Department of Diagnostic Pathology, Oita Kouseiren Tsurumi Hospital, Oita, Japan
4
Department of Hematology, Oita University Hospital, Oita, Japan
5
Department of Clinical Laboratory, Oita Kouseiren Tsurumi Hospital, Oita, Japan
6
Department of Gastroenterology, Oita Kouseiren Tsurumi Hospital, Oita, Japan
Although gastrointestinal lesions could develop anywhere in the gastrointestinal tract, the properties of duodenal lesions differ from those of other parts of the gastrointestinal tract. Duodenal lesions have been categorized as duodenal-type FL (DFL), which is an independent disease subtype of FL [2]. DFL has characteristic histopathological immunostaining patterns of CD21, localized in the peripheral part of neo
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