Letters to the Editor chemotherapy An unusual presentation of non-Hodgkin lymphoma: Cardiac involvement Sir, A 41-year-old man without any significant medical history was hospitalized in
Trang 1Journal of Cancer Research and Therapeutics - July-September 2010 - Volume 6 - Issue 3
transperineal interstitial brachytherapy for cervical cancer: High
pelvic control and low complication rates Int J Radiat Oncol Biol
Phys 1999;45:105-12
6 Haie-Meder C, Pötter R, Van Limbergen E, Briot E, De Brabandere M,
Dimopoulos J, et al Recommendations from Gynaecological (GYN)
GEC-ESTRO Working Group (I): Concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV Radiother Oncol 2005;74:235-45.
Letters to the Editor
chemotherapy
An unusual presentation of non-Hodgkin lymphoma: Cardiac involvement
Sir,
A 41-year-old man without any significant medical history
was hospitalized in cardiology service for progressive dyspnea,
palpitation and continuous weight loss for two months On
admission, the patient had an ECOG performance status
equal to 1 Physical examination revealed tachycardia with a
pulse rate of 95 beats per minute, a blood pressure of 140/80
mmHg, and a murmur due to pericardial friction Clinical
examination showed an axillary left node measuring 2 cm
Chest X-rays showed left pleural effusion without cardiac
hypertrophy Electrocardiogram showed a microvoltage
Bi-dimensional transthoracic echocardiography [Figure 1]
revealed a nonobstructing mass fixed to the right atrium,
without any vegetation, measuring 60 × 40mm, and a second
lesion attached to the left atrium measuring 50 × 45 mm; with normal left ventricular fonction and free right ventricular Chest computed tomography confirmed tow cardiac mass attached
to the atriums, and showed multiple mediastinal nodes, and pleural and pericardial effusion Laboratory investigations showed a normal blood formule Blood cultures and viral serologies (EBV, VHB, VHC, and HIV) were negative Biopsy of the axillary node with histological and immunohistochemistry studies showed DLBCL according to the Revised European-American Classification of Lymphoid Neoplasms/World Health Organisation classification of lymphoid neoplasms (REAL/ WHO).[1] Most of the neoplasic cells were positive for CD-20 Computed tomography of the abdomen and pelvis was normal
A bone marrow biopsy showed no abnormalities The patient was staged IV according to the Ann Arbor Staging system The patient received standard Rituximab 375 mg/m² on day 1, Cyclophosphamide 750 mg/m² on day 1, Doxorubicine 50 mg/ m² on day 1, Vincristine 1.4 mg/m² on day 1, and prednisone
50 mg/m² on day to 5, (RCHOP) regimen A bidimensionnal echocardiography after 4 chemotherapy courses showed the complete disappearance of the right and left atrials tumor [Figure 2] and a normal clinical cardiac exam He received 8 cycles of standard chemotherapy with complete clinical and radiological response He remained disease free, until now, 8
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months after the end of chemotherapy
Secondary involvement of the heart cavity by non-Hodgkin
lymphoma is more frequent than primary cardiac
non-Hodgkin’s lymphoma and represents the third most common
malignant tumour of the heart in autopsy studies.[2] The disease
may involve all cardiac structures, but lesions of the right heart
and particularly the right atrium are predominant.[3] Clinical
manifestations are usually non-specific and appear at a late
stage, reflecting diffuse involvement Cardiac involvement
as an initial presentation of malignant lymphoma is a rare
occurrence.[4]
Three mechanisms can be suggested to explain heart tissue
involvement: direct neighbouring extension of the tumor
from a primitive mediastinal site, retrograde flow through the
cardiac lymphatics and hematogenous spread.[3] In our case,
retrograde lymphatics or hematogenous spread was suspected
because there was no direct invasion to the epicardium
The prognosis of cardiac involvement lymphoma remains
poor due to diagnostic delay and advanced stage of organ
infiltration However, nowadays, the addition of rituximab
to the CHOP protocol increases the overall survival rate.[5] Our
patient achieved complete and successful response after the
end of the 8 cycles of chemotherapy with rituximab
Hassan Errihani, Rhizlane Belbaraka, Nabil Ismaili, Mohammed Cherti 1
Department of Medical Oncology, National Institute of Oncology,
1 Department of Cardiology, IBN SINA Hospital, Rabat, Morocco
For Correspondence:
Dr Rhizlane Belbaraka, Department of Medical Oncology, National Institute of Oncology, Avenue Allal Alfassi, Rabat, Morocco
E-mail: r_belbaraka@yahoo.fr
REFERENCES
1 Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, et al A
revised European-American classification of lymphoid neoplasms:
A proposal from the International Lymphoma Study Group Blood 1994;84:1361-92.
2 Mioulet D, Braem L, Heno P, Paule P, Peloni JM, Bonnet D, et al Cardiac
extension of a non-Hodgkin lymphoma revealed by an atrial flutter Ann Cardiol Angeiol (Paris) 2009;58:117-21
3 McDonnell PJ, Mann RB, Bulkley BH Involvement of the heart
by malignant lymphoma: A clinicopathologic study Cancer 1982;49:944-51
4 Ban-Hoefen M, Zeglin MA, Bisognano JD Diffuse large B cell lymphoma presenting as a cardiac mass and odynophagia Cardiol
J 2008;15:471-4.
5 Morillas P, Quiles J, Nuñez D, Senent C, Martınez S, Fernañdez JA,
et al Complete regression of cardiac non-Hodgkin lymphoma Int J
Cardiol 2006;106:426-7.
Scalp metastasis from squamous cell carcinoma of the lung
Sir,
A 60-year-old male presented to the dermatology outpatient
department with two painless nodules in the scalp His
physical examination was unremarkable except for the two
firm swellings over the scalp and poor performance status
[Figure 1] Fine needle aspiration cytology revealed atypical
keratinized squamous cells arranged in clusters and singly The
cells were pleomorphic, having scanty to moderate amount of
cytoplasm and enlarged hyperchromatic nucleus with coarse
chromatin Because the patient was a chronic smoker and
performance status 3, a chest X-ray was performed The chest X-ray showed a mass lesion with spiculated borders in the left mid zone Computerized tomography of the chest revealed a mass in the left lower lobe close to the left bronchus and liver metastasis Bronchoscopy and biopsy of the lesion confirmed squamous cell carcinoma of the lung [Figure 2]
Cutaneous metastasis in primary lung cancer is unusual, with
an incidence estimated at <5%.[1] The most common sites for skin metastasis in lung cancer are the chest and the abdominal wall.[2] This is presumably due to the high body surface area of these regions and also the closeness to the site of the primary neoplasm Scalp metastasis, however, is unusual in primary lung cancer
According to the case series published on lung cancer,[3] the more common histological types that metastasize to skin are large cell carcinoma and adenocarcinoma, while epidermoid
or squamous cell carcinoma show the least tendency for skin metastasis.[2] Our case, however, was one of squamous cell carcinoma As the patient was not fit for palliative
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Letters to the Editor
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