Hemophagocytic lymphohistiocytosis (HLH) is a syndrome characterized by immune activation and subsequent widespread organ damage. Patients affected by HLH commonly develop fever, cytopenias, liver damage, neurologic manifestations, and hypercytokinemia. In this case, we describe a 60-year-old male who presented with HLH and concurrent Epstein-Barr virus, cytomegalovirus, and Candida infections and was subsequently diagnosed with a Hodgkin lymphoma. This case highlights the importance of considering a cancer diagnosis in the differential diagnosis of patients presenting with HLH.
/home/tah 81Introduction Diffuse large B-cell lymphoma (DLBCL) with co-expression of MYC and BCL2 protein by immunohistochemistry (IHC) (i.e. doubleexpresser lymphoma, DEL) and/or rearrangements of MYC and BCL2 or BCL6 genes (i.e. double-hit lymphoma, DHL) is associated with poor outcomes after standard frontline therapy, independent of other clinical risk factors. [1][2][3][4] Less is documented concerning the impact of these genetic events in relapsed/refractory disease. R-ICE (rituximab, ifosfamide, carboplatin and etoposide) is an active regimen for patients with relapsed/refractory DLBCL and can effectively mobilize hematopoietic progenitor cells for subsequent autologous stem cell transplantation (ASCT). 5 R-ICE followed by ASCT is a common salvage approach for medically fit patients with relapsed/refractory DLBCL. In this study, we investigated the prognostic impact of DEL in the salvage setting by analyzing outcomes of patients with relapsed/refractory disease treated with R-ICE prior to planned ASCT.
Patients and methodsWe reviewed records of 204 consecutive patients with DLBCL treated with salvage R-ICE and intent for ASCT from 2000 to 2015 at the Taussig Cancer Institute of the Cleveland Clinic. A total of 37 patients were excluded for inadequate clinical data and/or follow up. Data were collected from the electronic medical record with IRB approval. Abstract: Diffuse large B-cell lymphoma (DLBCL) with co-expression of MYC and BCL2 protein by immunohistochemistry (IHC) -that is, double-expresser lymphoma (DEL) -is associated with poor outcomes after standard frontline therapy. Less is known about the prognostic impact of DEL in patients with relapsed/refractory disease treated with salvage therapy and autologous stem cell transplantation (ASCT). We analyzed the outcomes of 167 patients with relapsed/refractory DLBCL treated with R-ICE (rituximab, ifosfamide, carboplatin and etoposide), of whom 111 patients (66%) underwent ASCT. Using predefined cutoffs for positivity by IHC at relapse for MYC and BCL2 of ⩾40% and ⩾50% of positive tumor cells, respectively, 26 patients (16%) were categorized as DEL and the rest as non-DEL. Overall and complete response rates to R-ICE did not differ between DEL and non-DEL. With a median follow up of 20 months, the 3-year progression-free survival (PFS) and overall survival (OS) rates for DEL were inferior compared to non-DEL (for PFS: 6% versus 33%, p = 0.044, for OS: 39% versus 56%, p = 0.03). The negative impact of DEL on PFS and OS remained significant on multivariable analysis. In conclusion, positive DEL status predicts poorer outcomes following salvage therapy.
Background: Non-hematopoietic malignancies first presented as an axillary mass constitute a unique clinical presentation. We investigated the incidence of various types of malignancies and aimed to define clinicopathologic variables that may assist in the diagnosis, with focus on occult breast carcinoma (OBC).
Design:We reviewed the pathology reports of cases with non-hematopoietic malignancies of the axillary region in our institution between 2000 and 2016. We included patients who presented first with axillary mass and with absence of a known primary. We recorded patients' age and gender, tumor characteristics including size, histologic type, number of positive lymph nodes, and the clinical management. Then we focused on BC which were divided into occult BC (OBC) or primary BC (PBC).Results: There were 100 cases that met our criteria (28 melanoma, 7 sarcoma and 65 carcinoma). For carcinoma cases, there were 42 BC (19 OBC, 17 PBC, and 6 possible OBC), 17 non-BC, and 6 carcinoma of unknown primary (CUP). Tumors found incidentally were more likely to be of breast primary (p=0.01). Larger tumor size (in mm) favored melanoma or sarcoma over BC, non-BC carcinoma or CUP with median and range 61 (15,180), 60 (23,80), 30 (15,75), 31 (17,90), 26 (20,55), respectively (p<0.001). There were no differences in the histopathologic findings or clinical presentation.Terms of use and reuse: academic research for non-commercial purposes, see here for full terms. https://www.springer.com/aamterms-v1
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