Mediastinal lymphomas – A clinicopathologic study (original) (raw)
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International journal of health sciences
Mediastinal lymphoma is a rare tumor. Approximately 10% of primary mediastinal lymphoma occur in mediastinum. In this study we look for sex and age characteristics, histopathology and immunohistochemical profile of mediastinal lymphoma. Data were collected from the Anatomical Pathology laboratory Dr. Soetomo archives from January 2016 to August 2018. Seventeen cases of mediastinal lymphoma were found predominantly in males (76.47 %). The age range was between 17 and 64 years old. Distribution of tumor type was as follows: Non-Hodgkin’s Lymphoma, B-cell type high grade (Ki67 > 30%) 17.65 % and Non-Hodgkin’s Lymphoma, B-cell type low grade (Ki67 <30%) 11.76%, Non-Hodgkin’s Lymphoma, T-cell type high grade 11.76%, Non-Hodgkin’s Lymphoma unknown subtype 35.29%, Classical Hodgkin’s Lymphoma (CHL) 17.65%, T-cell Lymphoblastic Lymphoma (T-LBL) 5.88%. Histologically, Non-Hodgkin’s Lymphoma showed a diffuse pattern consisting of anaplastic lymphoid cells, pleomorphic nuclei, coarse chr...
Background :Mediastinal cavity (anterior middle and posterior mediastinum) harbours many vital organs,nerves and vessels of the body and hence can give rise to various mass lesions arising from those organs, both benign and malignant. According to percentage of incidence lymphomas and germ cell tumor top the list.Even though imaging helps to localise the lesion histopathological examinations in the form of image guided trucut biopsy still happens to be the gold standard. However, early diagnosis of these lesions along with further categorisation and grading needs to be done promptly to start treatment and benefit the patients.This study presents an array of such cases with special emphasis to mediastinal lymphoma and their clinico pathologic correlation over a small period of time. Material And Methods : A cross sectional observational study was done in RGKar medical college over a period of 2 years. CT scan was done along with other imaging techniques to localise the mediastinal mass lesions and then guided tru cut biopsy was done for confirmation,categorisation and grading of the lesions. Immunohistochemistry was done as and when required. Result: All the avialable.information were meticulously documented in a grand chart along with other variables like age, sex, addictive habbits, presenting complaints, anatomical location etc. Spss software was used to calculate statistical significance if any,of these variables with the final etiology or histological dignosis. Conclusion : Lymphomas constitute a considerable peecentage of mediastinal masslesions.This study help in early diagnosis, classification, topographical, demographical and symptomatic correlation help us in initiating early treatment and will be beneficial to the patients in more than one ways.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2005
The study points out the value of CT scan in the investigative algorithm of mediastinal lymphomas. Thirty-eight cases of mediastinal malignant lymphoma were evaluated in a statistical retrospective study. CT scan was used for staging the disease in 25 cases and for post-therapeutic evaluation in the other 13 cases. The CT scan for staging purpose has shown the presence of significant isolated and confluent enlarged lymph nodes in the mediastinum in all 25 cases. Post-therapeutic evaluation of the 13 cases examined by CT showed six remissions, five reductions of lymph node masses and two extra nodal extensions. CT scan is the imaging method of choice in the clinico-morphological and anatomical assessment of mediastinal lymphomas.
2011
In recent years, an overlap in biologic and clinical features has been identified between classic Hodgkin lymphoma (CHL) and primary mediastinal large B-cell lymphoma (PMBL). Further strengthening this relationship is the identification of lymphomas with clinical and morphologic features transitional between the two, known as gray zone lymphomas (GZL). However, this diagnostic gray zone is not just of theoretical interest: it presents a practical problem, as the treatment approaches for CHL traditionally differ from those for aggressive B-cell lymphomas. This article reviews the treatment approach for mediastinal lymphomas, including CHL of the nodular sclerosis subtype (CHL-NS), PMBL, and mediastinal GZL. Though several trials have evaluated different regimens with or without radiation in PMBL and CHL-NS, there is a lack of prospective experience in treating GZL because of the rarity of these tumors. Historical data indicate that they have done poorly with traditional approaches developed for the treatment of either CHL or diffuse large B-cell lymphoma.
Mediastinal B-cell lymphoma: A study of its histomorphologic spectrum based on 109 cases
Human Pathology, 1999
Mediasfinal B-cell lymphoma (MBL) is a distinct variant of aggressive non-Hodgkin's lymphoma with characteristic clinical and biological features but less well-defined histomorphology. We reevaluated 124 biopsy specimens from 109 MBL patients of an Italian/ French/German retrospective clinical study. MBL was primarily diagnosed on clinical and histological grounds in conjunction with the detection of CD20 expression by immunohistology. Cytologically, MBL features limited intralesional but considerable interindividual cytological diversity, ranging from medium-sized to very large, atypical cells. Sclerosis and necrosis are restricted to extrathymic and extranodal sites of involvement, predominantly the lung, as is angioinvasion, which predominantlyaffects larger vessels. The medium-sized and the large cell variants resemble marginal zone lymphoma variants, Primary mediastinal B-cell lymphoma (MBL) is a tumor displaying a unique combination of Clinical, immunologic, molecular, and cytogenetic features. MBL occurs in all age-gr0ups but predominates in young adults. 1-7 Typically, it is localized in the anterior mediastinum, and thymic involvement could be repeatedly demonstrated. Therefore, it is assumed that MBL is a primary thymic tumor with the thymic medullary B cell as its putative normal counterpart. 1,8-11 Its local growth is aggressive, often involving the lungs, whereas extrathoracic spread is uncommon at diagnosis. At relapse or progression. MBL eventually "metastasizes" to other organs such as the liver, kidney, breast, or ovary. ~2 Immunologically, MBL expresses B-lineage-specific surface molecules, such as CD19. CD20, CD22, and the immunoglobulin-associated CD79 molecule. 13,14 Although immunoglobulin genes are regularly rear-whereas the very large cell variant of MBL has not so far been found to have any extramediastlnal counterpart. We conclude that MBL displays a broad morphological spectrum covering more than is implied by the term "diffuse large cell lymphoma." Because statistical analysis of cytological and histological criteria failed to correlate with prognosis in this comprehensive group of patients, we think it inadvisable further to subclassify MBL. HUM PATHOL 30:178-187.
Histopathology, 1986
Eight cases of mediastinal non-lymphoblastic large-cell lymphoma have been studied by histopathological and immunohistochemical methods. A common clinical, morphological and immunophenotypic pattern was identified. Six of eight cases proved to be of B-cell origin by the expression of B-associated antigens detected by specific monoclonal antibodies. Cells of large size with nuclei of varying morphology and a peculiar type of fine compartmentalizing fibrosis were observed in all specimens. Clinically the disease was characterized by the young age of the patients, primary mediastinal involvement, aggressive behaviour and spread to unusual sites (kidneys in four cases).
A prospective study of mediastinal gray-zone lymphoma
Blood, 2014
Mediastinal B-cell lymphomas present in the mediastinum and are most frequent in young patients. Nodular sclerosis Hodgkin lymphoma (NSHL) and primary mediastinal B-cell lymphoma (PMBL) are the common types, whereas mediastinal gray-zone lymphoma (MGZL) is extremely rare and has pathological features intermediate between NSHL and PMBL. The indeterminate pathobiology of MGZL has led to uncertainty regarding therapeutic strategy, and its clinical characteristics and treatment have not been characterized. We conducted a prospective study of infusional dose-adjusted etoposide, doxorubicin, and cyclophosphamide with vincristine, prednisone, and rituximab (DA-EPOCH-R) and filgrastim in untreated MGZL. We analyzed biomarkers of outcome and compared their clinical and biological characteristics to PMBL. Twenty-four MGZL patients had a median age of 33 years (range, 14 to 59 years), and 46% had mediastinal masses ≥10 cm. At 59 months median follow-up, the event-free survival and overall surv...
Primary mediastinal large cell lymphoma
Hematological Oncology, 1994
Primary mediastinal large cell lymphoma PMLCL is a recently described entity which has provoked considerable interest lately. The unique immunophenotype of the malignant cell, as well as conflicting reports regarding its response to therapy, prompted us to review the current literature focusing on the pathological and clinical aspects of this disease. Design: We reviewed the current literature that contained details on the clinical presentation, pathological profile and clinical outcome. Results: Most reports agree that PMLCL typically affects a young female population and presents with symptoms related to compression of mediastinal structures. Pathologically, the malignant cells may arise from a distinctive thymic medullary B cell subpopulation which is characterized by the following phenotype: CDI 9 + , CD2 1-, CD20 + , CD22 +. Alterations of c-myc and lack of expression of HLA class 1 antigens on the tumour cell surface have been described. Response to treatment and clinical outcome have varied from one series to another and is possibly explained by the small number of patients in most series and by the heterogeneity of therapy. In general, the outcome does not appear to be worse than that of other large cell lymphomas although, given the young age of these patients, it might be expected to be more favourable. Conclusions: Primary mediastinal large cell lymphoma is a distinct clinico-pathological entity characterized by: (1) a predominance of young adults; (2) female predominance (female/male ratio of 2.1) in contrast to the other large cell lymphomas; (3) CD19+/CD21-immunophenotype; (4) absence of HLA-class 1 antigen expression; (5) possible involvement of c-myc; (6) frequent dissemination at relapse to unusual anatomic sites in a pattern reminiscent of Burkitt's lymphoma. The role of radiotherapy and the optimal treatment for this disorder are issues that remain unresolved.