Abstract

Amaç: Bu çalışmada 2001-2015 yılları arasında tanı alan primer ekstranodal lenfomaların lokalizasyonlarının ve histopatolojik olarak dağılımının, klinikopatolojik özelliklerinin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Uludağ Üniversitesi Tıp Fakültesi Patoloji Anabilim Dalı arşivindeki 1 Ocak 2001 ile 31 Aralık 2015 arasındaki patoloji raporları gözden geçirildi, lenfoma tanılı bütün olgular incelendi. Hasta dosyaları incelenerek primer olarak ekstranodal bölgeden kaynaklanan olguların tanısı, hastaneye başvuru semptomları, B semptomu varlığı/yokluğu, tümör çapı, başka ekstranodal organ, lenf nodu, kemik iliği, dalak, karaciğer tutulumu olup olmadığı, kronik enfeksiyon ve kronik hastalık varlığı, hastalığın evresi (Ann Arbor sınıflamasına göre), eşlik eden sekonder malignite varlığı, anemi, lenfositoz varlığı, serum B2 mikroglobulin, LDH, albumin değerleri, sedimentasyon hızı bilgileri dökümante edildi. Primer ekstranodal lenfomalı vakalarda belirlenen histopatolojik tanıların dağılımı, tipleri, yaş grupları, kadın/erkek oranları literatür bilgileri ışığında gözden geçirildi. Bulgular: 2001 – 2015 yılları arasında Uludağ Üniversitesi Tıp Fakültesi Tıbbi Patoloji Anabilim Dalı’nda toplam 1743 hastaya lenfoma tanısı verilmişti. Bu olguların 480 (%27,53) tanesi ekstranodal kaynaklıydı. Genel olarak en sık görülen ekstranodal lokasyon deri ve gastrointestinal sistemdi. Primer ekstranodal 226 deri, 90 gastrointestinal sistem, 44 santral sinir sistemi, 8 genitoüriner sistem, 50 baş-boyun, 18 kas-iskelet-yumuşak doku, 9 mediasten, 3 bronş, 10 orbita, 2 karaciğer, 6 pankreas, 4 omentum, 8 endokrin sistem, 2 meme yerleşimli olgu mevcuttu. Çalışmamızdaki primer ekstranodal lenfomaların 237’sini matür T/NK hücreli neoplaziler oluşturuyordu. Matür B hücreli lenfomalı 250 hasta mevcuttu. Hodgkin lenfoma tanılı 5, prekürsör lenfoid neoplazi tanılı 5 olgu mevcuttu. Sonuç: Sonuç olarak çalışmamızdaki veriler literatürle uyumludur. Bazı lokalizasyondaki ve bazı histopatolojik tanılı olguların sayıca azlığı sebebiyle bu antiteler hakkında anlamlı sonuçlara ulaşılamamıştır.

Keywords

• Ekstranodal lenfoma
• deri
• gastrointestinal sistem
• santral sinir sistemi
• Diffüz büyük B hücreli lenfoma

Clinicopathological Features of Extranodal Lymphomas

Abstract

Objective: In this study, we aimed to evaluate the localization and histopathological diagnosis, and clinicopathologic characteristics of primary extranodal lymphomas. Method: The pathology reports between 2001 and 2015 in the archives of Uludag University Faculty of Medicine Pathology Department were reviewed and all cases with an extranodal lymphoma diagnosis were analyzed. The information about the diagnosis, tumor localization, symptoms at presentation, presence of B symptoms, lymphocytosis and anemia, chronic infection and chronic disease and concomitant secondary malignancy, tumor diameter, the involvement of another extranodal organ, lymph node, bone marrow, spleen, liver, stage of the disease, serum B2 microglobulin, LDH, albumin levels, sedimentation rate were documented. The localization, histopathological types, age groups, male/female ratios in cases of primary extranodal lymphoma were evaluated. Results: Total sum of 1743 patients were diagnosed with lymphoma. 480 (%27,7) of these cases were extranodal lymphomas. The most commonly encountered locations of extranodal lymphomas were the skin and the gastrointestinal system. There were 229 primary extranodal skin, 90 gastrointestinal system, 44 central nervous system, 8 genitourinary system, 50 head and neck, 18 musculoskeletal system and soft tissue, 9 mediastinum, 3 bronchi, 10 orbital, 2 liver, 6 pancreas, 4 omentum, 8 endocrine system, and 2 breast located cases. 237 of the primary extranodal lymphomas from our work were mature T/NK celled neoplasias. There were 250 patients with mature B cell lymphoma, 5 cases of Hodgkin lymphoma, and 5 cases of precursor lymphoid neoplasia. Conclusion: The data from our series were coherent with the literature. Due to the small number of cases with some localization and some histopathological diagnosis, no significant results could be reached about these entities.

Keywords

• extranodal
• lymphoma
• skin
• gastrointestinal
• central nervous system

References

1. 1.Dişel U. Epidemiology of the Lymphoma and Staging. Turkiye Klinikleri J Med Oncol-Special Topics 2009;2(2):17-24.
2. 2. Ekström-Smedby K. Epidemiology and etiology of non-Hodgkin lymphoma –a review. Acta Oncologica 2006;45:3, 258-271.
3. 3. Lopez-Guillermo A, Colomo L, Jimenez M, Bosch F, Villamor N, Arenillaset L et al. Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin. J Clin Oncol 2005;23:2797-2804.
4. 4. Padhi S. Paul TR, Challa S, Prayaga AK, Rajappa S, Raghunadharao D et al. Primary extra nodal non Hodgkin lymphoma: a 5 year retrospective analysis. Asian Pac J Cancer Prev. 2012;13(10):4889-95.
5. 5. Vannata B, Zucca E. Primary extranodal B-cell lymphoma: current concepts and treatment strategies. Chin Clin Oncol. 2015;4(1):10.
6. 6. Krol AD, le Cessie S, Snijder S, Kluin-Nelemans JC, Kluin PM, Noordijk EM. Primary extranodal non-Hodgkin's lymphoma (NHL): the impact of alternative definitions tested in the Comprehensive Cancer Centre West population-based NHL registry. Ann Oncol 2003;14(1):131-9.
7. 7. Swerdlow S, Campo E, Harris N, et al., eds. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC,2008.
8. 8. Swerdlow S, Campo E, Harris N, et al., eds. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC,2017.

9. 9. Zucca E, Roggero E, Bertoni F, Cavalli F. Primary extranodal non-Hodgkin's lymphomas. Part 1: Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol 1997;8(8):727-37.
10. 10. Peng JC, Zhong L, Ran ZH. Primary lymphomas in the gastrointestinal tract. J Dig Dis. 2015;16(4):169-76.
11. 11. Zullo A, Hassana C, Ridola L, Repici A, Manta R , Andriani A. Gastric MALT lymphoma: old and new insights. Annals of Gastroenterology 2014;27-33.
12. 12. Hossain FS, Koak Y, Khan FH. Primary gastric Hodgkin's lymphoma. World J Surg Oncol 2007;5:119.
13. 13. Ghimire P, Wu GY, Zhu L. Primary gastrointestinal lymphoma. World J Gastroenterol 2011;14; 17(6): 697-707.
14. 14. Schottenfeld D, Beebe-Dimmer JL, Vigneau FD. The epidemiology and pathogenesis of neoplasia in the small intestine. Ann Epidemiol. 2009;19(1):58-69.
15. 15. Al-Saleem T, Al-Mondhiry H. Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms. Blood. 2005;105:2274-80.
16. 16. Ferreri AJM, Reni M. Primary central nervous system lymphoma. Critical Reviews in Oncology/Hematology 2007;257–268.
17. 17. Bhagavathi S, Wilson JD. Primary Central Nervous System Lymphoma. Arch Pathol Lab Med.2008;132:1830–4.
18. 18. Willemze R, Dreyling M. Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2010;177-180.
19. 19. ALHothali GI. Review of the treatment of mycosis fungoides and Sézary syndrome: A stage-based approach. International Journal of Health Sciences 2013;7-2.
20. 20. Çetin M, Ferahbaş A, Pala Ç. Primer deri lenfomaları. Türk Hematoloji Derneği 2013;3-2.
21. 21. Mohammadianpanah M, Omidvai S, Mosalei A, Ahmadloo N. Treatment results of tonsillar lymphoma: a 10-year experience. Ann Hematol. 2005;84(4):223-6.
22. 22. Zapater E, Baga´n JV, Carbonell F, Basterra J. Malignant lymphoma of the head and neck. Oral Diseases 2010;119–128.
23. 23. Zucca E, Roggero E, Bertoni F, Conconi A, Cavalli F. Primary extranodal non-Hodgkin's lymphomas Part 2: Head and neck,central nervous system and other less common sites. Annals of Oncology 1999;1023-33.
24. 24. Harris NL, Jaffe ES, Stein H et al. A Revised European-American Classification of Lymphoid Neoplasms: A Proposal From the International Lymphoma Study Group Blood 1994;1361-92.
25. 25. Bracke P, Vanhoenacker f, De Schepper AM. Soft Tissue Lymphoma. In: De Schepper AM, et al Imaging of Soft Tissue Tumours. Berlin 2001.
26. 26. Bhagavathi S, Kai F. Primary Bone Lymphoma. Arch Pathol Lab Med. 2009;133:1868–71.
27. 27. Singh T, Satheesh CT, Lakshmaiah KC et al. Primary bone lymphoma: a report of two cases and review of the literature. J Cancer Res Ther 2010;6(3):296-8.
28. 28. Zhang L, Lin Q, Zhang L, Dong L, Li Y. Primary skeletal muscle diffuse large B cell lymphoma: A case report and review of the literature. Oncol Lett 2015;10(4):2156-60.
29. 29. Duwe BV, Sterman DH, Musani AI. Tumors of the mediastinum. Chest. 2005;128(4):2893-909.
30. 30. Agarwal N, Wangnoo SK, Sidiqqi A, Gupta M. Primary thyroid lymphoma: a series of two cases and review of literature. J Assoc Physicians India 2013;61(7):496-8.
31. 31. Thieblemont C, Mayer A, Dumontet C. Primary thyroid lymphoma is a heterogeneous disease. J Clin Endocrinol Metab 2002;87(1):105-11.
32. 32. Aziz SA, Laway BA, Rangreze I, Lone MI, Ahmad SN. Primary adrenal lymphoma: Differential involvement with varying adrenal function. Indian J Endocrinol Metab 2011;15(3): 220–3. 33. Sharma T, Kamath M, Fekrat S, Scott IU. Diagnosis and management of orbital lymphoma. Ophtalmlogic Pearls Oncology 2015;37-39.
33. 34. Decaudin, Cremoux P, Vincent-Salomon A, Dendale R, Lumbroso-Le Rouic L. Ocular adnexal lymphoma: a review of clinicopathologic features and treatment options. Blood 2006;108:1451-60.
34. 35. Bhatia K, Vaid AK, Gupta S, Doval DC, Talwar V. Primary testicular non-Hodgkin's lymphoma--a review article. Sao Paulo Med J 2007;125(5):286-8.
35. 36. Cheah CY, Wirth A, Seymour JF. Primary testicular lymphoma. Blood. 2014;123(4):486-93.
36. 37. Vázquez-Alonso F, Puche-Sanz I,Sánchez-Ramos C, Flores-Martín J,Vicente-Prados J, Cózar-Olmo JM. Primary Renal Lymphoma: Long-Term Results of Two Patients Treated with a Chemotherapy + Rituximab Protocol . Case Reports in Oncological Medicine 2012 ;726424.
37. 38. Taheri MR, Dighe MK, Kolokythas O, True LD, Bush WH. Multifaceted genitourinary lymphoma. Curr Probl Diagn Radiol 2008;37(2):80-93.
38. 39. Ettahri H, Elkabous M, Laanaz S, et al. Primary Pancreatic Lymphoma, A Case Report and Review of Literature. Austin J Med Oncol 2015; 2(2): 10-18.
39. 40. Lin H, Li SD, Hu XG, Li ZS. Primary pancreatic lymphoma: report of six cases. World J Gastroenterol 2006;12(31):5064-7.
40. 41. Saif MW. Primary Pancreatic Lymphomas. JOP. J Pancreas (Online) 2006; 7(3):262-73.
41. 42. Zucca E. Extranodal lymphoma: a reappraisal. Annals of Oncology 2008;10.1093/204.
42. 43. Joks M, Myśliwiec K, Lewandowski K. Primary breast lymphoma – a review of the literature and report of three cases. Arch Med Sci 2011; 7(1): 27–33.
43. 44. Seifi S, Esfahani-Monfared Z, Khosravi A, Kamalian N, Eshaghi F, Khodadad K. Bilateral Lymphoblastic Lymphoma of Breast Mimicking Inflammatory Breast Cancer: A Case Report and Review of Literature. Tanaffos 2015;14(1): 63–6.
44. 45. Mouna B, Wafae A, Hind M, Hassan E. Primary Liver Lymphoma: A Case Report and Literature Review. Journal of Cancer Therapy 2011;2, 725-7.
45. 46. Noronha V, Shafi NQ, Obando JA, Kummar S. Primary non-Hodgkin's lymphoma of the liver. Crit Rev Oncol Hematol 2005;53(3):199-207.
46. 47. Cadranel J1, Wislez M, Antoine M. Primary pulmonary lymphoma. Eur Respir J 2002;20(3):750-62.
47. 48. Laohaburanakit P, Hardin KA. NK/T cell lymphoma of the lung: a case report and review of literature. Thorax 2006;61(3):267-70.