Tun Nay T, Mi Kaihong, Smith John
Department of Medicine, Easton Hospital, USA.
World J Oncol. 2013 Oct;4(4-5):205-209. doi: 10.4021/wjon700w. Epub 2013 Sep 27.
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.
一名53岁女性经左下颌下淋巴结及骨髓活检病理检查以及脾脏明显肿大确诊为脾边缘区淋巴瘤。给予了4个周期的利妥昔单抗化疗。完成利妥昔单抗化疗7个月后，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至左锁骨后区域以及左肩胛骨后方出现一个新的淋巴结。该淋巴结活检显示为边缘区淋巴瘤模式，大细胞数量增加，但并非完全的弥漫性大B细胞淋巴瘤。尽管重新使用利妥昔单抗，患者仍持续存在白细胞增多和严重贫血。再次分期的PET/CT显示左前颈部有3个新的淋巴结以及右腋窝有1个新的淋巴结。脾脏进一步肿大。开始给予R-CHOP化疗，白细胞增多情况有所改善。4个周期的R-CHOP化疗后，PET/CT显示右腹股沟和腹部淋巴结有新的代谢活性。患者接受了1个周期的苯达莫司汀治疗。她右内侧肘部出现一个可能的“血肿”。然而，MRI检查显示为淋巴瘤的皮下沉积。患者需要持续输血且病情迅速恶化。我们的患者患有侵袭性脾边缘区淋巴瘤，尽管脾边缘区淋巴瘤众所周知是一种惰性的低级别淋巴瘤，但对4次化疗均无反应。本病例报告强调了在脾边缘区淋巴瘤患者中个体化治疗以及疾病复发时重复进行骨髓活检的重要性。
