T-cell type non-Hodgkin's lymphoma associated with eosinophilia

A 65-year-old man was admitted to our hospital in January 1990, because of weakness of upper limbs. On admission he was found to have generalized lymphadenopathy and leukocytosis. His WBC count was 40,900/microliters with 88% eosinophils. The bone marrow showed an increased number of eosinophils and their precursors but no other abnormalities. A diagnosis of non-Hodgkin's lymphoma (diffuse, medium sized cell type) was made by biopsy of his inguinal lymph node. The result of marker analysis was consistent with CD3+4+8-. The antibody to human T-lymphotropic virus type I was negative. A stomach biopsy revealed lymphoma cell infiltration. Extensive studies to identify the cause of the eosinophilia were undertaken, with consistently negative results. Combination chemotherapy was begun, and resulted in a dramatic resolution of the eosinophilia and the lymphadenopathy. The association of hypereosinophilia with non-Hodgkin's lymphoma is unusual. We report a patient with eosinophilia and non-Hodgkin's lymphoma, and discussed its possible etiology.     

Successful treatment of vigorous achalasia associated with gastric lymphoma

Summary A 61-year-old male was evaluated for dysphagia. Esophageal manometry revealed vigorous achalasia. Upper-gastrointestinal endoscopy revealed a probable gastric neoplasm which was confirmed at laparotomy. Histologically the tumor was a lymphoma. Antineoplastic therapy resulted in rapid and complete improvement in the patient's dysphagia. Repeat esophageal manometry was normal. It is concluded that: (1) patients presenting with achalasia or vigorous achalasia should be carefully evaluated for the presence of a gastric malignancy involving the gastric fundus and lower esophagus; (2) chemotherapy may produce a resolution of esophageal symptoms.     

Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.     

Relapsing polychondritis associated with a lymphoplasmocytic lymphoma and erythema nodosum

Relapsing polychondritis is a disease of unknown etiology characterized by episodic inflammation of cartilaginous tissues. More rarely, it has been described as a paraneoplastic phenomenon mainly associated with myelodysplastic syndromes or other haematologic diseases. We present a case of relapsing polychondritis associated to low degree lymphoplasmocytic lymphoma whose picture was punctuated by cutaneous erythema nodosum and anterior uveitis. The clinical evolution was satisfactory with glucocorticoids and rituximab treatment.     

Pulmonary relapse of non-Hodgkin's lymphoma in bilateral upper lobes

We describe a 68-year-old male patient with diffuse large B-cell lymphoma (DLBCL) who suffered from relapse in bilateral upper lobes of the lung. The patient presented with cough, weakness and fever. A bronchovascular-lymphangitis-like shadow was detected in the bilateral upper lobes on a chest roentgenogram. Although cytological and cytofluorometric examinations revealed no malignant cells in the bronchoalveolar lavage fluid, trans-bronchial lung biopsy (TBLB) showed involvement of DLBCL in the bronchial mucosa. Recurrent lymphoma tends to extend along the bronchovascular bundles, resulting in granulomatous consolidation that may mimic tuberculosis and is likely to involve the lower lobes. Thus, TBLB proved to be essential for the diagnosis of the lung involvement of non-Hodgkin's lymphoma (NHL).     

Intestinal Behçet's disease associated with non-Hodgkin's lymphoma

A 45-year-old man with intestinal Behçet's disease noticed an enlarged right cervical lymph node, and was diagnosed with diffuse large cell type, non-Hodgkin's lymphoma. The intrapelvic lymph tract was markedly deformed because of recurrent ileocecal ulceration, and conventional lymphoscintigraphy with a common tracer did not abolish the suspicion that lymphoma cells may have invaded the lymph nodes. Dynamic lymphoscintigraphy with a new tracer,^99mtechnetium-diethylene triamine pentaacetic acid-human serum albumin, because of its high detection sensitivity, was very useful for excluding this suspicion, and for determining the clinical stage of lymphoma. Combination induction chemotherapy led to complete remission without any adverse effects, but subsequent supportive therapy with same protocol could not be completed because of progression of the intestinal lesions. Special management for the intestinal lesions, such as bowel rest, may be essential with chemotherapy for patients with intestinal Behçet's disease.     

Paraneoplastic dermatopolymyositis with mild glomerular lesion nephropathy associated with non-Hodgkin's lymphoma

INTRODUCTION: Dermatopolymyositis is an inflammatory disorder of an unknown origin. Twenty to thirty percent cases of this disease are associated with a cancer. Glomerular lesions in dermatopolymyositis are rare. EXEGESIS: We describe the case of a patient who presented a dermatopolymyositis together with a glomerulopathy and then a non Hodgkin's lymphoma. A treatment by corticoid and secondary intravenous immune globulins because of corticoid-resistance of the dermatopolymyositis and oesophagus injury led to a significant improvement of the cutaneous signs and of the muscular weakness. This favourable evolution was also determined by the chemotherapy for lymphoma. Nine months after the diagnosis of dermatopolymyositis remission for dermatopolymyositis and lymphoma is obtained. We also noticed a regression of the glomerular signs. CONCLUSION: A diagnosis of dermatopolymyositis must lead to a meticulous search for an associated cancer. Data from literature indicate that a cancer is usually discovered within the first year of dermatopolymyositis' diagnosis but it can appear until five years after this diagnosis. The most frequent organs concerned by cancer are ovary and the digestive tract. A meta-analysis showed an incidence-standardised rate for lymphoma important in patients suffering from dermatopolymyositis. The treatment of the cancer can improve the evolution of the dermatopolymyositis. However corticoid must be the first treatment for dermatopolymyositis. In case of corticoid-resistant dermatopolymyositis or dermatopolymyositis involving oesophagus treatment by intravenous immune globulins is justified. At last when a glomerular nephropathy is discovered in such a situation, paraneoplasic glomerulopathy, renal lymphomatous infiltration or another associated immune disease must be called to mind.     

Spurious macrocytosis associated with non-Hodgkin's lymphoma: report of two cases

Summary We report two rare cases of spurious macrocytosis (SM) associated with non-Hodgkin's lymphoma caused by cold agglutinin. SM was reversed, accompanied by the regression of lymphoma in case 1 but not in case 2, where the lymphoma was refractory to the chemotherapy. It is strongly suggested that lymphoma cells were related to the production of cold agglutinin and the cause of SM.     

Extranodal non-Hodgkin's lymphoma associated with systemic bone metastasis and secondary myelofibrosis

A 68-year-old woman was admitted in March 1997 because of lumbago, fever, vomiting, and general malaise. Laboratory data disclosed anemia and severe hypercalcemia (7.7 mEq/l). Multiple osteolytic lesions were detected in the patient's vertebra, pelvis, and bilateral tibia by x-ray films and 99mTc bone scintigrams. Bone marrow aspiration sample was not obtained due to dry tap. Marked myelofibrosis and proliferation of lymphoid cells were revealed by a bone marrow biopsy specimen. Immunohistochemical analysis showed that cells in the biopsy specimen were positive for L-26 and LCA, but not for UCHL-1. Gastrointestinal endoscopic examination found multiple polypoid lesions in the stomach; biopsy specimens of the lesion tissue disclosed invasion by B lymphoid cells. A diagnosis of diffuse large B cell lymphoma was thus made. THP-COP chemotherapy was performed, but only minimal response was obtained. Lymphoma cells subsequently invaded the brain stem, and the patient eventually died of respiratory failure.     

Carcinoma associated with achalasia

Carcinoma developed in a 67-year-old woman with achalasia of the esophagus 23 years after esophagomyotomy. Postoperative manometric and radiologic studies showed satisfactory relief of esophageal obstruction. The development of carcinoma after an unusually long interval after adequate surgical treatment emphasizes the need for lifelong surveillance for this complication.     

Pseudoaneurysm of the cystic artery associated with upper gastrointestinal bleeding

Pseudoaneurysm of the cystic artery is a cause of hemobilia, and is extremely rare, with only eight cases having been reported in the world literature. We report a case of pseudoaneurysm of the cystic artery in a 72-year-old Japanese man. The patient experienced epigastric pain and melena, and was found to have jaundice and liver dysfunction. Repeated gastroendoscopy did not reveal the cause of the alimentary tract bleeding; however, color-Doppler ultrasonography detected an aneurysm of the cystic artery in the gallbladder. Selective hepatic arteriography demonstrated that the posterior branch of the cystic artery was markedly dilated and that an aneurysm had formed in the midst of the artery. We diagnosed hemobilia due to the pseudoaneurysm of the cystic artery, and associated gastrointestinal bleeding. Cholecystectomy was performed immediately. Pathologically, the gallbladder showed acute calculous cholecystitis. This case emphasizes the importance of including hemobilia in the differential diagnosis whenever gastrointestinal bleeding is associated with signs of biliary disorder; color-Doppler imaging is a favorable modality for the diagnosis of pseudoaneurysm of the cystic artery.     

Spontaneous perforation of an oesophageal diverticulum in achalasia

Spontaneous perforation of the oesophagus is a rare occurrence that is usually due to vomiting and is seldom associated with an oesophageal lesion. We report a case of the spontaneous perforation of a large oesophageal diverticulum not preceded by any precipitating event in a 75-year-old male who was not known to have achalasia. The diverticulum was repaired by emergency surgery. Achalasia was later diagnosed and successfully treated with botulin toxin injection. Surgery decision-making and the treatment of achalasia are discussed.     

Haemorrhagic cystitis associated with adenovirus in a patient with AIDS treated for a non-Hodgkin's lymphoma

Adenovirus-induced haemorrhagic cystitis has been reported chiefly in bone marrow or kidney transplant recipients. We report here on an HIV-positive patient treated for a Burkitt's lymphoma who developed gross haematuria associated with fever and burning urination. Usual causes of haematuria were ruled out: lithiasis, urinary tract lesions, glomerulonephritis, mycobacterium and schistosoma infections, and drug toxicity. Adenovirus was detected by cellular cultures and BK/JC virus DNA sequences were detected using a polymerase chain reaction method. Because BK/JC virus shedding is very common (75%) in HIV patients receiving chemotherapy, our data strongly suggest that adenovirus was responsible for the haemorrhagic cystitis in our patient. In conclusion, adenovirus should be considered as a potential cause of haemorrhagic cystitis in AIDS patients whose immunosuppression is aggravated by cytotoxic drugs.     

Splenectomy in patients with malignant non-Hodgkin's lymphoma

Splenectomy in patients with non-Hodgkin's lymphoma (NHL) is performed for either diagnostic or therapeutic reasons. We report on a series of 29 patients with NHL and splenomegaly who underwent splenectomy during the years 1979-1998 in our hospital. According to the indication for splenectomy our patients were categorized in three groups. Group A: In 20 patients splenectomy was performed for diagnostic reasons. Group B: Three patients were splenectomized for autoimmune haemolytic anaemia (AIHA). Group C: Six patients underwent splenectomy because of hypersplenism. A definitive histopathological diagnosis of NHL was obtained in all patients of group A. Hypersplenism and AIHA were resolved in all patients after splenectomy. One (3.5%) patient died postoperatively because of septicemia complicated by disseminated intravascular coagulation. Six postoperative complications were observed in 4 (14%) patients. Splenectomy, with an acceptable surgical risk, has the potential to establish the diagnosis of NHL in patients with splenomegaly without lymphadenopathy and negative bone marrow findings. Moreover, splenectomy has the capacity to modify the disease course in patients with NHL complicated by AIHA or hypersplenism.