Patients with Fever of Unknown Origin and Splenomegaly: Diagnostic Value of Splenectomy and Preoperative Risk Factors Suggestive of Underlying Lymphomas

2017 ◽  
Vol 137 (4) ◽  
pp. 240-246
Author(s):  
Lu Zhang ◽  
Wei Zhang ◽  
Huacong Cai ◽  
Xinxin Cao ◽  
Miao Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Nodes ◽  
Hodgkin Lymphoma ◽  
Fever Of Unknown Origin ◽  
Characteristic Curve ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Diagnostic Value ◽  
Discrimination Power ◽  
Non Hodgkin Lymphoma

Background: We reviewed patients with fever of unknown origin (FUO) and splenomegaly and assessed the diagnostic value of splenectomy and measured risk factors suggestive of an underlying lymphoma. Methods: FUO patients (n = 83) who had splenomegaly and underwent splenectomy were enrolled into this retrospective single-center study. Clinical presentations were documented and risk factors suggestive of an underlying lymphoma were tested. Results: Seventy-four patients (89.2%) had a diagnosis of lymphoma or not after splenectomy and follow-up. Of those (55.4%) diagnosed with lymphoma, 29 had B-cell non-Hodgkin lymphoma and 12 had T-cell non-Hodgkin lymphoma. The remaining 33 (44.6%) had diseases other than lymphoma. Using multivariate logistic analysis, the following 3 independent risk factors were found to be related to a final diagnosis of lymphoma: age (continuous) (HR 1.086; 95% CI 1.033-1.141; p = 0.001), massively enlarged spleen (HR 7.797; 95% CI 1.267-47.959; p = 0.027), and enlarged intra-abdominal lymph nodes (HR 63.925; 95% CI 7.962-513.219; p < 0.001). The calibration of the model was satisfactory (p = 0.248 using the Hosmer-Lemeshow test), and the discrimination power was good (area under the receiver operating characteristic curve 0.925; 95% CI 0.863-0.987). Conclusions: Splenectomy is an effective diagnostic procedure for patients with FUO and splenomegaly and lymphoma is a common cause. Older age, a massively enlarged spleen, and enlarged intra-abdominal lymph nodes are risk factors suggesting an underlying lymphoma, and surgery for high-risk patients should be considered.

Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

2001 ◽  
Vol 40 (03) ◽  
pp. 59-70 ◽  
Author(s):  
W. Becker ◽  
J. Meiler
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Tumor Imaging ◽  
White Blood Cells ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Recurrent Fever ◽  
Nuclear Medicine Imaging

SummaryFever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

Niespecyficzny obraz chłoniaka B-komórkowego u dwuipółletniej dziewczynki – opis przypadku

2019 ◽  
Vol 24 (3) ◽  
Author(s):  
Ewa Krasuska-Sławińska ◽  
Izabela Królik-Elgas ◽  
Marzena Stypińska ◽  
Anna Matosek-Rutkowska
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Histopathological Examination ◽  
B Cell Lymphoma ◽  
Final Diagnosis ◽  
Lymphoblastic Lymphoma ◽  
Final Conclusion ◽  
Dental Surgery ◽  
Non Hodgkin Lymphoma ◽  
Primary Location

B-cell lymphoblastic lymphoma which is a type of non-Hodgkin lymphoma is rather uncommon in children. Focal changes in bones in the course of non-Hodgkin lymphoma are mostly secondary changes and their primal location in a bone is rare. PBL (primary bone lymphoma) mainly concerns a thighbone and a tibial bone; the primary location in jaw bones is quite sporadic. In diagnostics, there is mainly magnetic resonance, medical scan (tomography), and above all – histopathological test. There is also chemotherapy by choice, and primary location in a jaw or a mandible significantly advances the prognosis. The aim of the work is to introduce a patient who was definitively diagnosed B-cell lymphoblastic lymphoma from the early B-cells. The girl reported to Laryngological Clinic, Dental Surgery Clinic for Children, Oncological Clinic of Children’s Memorial Health Institute. The cause of the visit was an elevation on the right side of a nose base, present for two months and misdiagnosed by doctors as a post-traumatic swelling in this region. After introducing laboratory and scan diagnostics and taking biopsy from the lesion, a final conclusion was made. Also, a proper treatment according to the protocol for B-cell lymphoblastic lymphoma was introduced. Non-specific B-cell lymphoma picture, as mentioned in the described case, specifically due to location in a jaw bone and a slow pace of growing, may both constitute huge diagnostic problems and deteriorate prognosis. Therefore, it is important to take into account also lymphoma – in such location of a lesion. Moreover, it is worth remembering that the final diagnosis may only be passed on the basis of histopathological examination.

scholarly journals Single-Tube Flow Cytometry Assay for the Detection of Mature Lymphoid Neoplasms in Paucicellular Samples

2016 ◽  
Vol 60 (4) ◽  
pp. 385-394
Author(s):  
Alessandra Stacchini ◽  
Anna Demurtas ◽  
Sabrina Aliberti ◽  
Antonella Barreca ◽  
Domenico Novero ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Hodgkin Lymphoma ◽  
Final Diagnosis ◽  
Molecular Data ◽  
Malignant Lymphomas ◽  
Flow Cytometry Assay ◽  
Single Tube ◽  
Fine Needle Aspirates ◽  
Non Hodgkin Lymphoma ◽  
A Cell

Objectives: Flow cytometry (FC) has become a useful support for cytomorphologic evaluation (CM) of fine-needle aspirates (FNA) and serous cavity effusions (SCE) in cases of suspected non-Hodgkin lymphoma (NHL). FC results may be hampered by the scarce viability and low cellularity of the specimens. Study Design: We developed a single-tube FC assay (STA) that included 10 antibodies cocktailed in 8-color labeling, a cell viability dye, and a logical gating strategy to detect NHL in hypocellular samples. The results were correlated with CM and confirmed by histologic or molecular data when available. Results: Using the STA, we detected B-type NHL in 31 out of 103 hypocellular samples (81 FNA and 22 SCE). Of these, 8 were not confirmed by CM and 2 were considered to be only suspicious. The FC-negative samples had a final diagnosis of benign/reactive process (42/72), carcinoma (27/72), or Hodgkin lymphoma (3/72). Conclusions: The STA approach allowed obtainment of maximum immunophenotyping data in specimens containing a low number of cells and a large amount of debris. The information obtained by STA can help cytomorphologists not only to recognize but also to exclude malignant lymphomas.

Diagnostic value of [18F]-FDG PET/CT in children with fever of unknown origin or unexplained signs of inflammation

2009 ◽  
Vol 37 (1) ◽  
pp. 136-145 ◽  
Author(s):  
Niklas Jasper ◽  
Jan Däbritz ◽  
Michael Frosch ◽  
Markus Loeffler ◽  
Matthias Weckesser ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diagnostic Value ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

scholarly journals Diagnostic Value of 18F-FDG PET/CT vs. Chest-Abdomen-Pelvis CT Scan in Management of Patients with Fever of Unknown Origin, Inflammation of Unknown Origin or Episodic Fever of Unknown Origin: A Comparative Multicentre Prospective Study

2022 ◽  
Vol 11 (2) ◽  
pp. 386
Author(s):  
Kim-Heang Ly ◽  
Nathalie Costedoat-Chalumeau ◽  
Eric Liozon ◽  
Stéphanie Dumonteil ◽  
Jean-Pierre Ducroix ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Diagnostic Value ◽  
University Hospital ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
Multicentre Prospective Study

Fluorodesoxyglucose Positron Emission Tomography (PET/CT) has never been compared to Chest-Abdomen-Pelvis CT (CAPCT) in patients with a fever of unknown origin (FUO), inflammation of unknown origin (IUO) and episodic fever of unknown origin (EFUO) through a prospective and multicentre study. In this study, we investigated the diagnostic value of PET/CT compared to CAPCT in these patients. The trial was performed between 1 May 2008 through 28 February 2013 with 7 French University Hospital centres. Patients who fulfilled the FUO, IUO or EFUO criteria were included. Diagnostic orientation (DO), diagnostic contribution (DC) and time for diagnosis of both imaging resources were evaluated. One hundred and three patients were included with 35 FUO, 35 IUO and 33 EFUO patients. PET/CT showed both a higher DO (28.2% vs. 7.8%, p < 0.001) and DC (19.4% vs. 5.8%, p < 0.001) than CAPCT and reduced the time for diagnosis in patients (3.8 vs. 17.6 months, p = 0.02). Arthralgia (OR 4.90, p = 0.0012), DO of PET/CT (OR 4.09, p = 0.016), CRP > 30 mg/L (OR 3.70, p = 0.033), and chills (OR 3.06, p = 0.0248) were associated with the achievement of a diagnosis (Se: 89.1%, Sp: 56.8%). PET/CT both orients and contributes to diagnoses at a higher rate than CAPCT, especially in patients with FUO and IUO, and reduces the time for diagnosis.

scholarly journals Expression of the oncofetal ED-B–containing fibronectin isoform in hematologic tumors enables ED-B–targeted 131I-L19SIP radioimmunotherapy in Hodgkin lymphoma patients

Blood ◽  
2009 ◽  
Vol 113 (10) ◽  
pp. 2265-2274 ◽  
Author(s):  
Stefanie Sauer ◽  
Paola A. Erba ◽  
Mario Petrini ◽  
Andreas Menrad ◽  
Leonardo Giovannoni ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Hodgkin Lymphoma ◽  
Hematologic Malignancies ◽  
Current Treatment ◽  
Cancer Therapies ◽  
Bone Marrow Biopsies ◽  
Normal Tissues ◽  
Non Hodgkin Lymphoma ◽  
Promising Target

Abstract Current treatment of hematologic malignancies involves rather unspecific chemotherapy, frequently resulting in severe adverse events. Thus, modern clinical research focuses on compounds able to discriminate malignant from normal tissues. Being expressed in newly formed blood vessels of solid cancers but not in normal mature tissues, the extradomain B of fibronectin (ED-B FN) is a promising target for selective cancer therapies. Using immunohistology with a new epitope retrieval technique for paraffin-embedded tissues, ED-B FN expression was found in biopsies from more than 200 Hodgkin and non-Hodgkin lymphoma patients of nearly all entities, and in patients with myeloproliferative diseases. ED-B FN expression was nearly absent in normal lymph nodes (n = 10) and bone marrow biopsies (n = 9). The extent of vascular ED-B FN expression in lymphoma tissues was positively correlated with grade of malignancy. ED-B FN expression was enhanced in lymph nodes with severe lymphadenopathy and in some hyperplastic tonsils. The in vivo accessibility of ED-B FN was confirmed in 3 lymphoma patients, in whom the lymphoma lesions were visualized on scintigraphy with 131I-labeled L19 small immunoprotein (131I-L19SIP). In 2 relapsed Hodgkin lymphoma patients131I-L19SIP radioimmunotherapy induced a sustained partial response, qualifying ED-B FN as a promising target for antibody-based lymphoma therapies.

Profiling of the Risk Factors and Designing of a Model to Identify Ischemic Stroke in Patients with Non-Hodgkin Lymphoma: A Multicenter Retrospective Study

2020 ◽  
Vol 83 (1) ◽  
pp. 41-48
Author(s):  
Yunfei Wei ◽  
Qingqing Yang ◽  
Qixiong Qin ◽  
Ya Chen ◽  
Xuemei Quan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Retrospective Study ◽  
Hodgkin Lymphoma ◽  
Multiple Logistic Regression Analysis ◽  
Elevated Serum ◽  
Non Hodgkin Lymphoma ◽  
Independent Risk Factors ◽  
Identification Model ◽  
D Dimer

Background: The occurrence of ischemic stroke in patients with non-Hodgkin lymphoma (NHL) is not well understood. This study aimed to determine independent risk factors to identity ischemic stroke in non-Hodgkin lymphoma-associated ischemic stroke (NHLAIS) patients. Methods: This retrospective study was conducted on NHLAIS patients and age- and gender-matched NHL patients. We collected clinical data of patients in both groups and used multiple logistic regression analysis to identify independent risk factors for NHLAIS. A receiver operating characteristic (ROC) analysis was used to establish an identification model based on potential risk factors of NHLAIS. Results: Sixty-three NHLAIS patients and 63 NHL patients were enrolled. Stage III/IV (58/63, 92.1%) and multiple arterial infarcts (44/63, 69.8%) were common among NHLAIS patients. Notably, NHLAIS patients had higher levels of serum fibrinogen (FIB), D-dimer, and ferritin (SF) and prolonged thromboplastin time and prothrombin time (PT) compared with NHL patients (all p < 0.05). Elevated FIB, D-dimer, and SF and prolonged PT were independent risk factors for NHLAIS. The area under the ROC curve of the identification model of NHLAIS patients was largest compared to that of other risk factors (0.838, 95% confidence interval: 0.759–0.899) (p < 0.05). Conclusion: This study reveals that elevated serum FIB, D-dimer, and SF and prolonged PT are potential independent risk factors of NHLAIS. The identification model established in this study may help monitor NHL patients who are at high risk of developing NHLAIS.

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