Extranodal and nodal diffuse large B cell lymphoma of the head and neck: two different entities?

Abstract

This study analyzes patients with head and neck diffuse large B cell lymphoma (HN-DLBCL), focusing on the differences in the biological characteristics and prognosis of lymphomas of nodal and extranodal origin. We have included 72 patients with stage I-II HN-DLBCL who had updated survival information and diagnostic paraffin-embedded tissue blocks available for review. Non-germinal center phenotype (73.7 vs. 32.4 %, P = 0.001) and high level of Bcl-2 expression (78.9 vs. 52.9 %, P = 0.025) were more frequent in nodal than extranodal lymphomas. Univariate analyses indicated that bulky disease, Ann Arbor stage II, high level of Ki-67 expression, and primary nodal disease had adverse effects on complete remission (CR), but these effects were confirmed in a multivariate analysis for primary nodal disease and bulky disease. Patients with primary extranodal lymphoma also had better overall survival (OS) (87.7 vs. 72.5 %, P = 0.04) and event-free survival (EFS) (84 vs. 58.5 %, P = 0.046) than patients with nodal disease, although in the multivariate analysis, only Ann Arbor stage II continued to predict worse OS and EFS, whereas bulky disease was an independent prognostic factor only for EFS. We found significant differences in the biological characteristics and prognosis between primary nodal and extranodal HN-DLBCL.

Outcome prediction by extranodal involvement, IPI, R‐IPI, and NCCN‐IPI in the PET/CT and rituximab era: A Danish–Canadian study of 443 patients with diffuse‐large B‐cell lymphoma

“…Reasons for the inferior outcome of patients with extranodal involvement are largely unknown, but MYC with or without either BCL2 or BCL6 (double‐hit) rearrangements are more common among patients with extranodal disease . In addition, the activated B‐cell phenotype may be more common in DLBCL involving extranodal sites . Double hit and cell of origin were not routinely examined in our study cohort, but their presence may explain the more aggressive clinical course seen in patients with extensive extranodal disease.…”

Extranodal lymphoma of the posterior auricle

“…The vast majority of these are NHL, approximately 85%, and of the DLBCL subtype, approximately 80%, as in our patient [4]. Two-thirds of these are confined to lymph nodes and one-third are so-called extranodal lymphomas [7]. HL is exceedingly rare outside of lymph nodes.…”

“…For stage III and IV disease, survival is closer to 50% at 5 years [3]. Sanchez et al performed a retrospective review of patients with DLBCL of the head and neck and found that extranodal DLBCL may have an overall better response to treatment than nodal DLBCL [7].…”

“…There is significant geographic variability amongst some lymphoma types, but DLBCL is common throughout the world [5]. B symptoms refer to night sweats, weight loss >10% and fevers and are present in 5% or less of patients [7]. CT and PET/CT scanning has replaced staging laparotomies for determination of the extent of disease [5].…”

Clinical features and outcome of the patients with sinonasal tract diffuse large B‐cell lymphoma in the pre‐rituximab and rituximab eras

“…[18][19][20] In an analysis of immunochemotherapy-treated HN DLBCL patients, including nine SNT cases (including also larynx tumors), 68% of the extranodal HN DLBCL patients had GCB immunophenotype, but SNT DLBCL was not studied separately, 21 the COO did not have an impact on survival. 21 In a Japanese study on 29 SNT DLBCL patients treated between 2002 and 2013, 82% of the patients had non-GCB immunophenotype, which correlated with inferior survival. 22 BCL2 expression has been observed in 55% of the Waldeyer's ring DLBCL patients and found to associate with adverse survival in the pre-R era, the effect, however, overcome by COO distinction.…”