Unusual Course of Splenic Marginal Zone Lymphoma
Unusual Course of Splenic Marginal Zone Lymphoma
复制标题
脾边缘区淋巴瘤的异常病程
作者：
Nay T. Tun;Kaihong Mi;John Smith
一位53岁女性，经左颌下淋巴结及骨髓切片病理检查及脾脏明显肿大，诊断为脾脏边缘区淋巴瘤。给予4个周期的利妥昔单抗化疗。在完成利妥昔单抗化疗后7个月，她出现左上肢肿胀，无深静脉血栓形成的证据。重复PET/CT扫描显示多个左腋窝淋巴结延伸到左锁骨后区域，并在左肩胛骨后发现一个新的淋巴结。淋巴结活检显示边缘区淋巴瘤模式，大细胞数量增加，但不是完全弥漫性大B细胞淋巴瘤。尽管重新开始利妥昔单抗治疗，患者仍出现持续性白细胞增多和重度贫血。再分期PET/CT显示3个新的左颈前淋巴结和1个新的右腋窝淋巴结。脾脏进一步扩大。开始R-CHOP化疗，白细胞升高改善，4个周期R-CHOP后，PET/CT显示右侧腹股沟和腹部淋巴结内有新的代谢活动。患者接受了一个周期的苯达莫司汀治疗。她的右肘内侧可能出现“血肿”。然而，MRI检查显示淋巴瘤的皮下存款。病人需要持续输血，病情迅速恶化。我们的病人有一个积极的过程脾边缘区淋巴瘤，没有回应四个试验的化疗，虽然SMZL是众所周知的惰性低级别淋巴瘤。本病例报告强调了SMZL患者个体化治疗的重要性，如果疾病复发，应重复骨髓活检。
A 53-year-old woman was diagnosed with splenic marginal zone lymphoma by pathological examination on left submandibular lymph node and bone marrow biopsies and markedly enlarged spleen. Four cycles of Rituximab chemotherapy were given. Seven months after finishing Rituximab chemotherapy, she developed left upper extremity swelling without evidence of deep venous thrombosis. Repeat PET/CT scan demonstrated multiple left axillary lymph nodes extending to left retroclavicular region and a new lymph node posterior to the left scapula. Biopsy of the lymph node demonstrated marginal zone lymhoma pattern with increased numbers of large cells, but not outright diffuse large B-cell lymphoma. Despite resuming rituximab, patient had persistent leukocytosis and severe anemia. Restaging PET/CT showed 3 new left anterior cervical lymph nodes and 1 new right axillary lymph node. Spleen has further enlarged. R-CHOP chemotherapy was started, which improved leukocytosis.After 4 cycles of R-CHOP, PET/CT showed new metabolic activity within right inguinal and abdominal lymph nodes. Patient was given one cycle of Bendamustine. She developed a possible “hematoma” in right medial elbow. However, MRI study revealed a subcutaneous deposit of the lymphoma. Patient needs consistently blood transfusion and she deteriorated quickly. Our patient had an aggressive course of splenic marginal zone lymphoma, not responding to four trials of chemotherapy although SMZL is well-known to be an indolent low grade lymphoma. This case report emphasizes the importance to individualize the treatment in SMZL patients and repeat bone marrow biopsy if the disease recurs.
影响因子：
11.4
作者：
Peveling-Oberhag, J.;Crisman, G.;Hansmann, M-L
通讯作者：
Hansmann, M-L