Mărginean Cristina Oana, Meliţ Lorena Elena, Horvath Emoke, Gozar Horea, Chinceşan Mihaela Ioana
Department of Pediatrics I Department of Pathology Department of Pediatric Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania.
Medicine (Baltimore). 2018 Feb;97(8):e9802. doi: 10.1097/MD.0000000000009802.
Non-Hodgkin lymphoma remains an unpredictable condition in pediatric patients.
Our first case describes an 8-year-old boy with a history of iron deficiency anemia, admitted in our clinic for recurrent abdominal pain, weight loss, loss of appetite, diarrheic stools, and fever. The second case also describes an 8-year-old boy admitted for abdominal pain and vomiting. The 3rd case refers to a 4 years and 10 months old boy admitted in our clinic with abdominal pain and loss of appetite, who was initially admitted in the Pediatrics Surgery Clinic with the suspicion of appendicitis. Our 4th patient was a 5-year-old boy admitted in our clinic for abdominal pain and intermittent diarrheic stools.
In the first case, the laboratory tests showed anemia, thrombocytosis, elevated inflammatory biomarkers, a low level of iron, and hypoproteinemia. The abdominal ultrasound and CT exam revealed an abdominal mass, and the histopathological exam established the diagnosis of diffuse large B-cell lymphoma of the bowel. In the second case, the laboratory tests pointed out anemia, elevated ESR and lactate dehydrogenase level, while both abdominal ultrasound and CT exams showed an abdominal mass. The histopathological exam confirmed the diagnosis of Burkitt lymphoma. Regarding our 3rd case, the laboratory findings revealed leukocytosis, anemia, thrombocytosis, increased inflammatory biomarkers, elevated LDH, and a low level of iron. The abdominal ultrasound and the CT scan revealed an abdominal mass which, according to the histopathological exam, was a Burkitt lymphoma. Due to the cranial CT findings the patient was diagnosed with IV stage Burkitt lymphoma with central nervous system metastases. In our 4th patients we found leukocytosis, anemia, mildly increased inflammatory biomarkers, a high level of LDH, hypoproteinemia, and a low level of serum Ir. Both ultrasound and abdominal CT exams were negative, but the exploratory laparotomy identified an abdominal mass, and according to the histopathological exam the patient was diagnosed with Burkitt lymphoma.
All the patients followed chemotherapy (B-NHL BFM 04 protocol) and supportive treatment.
The first patient died approximately 4 months after the completion of chemotherapy due to tumor relapse, the second patient died after the first cure of chemotherapy and the fourth patient died at approximately 2 years after the diagnosis. The third patient is recurrence-free after 2 years.
Despite the advances in the management, NHL remains a fatal condition in pediatrics.
非霍奇金淋巴瘤在儿科患者中仍然是一种难以预测的疾病。
我们的第一个病例是一名8岁男孩，有缺铁性贫血病史，因反复腹痛、体重减轻、食欲不振、腹泻和发热入住我们的诊所。第二个病例也是一名8岁男孩，因腹痛和呕吐入院。第三个病例是一名4岁10个月大的男孩，因腹痛和食欲不振入住我们的诊所，最初因疑似阑尾炎入住儿科外科诊所。我们的第四个患者是一名5岁男孩，因腹痛和间歇性腹泻入住我们的诊所。
在第一个病例中，实验室检查显示贫血、血小板增多、炎症生物标志物升高、铁水平低和低蛋白血症。腹部超声和CT检查显示腹部有肿块，组织病理学检查确诊为肠道弥漫性大B细胞淋巴瘤。在第二个病例中，实验室检查指出贫血、血沉和乳酸脱氢酶水平升高，而腹部超声和CT检查均显示腹部有肿块。组织病理学检查确诊为伯基特淋巴瘤。关于我们的第三个病例，实验室检查结果显示白细胞增多、贫血、血小板增多、炎症生物标志物增加、乳酸脱氢酶升高和铁水平低。腹部超声和CT扫描显示腹部有肿块，根据组织病理学检查，这是伯基特淋巴瘤。由于头颅CT检查结果，该患者被诊断为IV期伯基特淋巴瘤伴中枢神经系统转移。在我们的第四个患者中，我们发现白细胞增多、贫血、炎症生物标志物轻度增加、乳酸脱氢酶水平高、低蛋白血症和血清铁水平低。超声和腹部CT检查均为阴性，但剖腹探查发现腹部有肿块，根据组织病理学检查，该患者被诊断为伯基特淋巴瘤。
所有患者均接受化疗（B-NHL BFM 04方案）和支持治疗。
第一名患者在化疗完成后约4个月因肿瘤复发死亡，第二名患者在首次化疗治愈后死亡，第四名患者在诊断后约2年死亡。第三名患者在2年后无复发。
尽管在治疗方面取得了进展，但非霍奇金淋巴瘤在儿科仍然是一种致命疾病。
