CASE N°20 – Systemic disease: Non Hodgkin’s Lymphoma
Two months ago she was hospitalized in a foreign clinic. During hospitalization underwent excision of multiple omental nodules which had been highlighted during an abdominal CT-SCAN performed for other reasons. Histological diagnosis: non-Hodgkin’s Lymphoma “B”, diffuse large cell type. Immunophenotype: CD20 +, CD10 +, Bcl2 +, BCL6 +, MUM1-, CD30-, CD23-, CD3-, CD5-, CiclinaD1-, Tdt-. Proliferation index (MIB-1): about 80%.
Physical examination: Currently ascites, dizziness and vomiting. Subjected to drain ascites, reduction of intracranial pressure with removal of CSF and gastroscopy
Ascites: Figure 1-4
Liquor: Figure 5-13
Ascites & Liquor have the same cytological diagnosis: cytologic findings suggestive of lymphoid cell proliferation. Histology raccomanded
Histological material: gastric biopsy
Non-Hodgkin’s Lymphoma “B”, diffuse large cell type. Immunophenotype: CD20 +, CD10 +, Bcl2 +, BCL6 +, MUM1-, CD30-, CD23-, CD3-, CD5-
Non Hodgkin’s lymphoma (NHL) may occur preferentially affecting different anatomic sites, they
debut involving multiple lymph nodes and spread to the spleen, bone marrow and
to other tissues and organs. Localizations extralymphatic primitives are found in 20-30% of
cases and preferentially affecting the gastrointestinal tract, skin, central nervous system (CNS)
The NHL as other hematopoietic malignancies, should be considered systemic diseases,
those primitives of the gastrointestinal tract, of the Skin, of the Testis and in particular of the
CNS tend to remain confined in the tissue of origin, even in advanced stages of disease.
Treatment aim is to cure the common and aggressive lymphomas because in these groups of
cancer is now possible to obtain a high percentage of durable complete remissions.
Protocols using modern intensive chemotherapy, including treatment at high
doses with support of hemopoietic progenitors circulating. In indolent lymphomas at presentation does not now seems possible to achieve a cure with the means of treatment today
available, probably due to one of the oncogenes of drug resistance (bcl-2), therefore treatment is aimed primarily at controlling the disease using a long less aggressive therapies.