Clinical Characteristics Of Primary Extranodal Diffuse Large B Cell Lymphoma

Part OneAnalysis of clinical characteristics of 29 cases of primary tonsil diffuse large B cell lymphoma ObjectiveThe tonsil is the most frequent involvement site of the head and neck non-Hodgkin's lymphoma(NHL)and the diffuse large B cell lymphoma(DLBCL)is the most common pathological type of tonsil NHL.The aim of this study was to investigate the clinical characteristics,immunophenotypes,prognostic factors and the treatment strategies of primary tonsil DLBCL(PT-DLBCL).MethodTwenty-nine newly diagnosed PT-DLBCL patients were retrospectively enrolled from October 2009 to January 2017.ResultsAmong the 29 cases,17 patients(58.6%)were male and 12 patients(41.4%)were female.The median age was 58(16 86)years.The first symptom was usually pharynx paresthesia(89.7%)or sore throat(27.6%).Among the 28 cases who had complete immunohistochemical results,21 cases(75%)were germinal center B-cell(GCB)and 7 cases(25%)were non-germinal center B-cell(non-GCB).Twelve patients(41.4%)were at stage I according to the Ann Arbor classification and 17 patients(58.6%)were in stage.There were 28 patients completed the treatments and the median cycles of 6(range from 3-8).With the medial follow-up of 39 moths(range from 3-89 months),20 cases 71.4%)reached complete remission(CR),7 cases(25%)of partial remisson(PR)and 1 patient(3.6%)of stable disease(SD).The 3-years and 5-year progression-free surviva(PFS)were both 83%while the 3-years and 5-year overall survival(PFS)were both 95.5%.Age more than 70 years old(P=0.034)was a poor prognostic factor of PFS.IPI?2(P=0.034)abnormally elevated lactate dehydrogenase(LDH)and treatment with rituximab were negatively related to OS.ConclusionsMost PT-DLBCL patients are at early stage,older age and with erminal center B-cell(GCB)type.Patients were sensitive to chemotherapy and/or radiotherapy with good prognosis.The prognosis of patients with older age or LDH elevated relatively poor.Patients who were administrated with chemotherapy combined R strategies might have superior outcomes.Part TwoAnalysis of the clinical characteristics of 42 patients with primary central nervous system diffuse larger B cell lymphomaObjectiveThe objective of this study was to assess the clinical characteristics and treatment strategies and prognostic factors of the primary central nervous system diffuse large B cell lymphoma(PCNS-DLBCL).MethodsForty-two newly diagnosed PCNS-DLBCL patients were retrospectively enrolled from May 2008 to January 2017.ResultsThe median age was 61(range from 13 to 77)years,with a ratio of male to female 11:10(22 cases to 20 cases).The most common presentations were dizzy(33.3%)or limb numbness(35.7%).All the cases were pathologically diffuse large B cell lymphoma(DLBCL)with 11 cases(31.4%)of germinal center B-cell(GCB)type and 24 cases(68.6%)of non-germinal center B-cell(non-GCB)type.Regarding to the treatment distributions of the 42 patients,5 patients(11.9%)accepted simple radiotherapy,9 patients(21.4%)underwent simple chemotherapy,25 patients(59.6%)accepted the combined treatment,the other 3 patients(7.1%)underwent only support therapy.The median follow-up for all patients was 24(2-65)months.The median overall survival(OS)was 34 months(range from 2 to 65 months)and 5-year OS rates were 31.9%.Age more than 70 years old was a poor prognostic factor of progression-free survival(PFS)and OS(P<0.0001,P=0.001),Deep brain tissue infiltrations was negatively related to OS(P=0.008).After surgery,PCNS-DLBCL patients treated with combined strategies had better OS than those underwent nither chemotherapy nor radiotherapy(P=0.035).ConclusionIn all,the prognosis of patients diagnosed with PCNS-DLBCL was poor expecially those with poor prognostic factors such as age more than 70 years old,deep brain tissue infiltration and abnormally elevated protein in the CSF.Patients who were administrated with chemotherapy combined radiotherapy might have superior outcomes than those treated with simple chemotherapy.Part ThreeAnalysis of clinical characteristics of 18 patients with primary breast diffuse large B dell lymphomaObjectThe purpose of this study was to analyze the clinical characteristic of primary breast diffuse large B cell lymphoma(PB-DLBCL).MethodsEighteen newly diagnosed PB-DLBCL patients were retrospectively enrolled from January 2007 to January 2017.ResultsAll 18 patients were admitted to hospital because of breast mass and Pathological diagnosed diffuse large B cell lymphoma(DLBCL).Four cases(26.7%)were classified as germinal center B-cell(GCB)subtype in 15 patients with complete immunohistochemical data and the other 11 cases(73.3%)were classified as non-germinal center B-cell(non-GCB)subtype.Eight patients(44.4%)were in Ann Arbor stage I and 10(55.6%)were in stage ?.One patient(5.6%)was lost to follow-up.The median follow-up time was 66(13-112)months.Two patients(11.8%)died of lymphoma.Estimated of progression-free survival(PFS)and overall survival(OS)at 5 years was 88.2%and 86.7%respectively.Age?60(P=0.021),stage-modified International Prognostic Index(IPI)?2(P=0.006)and elevated ?2-MG(P=0.037)were significant prognostic factors for PFS while Age?60(P=0.034)and stage-modified IPI>2(P=0.012)were negative for OS.One patient survived 16 months with simple surgery.Patients treated with simple chemotherapy or combined with radiotherapy were alived except one.ConclusionsThe PB-DLBCL is extremely rare with no specific clinical features compared with the other breast tumor.Pathology was still the gold standard for the diagnosis of PB-DLBCL.After surgery,PB-DLBCL patients treated with chemotherapy and/or radiotherapy might have better prognosis than.those who didn't get the follow-up treatment.