A case of primary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma treated by radiofrequency ablation (RFA), and a literature review

Primary hepatic mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare liver malignancy that usually lacks characteristic imaging findings and which is often misdiagnosed. We report a 63-year-old woman diagnosed with primary hepatic extranodal marginal zone B-cell lymphoma, MALT type. The patient underwent needle biopsy and radiofrequency ablation (RFA), and showed no signs of relapse during the 12-month postoperative follow-up. This case stresses the rarity of primary hepatic MALT-type lymphoma and the unique and effective treatment for this patient. Our patient received RFA, which showed good efficacy and which provides a new option for the treatment of hepatic MALT lymphoma. We also present our findings from a systematic review to improve the current understanding of this disease.

Primary Breast Lymphoma: Case Report Of A Rare Pathological Entity

Primary breast lymphoma is a rare disease, which accounts for 0.4% of all malignancies seen in the breast and 2% of extranodal lymphomas. The majority of cases are B-cell lymphomas, with diffuse large cell (B) lymphoma the predominant histological type. A variety of treatment modalities have been suggested, with radiation therapy recommended for stage I patients and chemotherapy recommended for stage II patients. Outcome following treatment is predicted by the pathological grade of the tumor and the presence of lymph node involvement. Radical surgical resection including mastectomy has not been shown to affect the outcome of this entity. A 61-year-old woman presented with a one month history of a painful right breast lump. Examination identified the presence of two lumps which were biopsied, confirming the presence of a lymphocytic lymphoma expressing a B-cell phenotype with co-expression of CD 43 (MT-1) consistent with MALT-type lymphoma. She underwent further excision for recurrent tumor but declined adjuvant therapy. She has remained disease free during a 7-year follow up period. Primary breast lymphoma is a rare malignancy of the breast representing less than 2% of non-Hodgkin lymphoma. The features on clinical breast examination and imaging are not characteristic and cannot be differentiated from breast carcinoma. Treatment involves surgical resection with adjuvant chemotherapy and radiotherapy administered in selected cases. A 61-year-old woman presented with a one month history of a painful right breast lump. Examination identified the presence of two lumps which were biopsied, confirming the presence of a lymphocytic lymphoma expressing a B-cell phenotype with co-expression of CD 43 (MT-1) consistent with MALT-type lymphoma. She underwent further excision for recurrent tumor but declined adjuvant therapy. She has remained disease free during a 7-year follow up period. Primary breast lymphoma is a rare malignancy of the breast representing less than 2% of non-Hodgkin lymphoma. The features on clinical breast examination and imaging are not characteristic and cannot be differentiated from breast carcinoma. Treatment involves surgical resection with adjuvant chemotherapy and radiotherapy administered in selected cases.

Treatment of MALT lymphoma of the conjunctiva with intralesional rituximab supplemented with autologous serum

Patients with indolent conjunctival lymphomas exhibit good prognosis, with exceptional cases of dissemination, and are suitable candidates for intralesional therapies. We report the first prospective phase 2 trial using intralesional rituximab supplemented with autologous serum in adults with relapsed/refractory indolent CD20+ lymphoma of the conjunctiva (NCT01514344). Patients received 4 weekly intralesional injections of rituximab, followed by 6 monthly injections; 500 μL of autologous serum was added to rituximab in patients with lymphoma unresponsive to weekly doses. Safety, activity, and antitumor effect of autologous serum were investigated. Twenty patients with mucosa-associated lymphoid tissue (MALT)–type lymphoma were enrolled. Tolerability was excellent, with only 3 mild local reactions. After weekly injections, 11 patients achieved tumor regression, 8 had stable disease, and 1 experienced progressive disease; 9 patients received autologous serum, with response improvement in 4 cases (3 complete responses, 1 partial response). At the end of treatment, 12 patients achieved a complete remission, and 1 achieved a partial response, with an overall response rate of 65% (95% confidence interval, 45-85). At a median follow-up of 42 months (range, 10-78), 12 patients remain relapse free, with 5-year progression-free survival and time-to-next-treatment rates of 59% ± 11% and 69% ± 11%, respectively. Three patients with local relapse were retreated with intralesional rituximab and serum; 2 achieved a complete response that lasted 25+ and 38+ months. Thus, intralesional rituximab is a safe and active therapy in patients with relapsed conjunctival MALT lymphoma. The addition of autologous serum improves response in some cases. Retreatment of local relapses can result in a second durable remission.

Multiple Intestinal Lymphoma

Gastrointestinal tract is the most common location for extralymphonodular lymphomas. The small intestine is affected only in 9% of the cases. Intestinal lymphoma may have single or multiple location. This paper describes a case of multiple location in the small intestine of a non-Hodgkin B-cell in a 53 years old patient, who was initially diagnosed with bilateral pneumonia with pleurisy with E. coli, steeper on the right side, but the persistence of symptoms as fever, malaise, despite appropriate treatment, required further investigation. The CT exam observed fluid collection in the hypogastrium around a digestive loop. The patient underwent surgery, the intraoperative foundings being: a large mesenteric tumor ~ 5 cm in diameter, a terminal ileal mesenteric tumor, a mesenteric tumor ~ 6 cm in diameter, omentum with nodular formations, a tumor ~ 3.3/2.5.1 cm in the abdominal wall, pseudotumoral appendix. Segmental enterectomy with entero-enterostomy, excision of mesenteric tumors, appendectomy and omentectomy were performed. Pathological diagnosis was non-Hodgkin marginal zone B-cell MALT type lymphoma of the small intestine with extension to the appendix, meso, omentum and abdominal wall. Postoperatively, the patient received chemotherapy for remission.