原发性乳腺弥漫性大B细胞淋巴瘤5例并文献复习

目的探讨原发性乳腺弥漫性大B细胞淋巴瘤(primary breast diffuse large B-cell lymphoma,PB-DLBCL)的临床病理学特点、诊断及鉴别诊断、治疗及预后。方法采用HE染色和免疫组织化学SP法分析5例PB-DLBCL患者的临床表现、病理学及免疫表型特征,并复习相关文献。结果 5例均为女性患者,发病年龄48~70岁,中位年龄59.2岁,均为单侧乳腺肿块,其中左乳3例,右乳2例。镜下见乳腺正常结构被破坏,成片的中等偏大的肿瘤细胞弥漫浸润乳腺小叶、导管周围、间质及周围脂肪组织。根据免疫组织化学表型,4例为非生发中心型,1例为生发中心型;Ki67增殖指数为60%~90%;根据 Ann Arbor 分期标准,5例均为II E期。病例随访时间截止至2018年6月,随访期内,有2例复发,分别于7和19个月后死亡;2例健在,分别已存活12和72个月;另外一例失访。结论 PB-DLBCL是一种少见的恶性淋巴瘤,临床表现为单侧乳腺无痛性包块进行性增大,以右侧多见。确诊主要依靠病理活检及免疫表型,免疫表型以非生发中心为主,以化疗联合放疗等综合治疗方案为宜。     

非霍杰金氏淋巴瘤骨髓侵犯的骨髓涂片和骨髓病理分析

目的:探讨非霍杰金淋巴瘤(NHL)骨髓侵犯发生率与临床分期和病理分型的关系。方法:160例NHL患者均做骨髓涂片和骨髓活检,48例骨髓侵犯病例做免疫组织化学染色。结果:骨髓涂片和活检侵犯率分别为18.7%和30.0%,骨髓涂片噬血现象多见Ⅳ期。骨髓侵犯的NHL病理组织分型以B细胞为主,骨髓侵犯模式以弥散型为主。结论:骨髓活检可提高淋巴瘤骨髓侵犯的诊断率,噬血现象出现和临床分期有关。     

Epstein-Barr病毒相关T/NK细胞淋巴瘤与B细胞淋巴瘤的临床分析

Epstein-Barr病毒(Epstein-Barr virus,EBV)是可导致人类感染的淋巴滤泡病毒,感染非常普遍。本研究通过对2013年1月-2016年12月于复旦大学附属华东医院就诊并确诊为淋巴瘤且伴有EBV感染的49例患者的临床资料进行回顾性分析,探讨EBV相关淋巴瘤患者的临床特点及生存情况。结果显示,49例EBV相关淋巴瘤患者中,18例为B细胞淋巴瘤,31例为T/NK细胞淋巴瘤。EBV相关B细胞淋巴瘤与T/NK细胞淋巴瘤患者之间白细胞、血小板、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、乳酸脱氢酶、铁蛋白、纤维蛋白原、红细胞沉降率、C反应蛋白的差异有统计学意义(P<0.05)。中位随访5.0个月,49例患者的1个月、6个月、1年、3年生存率分别为 84.4%、59.8%、53.2%、40.3%。结果表明,与EBV相关B细胞淋巴瘤患者相比,EBV相关T/NK细胞淋巴瘤患者的肝功能损伤严重,更易合并噬血细胞综合征,生存期更短,但生存期差异无统计学意义。     

EPOCH-L方案治疗复发难治性T细胞淋巴瘤的临床研究

目的:探讨EPOCH-L方案治疗复发难治性T细胞淋巴瘤的疗效及安全性。方法:回顾性分析解放军某医院2012年1月至2017年1月收治的12例复发难治性T细胞淋巴瘤患者的临床资料,均采用EPOCH-L方案化疗(依托泊苷50 mg/m2第1～4天、吡柔比星10 mg/m2第1～4天、长春地辛1 mg/d第1～4天、环磷酰胺750 mg/m2第5天、泼尼龙60 mg/m2第1～5天、培门冬酶2500 iu/m2第6天)3～6个周期,并随机选取同期进行异基因造血干细胞移植治疗的12例复发难治性T细胞淋巴瘤患者为对照组,比较两组的临床疗效及不良反应的发生情况。结果:随访至2018年1月,EPOCH-L方案组患者取得完全缓解4例(33.3%),部分缓解4例(33.3%),总有效率为66.7%,中位生存期为23.7(7～65)个月,随访期间总生存率为25%;对照组患者中位生存期为9.2(3～60)个月,无病生存率为41.7%,总体生存时间分布差异无统计学意义(P=0.683)。实验组没有患者死于化疗合并症(0.0%),对照组4例死于移植合并症(33.3%),差异有统计学意义(P=0.028)。结论:EPOCH-L方案治疗复发难治性T细胞淋巴瘤的临床效果与异基因造血干细胞移植治疗相当,且安全性较高。     

凋亡抑制蛋白XIAP 在急性髓系白血病和淋巴瘤骨髓组织中 的表达及意义

目的:研究凋亡抑制蛋白(XIAP)在白血病及淋巴瘤骨髓活检组织中的表达及意义。方法:采用免疫组织化学法检测10例急性髓系白血病,13例淋巴瘤,9例非恶性血液病患者骨髓活检组织中XIAP的表达水平。结果:XIAP蛋白在急性髓系白血病、淋巴瘤骨髓活检组织中的阳性表达积分均高于非恶性血液病,差异均有统计学意义(P<0.05)。结论:XIAP的表达水平与白血病及淋巴瘤的发生发展有一定关联,可能与其抑制肿瘤细胞的凋亡有关。     

弥漫性大B细胞淋巴瘤组织CMYC、叉头框转录蛋白1、ki-67蛋白表达及临床意义

摘要 目的：探讨弥漫性大B细胞淋巴瘤（DLBCL）组织CMYC、叉头框转录蛋白1（FOXP1）、ki-67蛋白表达及临床意义。方法：选择2013年2月～2018年1月我院收治的DLBCL患者100例,以免疫组织化学法分别检测DLBCL组织及癌旁组织中CMYC、FOXP1、ki-67蛋白表达情况,并分析DLBCL组织中上述蛋白表达和患者临床病理特征的关系。此外,对所有患者均进行为期2年的随访观察,将其按照生存情况分成存活组69例和死亡组31例,比较两组CMYC、FOXP1、ki-67蛋白表达情况。结果：DLBCL组织CMYC、FOXP1、ki-67蛋白阳性表达率均高于癌旁组织（P＜0.05）。国际预后指数（IPI）评分为3～4分的患者DLBCL组织CMYC蛋白阳性表达率低于IPI评分为0～2分的患者（P＜0.05）。病理分型为生发中心B细胞来源（GCB）、IPI评分为3～4分的患者DLBCL组织FOXP1蛋白阳性表达率分别低于病理分型为非生发中心B细胞来源（non-GCB）、IPI评分为0～2分的患者（P＜0.05）。年龄＜60岁、Ann Arbor分期为Ⅰ～Ⅱ期、IPI评分为3～4分的患者DLBCL组织ki-67蛋白阳性表达率分别低于年龄≥60岁、Ann Arbor分期为Ⅲ期、IPI评分为0～2分的患者（P＜0.05）。死亡组CMYC、FOXP1、ki-67蛋白阳性表达率均高于存活组（P＜0.05）。结论：DLBCL组织CMYC、FOXP1、ki-67蛋白表达均与IPI评分关系密切,FOXP1蛋白表达与病理分型有关,而ki-67蛋白表达与年龄以及Ann Arbor分期有关,DLBCL患者不良预后可能与上述三项蛋白阳性表达率的异常升高有关。     

骨髓单个核细胞抗体及外周血B淋巴细胞与IRP的相关性研究

采用流式细胞术双标法检测拟诊免疫相关性全血细胞减少症患者(A组)、非免疫相关性恶性血液病患者(B组)及正常人(正常对照组)的骨髓单个核细胞结合的自身抗体,同时检测B组、确诊免疫相关性全血细胞减少症(C组)及正常对照组外周血B淋巴细胞及CD5+B淋巴细胞比率;A组中16例骨髓造血细胞自身抗体阳性,阳性率88.88%;B组1例骨髓造血细胞自身抗体阳性,阳性率9.09%。C组外周血B淋巴细胞、CD5+B淋巴细胞比率显著高于B组及正常对照组(P均<0.05),而正常对照组外周血B淋巴细胞、CD5+B淋巴细胞显著高于B组(P均<0.05);IRP患者骨髓单个核细胞自身抗体表达显著增高,B淋巴细胞总数及CD5+B淋巴细胞数量显著增高可能是IRP发病的重要因素之一;利用流式细胞术检测骨髓造血细胞自身抗体及B淋巴细胞数可以为IRP提供科学可靠的依据,优于骨髓Coomb’s实验。     

恶性血液病患者医院侵袭性真菌感染的危险因素分析

目的了解恶性血液病患者袭性真菌感染的发生率及危险因素,为重症患者的真菌感染防治提供依据。方法回顾性调查2013年1月至12月期间的495例恶性血液病住院患者资料,用卡方检验及多因素Logistic回归分析等统计方法分析侵袭性真菌感染的危险因素。结果 16.4%(81/495)的患者发生侵袭性真菌感染,其中急性白血病、慢性白血病、骨髓增生异常综合征、淋巴瘤和多发性骨髓瘤患者的真菌感染发生率分别为31.1%(66/212)、0.0%(0/19)、31.2%(5/16)、4.8%(10/207)和0.0%(0/41)。外周血白细胞计数低值≤1.0E+9/L、粒细胞缺少时间≥8天、使用糖皮质激素及抗生素使用种类≥3种是恶性血液病患者侵袭性真菌感染的独立危险因素,预防性使用抗真菌药物是独立保护因素(OR值分别为15.830、41.667、3.745、8.264及39.085,P值分别为0.000、0.011、0.035、0.007及0.000)。结论合理使用抗生素和糖皮质激素、在粒细胞缺少时间较长病例中及时使用集落刺激因子、抗真菌药或重建微生态是防治恶性血液病患者真菌感染的必要措施。     

23例儿童霍奇金淋巴瘤临床分析(英文)

目的:分析儿童青少年霍奇金淋巴瘤(HL)患者的病理特征、临床表现及其预后影响因素。方法:收集青岛大学医学院附属医院血液儿科2001年5年至2013年8月收治的23例经病理确诊的儿童青少年HL患者的临床资料,采用Fisher确切概率法等进行各组间差异检验。结果:确诊病例共23例,中位年龄7.5岁,男:女发病比例=6.7:1,Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期分别占13.0%、26.2%、30.4%、30.4%;结节性淋巴细胞为主型(NLPHL)1例(4.3%),经典型HL22例(95.7%):混合细胞型(MC)10例(43.5%),淋巴细胞为主型(LP)11例(47.9%),结节硬化型(NS)1例(4.3%);受累部位以颈部淋巴结最多见,其次依次为纵隔、腹腔及腹膜后、脾、骨骼、肺组织等,其中巨大纵隔肿块者2例;具有B症状者8例(34.7%)。化疗2个疗程评估总有效率为100%,完全缓解(CR)率69.6%,部分缓解(PR)率30.4%。Ⅰ期和Ⅱ期患者CR率100%,明显高于Ⅲ期和Ⅳ期患者(50%),P0.05;23例患者7例复发,复发率Ⅲ期和Ⅳ期患者为46.2%,Ⅰ期和Ⅱ期患者为11.1%,前者高于后者(P=0.0098);有B症状与无B症状患者之间复发率有显著统计学差异(P=0.019);2例有巨大包块患者皆复发;各病理分型与疾病的复发间差异无统计学意义(x2=2.695,P0.05)。结论:儿童霍奇金淋巴瘤预后相对较好,但Ⅲ期和Ⅳ期、合并B症状及大肿块或大纵隔肿瘤的患者复发率高,应依据疾病危险度分层治疗,以期更好的预后。     

252 例胸膜恶性肿瘤的临床病理分析

目的：探讨胸膜恶性肿瘤的病理类型、肿瘤所占比例、临床病理特征及鉴别诊断。方法：结合病理形态学及免疫组化方法对 252 例胸膜恶性肿瘤进行诊断及鉴别诊断。结果：252 例胸膜恶性肿瘤包括胸膜穿刺活检120 例,胸腔镜活检25 例,伴有胸膜转 移的恶性胸水107 例;男性143 例,女性109 例,年龄19-87 岁,平均年龄59.9 岁。临床主要症状是胸闷、气短、咳嗽、胸痛等。CT 表现为胸膜增厚、胸水(90%)、多发或单发胸膜结节和原发器官占位性病变。活检病例中,转移性癌86 例(34.1%),包括肺腺癌64 例(25.4%),小细胞癌11 例(4.4%),鳞癌11 例(4.4%),恶性间皮瘤47 例(18.7%),滑膜肉瘤9 例(3.6%),非霍奇金淋巴瘤3 例(1.2%); 恶性胸水病例病例中转移性癌95 例(37.7%),包括肺腺癌85 例(33.7%),小细胞癌6 例(2.4%),鳞癌2 例(0.8%),乳腺腺癌2 例 (0.8%),恶性间皮瘤8 例(3.2%),非霍奇金淋巴瘤4 例(1.6%)。结论：胸膜恶性肿瘤中以转移性腺癌多见,其次为恶性间皮瘤,结合 形态学及免疫组织化学检测不同标志物的表达有助于诊断胸膜恶性肿瘤的种类。     

Extrauterine malignancies. Role of Pap smears in diagnosis and management.

OBJECTIVE: To further elucidate the cytologic manifestations of extrauterine malignancies, to evaluate their possible distinction from primary cervical malignancies and to analyze their clinical significance and role in staging. STUDY DESIGN: Papanicolaou (Pap) smears in 33 cases with abnormal cells originating in histologically proven extrauterine carcinomas were evaluated. These cases came from the files of the Medical College of Pennsylvania and Lankenau Hospitals. RESULTS: Ovary, gastrointestinal tract and breast were the three most frequent primary sites, accounting for 28 of the 33 cases (85%). The histologic types encountered were adenocarcinoma, 29 cases (88%); mucoepidermoid carcinoma, 1 (3%); small cell carcinoma, 1 (3%); cloacogenic carcinoma and large cell lymphoma, 1 (3%). The following diagnoses were rendered at the time of initial evaluation: adenocarcinoma consistent with metastasis, 21 cases; carcinoma, primary versus metastatic, 2; adenocarcinoma, suspicious for endometrial primary, 2; suspicious for carcinoma, 1; and atypical glandular cells, 7. CONCLUSION: The yield for positive Pap smear diagnoses in extrauterine malignancies is best in patients with an established diagnosis of a primary neoplasm. The degree of tumor differentiation and extent of tumor involvement did not appear to correlate with diagnostic yield. There appeared to be no statistically significant association of tumor diathesis with primary versus metastatic carcinoma and presence or absence of documented local involvement of the endometrium, cervix or vagina. Therefore, while Pap smears can serve as a diagnostic tool in the evaluation of extrauterine malignancies, they are best utilized as an adjunct to tumor staging and patient management.     

Primary non-Hodgkin's lymphoma of the breast: a case report

Extranodal non-Hodgkin's lymphoma (NHL) of the breast is a rare entity. It represents 0.04-1.1% of malignant tumors of the breast. 1.7-2.2% of extranodal lymphomas and 0.7% of all NHL. However, primary NHL (PNHL) is the most frequent hematopojetic tumor of the breast. CASE: A 23-year-old woman presented with a mass in the left breast for 3 months followed by enlarged left axillary lymph nodes. Mammography showed a diffuse increase in the density of the left breast. Other investigations were unremarkable. Both fine needle aspiration cytology (FNAC) and histopathology were diagnostic of NHL. Immunohistochemistry was confirmatory of NHL, diffuse large cell type, of B-cell lineage. CONCLUSION: Primary and secondary lymphomas of the breast, though rare, should be considered in the differential diagnosis of breast malignancies. PNHL of the breast is usually right sided, but this patient had left breast involvement. Diagnosis by FNAC was successful as the cytologic picture is similar to that of any other lymphoid or extranodal NHL. When histopathology and immunohistopathology are conclusive, FNAC, supplemented by immunocytochemistry, can be applied as a simple, reliable and cost-effective tool in the early diagnosis of breast lymphomas.     

Altered PTEN expression; a diagnostic marker for differentiating normal, hyperplastic and neoplastic endometrium

Background

Primary non-Hodgkin lymphoma (NHL) of the breast represents 0.04–0.5% of malignant lesions of the breast and accounts for 1.7–2.2% of extra-nodal NHL. Most primary cases are of B-cell phenotype and only rare cases are of T-cell phenotype. Anaplastic large cell lymphoma (ALCL) is a rare T-cell lymphoma typically seen in children and young adults with the breast being one of the least common locations. There are a total of eleven cases of primary ALCL of the breast described in the literature. Eight of these cases occurred in proximity to breast implants, four in relation to silicone breast implant and three in relation to saline filled breast implant with three out of the eight implant related cases having previous history of breast cancer treated surgically. Adjuvant postoperative chemotherapy is given in only one case. Secondary hematological malignancies after breast cancer chemotherapy have been reported in literature. However in contrast to acute myeloid leukemia (AML), the association between lymphoma and administration of chemotherapy has never been clearly demonstrated.

Case Presentation

In this report we present a case of primary ALCL of the breast arising in reconstruction mamoplasty capsule of saline filled breast implant after radical mastectomy for infiltrating ductal carcinoma followed by postoperative chemotherapy twelve years ago.

Conclusion

Primary ALK negative ALCL arising at the site of saline filled breast implant is rare. It is still unclear whether chemotherapy and breast implantation increases risk of secondary hematological malignancies significantly. However, it is important to be aware of these complications and need for careful pathologic examination of tissue removed for implant related complications to make the correct diagnosis for further patient management and treatment. It is important to be aware of this entity at this site as it can be easily misdiagnosed on histologic grounds and to exclude sarcomatoid carcinoma, malignant melanoma and pleomorphic sarcoma by an appropriate panel of immunostains to arrive at the correct diagnosis of ALCL.     

Expression of the MDR1 and MRP genes in patients with lymphoma with primary bone marrow involvement

Expression of MDR1 and MRP genes in patients with low-grade and high-grade non-Hodgkin's lymphomas with primary bone marrow involvement before and after chemotherapy was investigated. The data demonstrate that overexpression of MDR1 and MRP genes in hematological malignancies elevates in patients after chemotherapy and correlates with poor clinic prognosis and more frequent recurrences of the malignancies.     

Prognostic factors in primary diffuse large B-cell lymphoma of adrenal gland treated with rituximab- CHOP chemotherapy from the Consortium for Improving Survival of Lymphoma (CISL)

ABSTRACT: BACKGROUND: The objective of this study was to identify prognostic factors for survival in patients with primary diffuse large B-cell lymphoma (DLBCL) of the adrenal gland. METHODS: Thirty one patients diagnosed with primary adrenal DLBCL from 14 Korean institutions and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) were analyzed. RESULTS: Complete remission (CR) and overall response rate after R-CHOP chemotherapy were 54.8% and 87.0%. The 2-year estimates of overall survival (OS) and progression-free survival (PFS) were 68.3% and 51.1%. In patients achieving CR, significant prolongations of OS (P = 0.029) and PFS (P = 0.005) were observed. Ann Arbor stage had no influence on OS. There was no significant difference in OS between patients with unilateral involvement of adrenal gland and those with bilateral involvement. When staging was modified to include bilateral adrenal involvement as one extranodal site, early stage (I or II) significantly correlated with longer OS (P = 0.021) and PFS (P <0.001). CONCLUSIONS: Contrary to prior reports, our data suggests that outcomes of primary adrenal DLBCL are encouraging using a regimen of R-CHOP, and that achieving CR after R-CHOP is predictive of survival. Likewise, our modified staging system may have prognostic value.     

Fine needle aspiration cytology of primary lymphoma of the thyroid: a report of 17 cases.

Between 1980 and 1998, 4272 thyroid surgical specimens with a preoperative fine needle aspirate were sent to our Anatomical Pathology Department. Among these cases there were 17 primary thyroid lymphomas, which constituted 0.3% of all the thyroid lesions and 2.3% of the thyroid malignancies. Seven cases were diffuse large B-cell (DLBC) lymphomas and 10 were MALT lymphomas. Of the DLBC lymphomas six were correctly diagnosed by fine needle aspiration cytology (FNAC) and one was diagnosed as positive for malignancy, and among MALT lymphomas four were diagnosed as lymphoma, four as suspicious for lymphoma, and three as Hashimoto's thyroiditis (HT). Our data indicate that the diagnosis of primary thyroid lymphoma of high grade is easy, and immunocytochemistry (ICC) can confirm suspicious cases. The diagnosis of MALT lymphoma is more difficult; ICC can confirm suspicious cases, and false-negative results seem to be caused by sampling error, because HT usually coexists with MALT lymphoma.     

Diagnostic and prognostic value of immunohistological bone marrow examination: results in 212 patients with lymphoproliferative disorders

Cryostat sections of 246 consecutive bone marrow biopsies from 212 patients with lymphoproliferative disease were investigated using a panel of monoclonal antibodies (MOAb's) and an immunoperoxidase technique. Bone marrow involvement was demonstrated by immunohistological examination in 121/160 patients (76%) with non-Hodgkin lymphomas (NHL) and 16/23 patients (70%) with plasma cell malignancies; the definite immunological diagnosis could be performed in 77% and 88%, respectively. Reactivity with the MoAb Ki-67 correlated with clinical parameters: in all cases exhibiting more than 5% positive cells an unfavourable course was seen, independent of the histological subtype. Another MoAb of potential prognostic relevance is KiM 4 b, which reacts with follicular dendritic cells (FDC). Besides the presence of FDC in germinal center tumors (CB/CC and CC-NHL) we found FDC in a minority of cases with B-CLL (5/44) and IC lymphoma (4/18). In the latter group 3/4 patients showed a favourable clinical course (vs 2/14 without FDC). The MoAb Tü 1 could discriminate between the lymphoplasmocytoid (11/12 positive) and the lymphoplasmocytic (0/6 positive) subtype of IC lymphoma and has proven of diagnostic importance. Expression of IL-2 receptors, detected by MoAb anti-Tac (CD 25), was demonstrated on leukemic cells from patients with hairy cell leukemia (100%), B-CLL (82%), IC (61%), CC (50%) and CB/CC lymphoma (50%). A considerable number of reactive T-lymphocytes (5%-60% of tissue cells) were identified among the neoplastic B cells with a predominance of CD4+ cells in most cases with NHL, whereas the CD4+/CD8+ ratio was significantly lower in myelomas and non-infiltrated bone marrows. The potential meaning of these findings is discussed. The immunohistological bone marrow analysis represents an important additional method in the diagnostic procedures of lymphoproliferative diseases involving the bone.     

Expression of the MDR1 and MRP Genes in Patients with Lymphoma with Primary Bone Marrow Involvement

Expression of MDR1 and MRP genes in patients with low‐grade and high‐grade non‐Hodgkin's lymphomas with primary bone marrow involvement before and after chemotherapy was investigated. The data demonstrate that overexpression of MDR1 and MRP genes in hematological malignancies elevates in patients after chemotherapy and correlates with poor clinic prognosis and more frequent recurrences of the malignancies.     

Diverse Hematological Malignancies Including Hodgkin-Like Lymphomas Develop in Chimeric MHC Class II Transgenic Mice

A chimeric HLA-DR4-H2-E (DR4) homozygous transgenic mouse line spontaneously develops diverse hematological malignancies with high frequency (70%). The majority of malignancies were distributed equally between T and B cell neoplasms and included lymphoblastic T cell lymphoma (LTCL), lymphoblastic B cell lymphoma (LBCL), diffuse large B cell lymphoma (DLBCL), the histiocyte/T cell rich variant of DLBCL (DLBCL-HA/T cell rich DLBCL), splenic marginal zone lymphoma (SMZL), follicular B cell lymphoma (FBL) and plasmacytoma (PCT). Most of these neoplasms were highly similar to human diseases. Also, some non-lymphoid malignancies such as acute myeloid leukemia (AML) and histiocytic sarcoma were found. Interestingly, composite lymphomas, including Hodgkin-like lymphomas, were also detected that had CD30⁺ Hodgkin/Reed-Sternberg (H/RS)-like cells, representing a tumor type not previously described in mice. Analysis of microdissected H/RS-like cells revealed their origin as germinal center B cells bearing somatic hypermutations and, in some instances, crippled mutations, as described for human Hodgkin lymphoma (HL). Transgene integration in an oncogene was excluded as an exclusive driving force of tumorigenesis and age-related lymphoma development suggests a multi-step process. Thus, this DR4 line is a useful model to investigate common molecular mechanisms that may contribute to important neoplastic diseases in man.     

Role of endoscopic ultrasound‐guided‐fine needle aspiration biopsy in the diagnosis of lymphoma of the pancreas: A clinicopathological study of nine cases

Objective

Endoscopic ultrasound‐guided‐fine needle aspiration (EUS‐FNA) is an established first‐line procedure in the management of solid and cystic pancreatic masses. Lymphoma is an uncommon diagnosis in EUS‐FNA of the pancreas, and it is more common for such a diagnosis to be because of secondary involvement of the pancreas by a lymphoproliferative disorder than for this to represent isolated primary pancreatic lymphoma (PPL). We present the clinical, EUS and cytological features of these lesions.

Material and methods

After obtaining approval from our Institutional Review Board (IRB), nine cases of lymphoma diagnosed on EUS‐FNA at a tertiary care cancer centre over a period of 8 years from 2008 to 2016 were retrieved from our endoscopy and pathology archives. Rapid onsite evaluation (ROSE) was carried out by a trained cytopathologist in all these cases. Cell blocks were available in seven cases, and immunophenotyping was performed on cell blocks using the immunoperoxidase method. Flow cytometry was performed in two cases.

Results

The most frequent site of involvement was the head of the pancreas (n=5, 55.6%). Four out of nine cases were diagnosed as PPL (44.4%). Five cases were diagnosed as lymphoma secondarily involving the pancreas (55.6%). The most frequent diagnosis was diffuse large B‐cell lymphoma (n=6, 66.7%), followed by Hodgkin's lymphoma (n=2, 22.2%) and peripheral T‐cell lymphoma (n=1, 11.1%).

Conclusion

EUS‐FNA in experienced hands is a valuable diagnostic modality, in conjunction with ROSE, immunohistochemistry and flow cytometry, in the diagnosis and sub‐typing of both primary and secondary pancreatic lymphoma.