FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1480517072> ?p ?o ?g. }

• W1480517072 endingPage "794" @default.
• W1480517072 startingPage "791" @default.
• W1480517072 abstract "Although rare, non-Hodgkin lymphomas (NHL) localized within the lower female genital tract have histological appearances consistent with diffuse large B-cell lymphoma (DLBCL), present with mass lesions and respond typically to chemo-immunotherapy. In contrast, patients who present either with abnormal cervical smear or bleeding, with highly proliferative lymphoid lesions usually within the uterine cervix, without significant mass lesions on computerized tomography (CT) or magnetic resonance imaging may pose considerable diagnostic and therapeutic problems. Such lesions were first described by Young et al (1985) and termed ‘lymphoma-like lesions’(LLL). Their observations have been confirmed subsequently (Ferry & Young, 1991; Au et al, 2003; Ma et al, 2007; Geyer et al, 2010). LLL of the cervix may be associated with localized, chronic cervical infections, including Chlamydia sp. infection, or more rarely with systemic infections such as infectious mononucleosis or papilloma virus. Histologically, LLL are characterized by large, transformed B-cells with a high proliferation index. Moreover, recent studies have demonstrated immunoglobulin light chain restriction by immunohistochemistry or monoclonality by immunoglobulin heavy chain (IGH) V/D/J polymerase chain reaction (PCR) (Ma et al, 2007; Geyer et al, 2010). However, despite appearances consistent with DLBCL, long-term follow up has shown that LLL do not require systemic chemotherapy and resolve spontaneously. It has been suggested that LLL can be distinguished from cervical DLBCL by a combination of histological and clinical features including the superficial nature of the lesion, the absence of a mass lesion, lack of invasiveness, cellular pleomorphism and the presence of numerous plasma cells as well as residual T-cells. Nevertheless, the histological features are virtually indistinguishable from DLBCL and when reinforced by monoclonality, it is a brave pathologist who fails to make a diagnosis of DLBCL. We have encountered six such cases over the past 10 years presenting in the laboratory of one of us, and report our experience of two cases for which we have comprehensive clinical, histological and molecular data. Patient details are summarized in Table I. In the first patient, the diagnosis was made following a routine cervical smear test showing abnormal cells. The second presented with a 6-month history of post-coital bleeding. Both presented with superficial lesions of the cervix, with otherwise completely normal staging investigations including CT/and bone marrow aspirate and trephine. 18Fluorodeoxyglucose-positron emission tomography/CT scan showed no extension beyond the cervix in Patient 2. Both patients were human immunodeficiency virus negative. The histological appearances in both cases were very similar and images from the second case are shown in Fig 1. Biopsies of the cervix showed diffuse infiltration by monomorphic large CD20+ lymphoid cells (Fig 1A, B). The cells displaced, without infiltrating, endocervical glands. There was a background population of small lymphocytes and clusters of plasma cells were present immediately beneath the superficial endocervical epithelium. The infiltrate extended superficially into the cervix to about the level of the base of the endocervical glands. The immunophenotype of the cases is shown in Table I and was consistent with DLBCL of germinal centre type. The high proliferation index was notable in both cases (Fig 1C). Interestingly, both cases exhibited p53 staining in the larger cells; the significance of this is not known (Fig 1D). Interphase fluorescent in situ hybridization using IGH, BCL6, BCL2 and MYC probes showed normal hybridization patterns, indicating a lack of the common chromosomal translocations associated with DLBCL (Fig 1E). IGH FR3-JH PCR showed that both cases were monoclonal (Fig 1F). Histological, immunohistochemical, FISH and IGH clonality studies in lymphoma like-lesions of the uterine cervix. Biopsies of the cervix of Patient 2 showed diffuse infiltration by monomorphic large CD20+ lymphoid cells with prominent nucleoli and a moderate amount of eosinophilic cytoplasm. There was a high proliferative rate and also nuclear p53 staining in larger cells. (A) Staining with haematoxylin and eosin. (B) CD20 staining. (C) Ki67 staining showing high proliferation rate. (D) p53 nuclear staining of larger cells. All histological figures ×40 magnification. (E) IGH‘breakapart’ FISH assay showing lack of IGH chromosomal translocation in Patient 2. Lack of rearrangement was also observed with BCL2, BCL6 and MYC probes. (F) Polyacrylamide gel of IGH FR3 VDJ PCR. Lane 1, negative control. Lane 2, positive control (DLBCL). Lanes 3–8, other cases in duplicate; lanes 3 and 4 monoclonal, lanes 5–8 monoclonal. Lanes 9 and 10, patient with LLL of the cervix showing monoclonal band. Despite the lack of mass lesions in both patients and the superficial nature of the biopsy specimens, a diagnosis of DLBCL was made in both cases and both received chemotherapy (Table I). Both patients have been in complete remission since completion of therapy. Repeat loop biopsies of the cervix in Patient 2 have shown no evidence of lymphoid cells but persistent cervical intraepithelial neoplasia grade 1, and the patient continues gynaecological follow up. These two cases illustrate the difficulties in making a diagnosis of LLL involving the lower female genital tract. Firstly, this condition is rare. Patient 2 was the only case seen in the Leicester database (derived from a population of about one million individuals) over a 10-year period (Martin J. S. Dyer, unpublished observations). Although all our cases were diagnosed and treated as DLBCL, it is clear from cases reported in the literature that received no treatment and the excellent completes responses in other cases such as the two reported here, that this is best regarded as a benign condition, appropriately named ‘lymphoma-like lesion’. The question regarding the true nature of LLL remains however, especially as the lesion fulfils all the requirements for a diagnosis of DLBCL. The possibilities include the following: The lesion represents a benign lymphoma. A benign lymphoma with these histological features has not been described. Moreover, a benign lymphoma would continue to grow locally after (incomplete) excision and would be unlikely to respond durably to chemotherapy. The lesion represents the early stage of classical DLBCL that is curable by local excision alone. This proposition cannot be refuted without documenting cases that have been followed up after incisional biopsy without further therapy and remains a possibility. The lesion represents an as yet undescribed lymphoproliferative disorder that is a response to an as yet undefined microorganism. A very similar lesion has been described in some extranodal sites, including the stomach, rectum and bladder, where it has been characterized as DLBCL responsive to antibiotics, usually, but not always, in patients harbouring Helicobacter pylori in their stomachs. Indeed, some cases of gastric DLBCL are known to spontaneously regress without antibiotics (Cavanna et al, 2008; Makino et al, 2010). This suggests the inflammatory response to an (unknown) organism can rarely result in the clonal proliferation of B-cells by an unknown mechanism. Which, if any, of these proposals is the explanation remains enigmatic. However, when confronted with a case of apparent DLBCL of the cervix in a young woman that is superficial and shows no indication of dissemination after full staging including 18FDG-PET/CT, it is wise initially to withhold inappropriate therapy and simply follow the patient. We thank Dr Simon Rose, Royal United Hospital, Bath for help with the clinical information in Patient 1." @default.
• W1480517072 created "2016-06-24" @default.
• W1480517072 creator A5020421276 @default.
• W1480517072 creator A5031600864 @default.
• W1480517072 creator A5081516283 @default.
• W1480517072 date "2011-03-16" @default.
• W1480517072 modified "2023-10-17" @default.
• W1480517072 title "Primary lymphoma-like lesions of the uterine cervix; sheep in wolves’ clothing" @default.
• W1480517072 cites W1971081957 @default.
• W1480517072 cites W2023023966 @default.
• W1480517072 cites W2038978874 @default.
• W1480517072 cites W2064717093 @default.
• W1480517072 cites W2069776187 @default.
• W1480517072 cites W2153925042 @default.
• W1480517072 doi "https://doi.org/10.1111/j.1365-2141.2011.08659.x" @default.
• W1480517072 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21410452" @default.
• W1480517072 hasPublicationYear "2011" @default.
• W1480517072 type Work @default.
• W1480517072 sameAs 1480517072 @default.
• W1480517072 citedByCount "11" @default.
• W1480517072 countsByYear W14805170722012 @default.
• W1480517072 countsByYear W14805170722013 @default.
• W1480517072 countsByYear W14805170722014 @default.
• W1480517072 countsByYear W14805170722017 @default.
• W1480517072 countsByYear W14805170722018 @default.
• W1480517072 countsByYear W14805170722021 @default.
• W1480517072 crossrefType "journal-article" @default.
• W1480517072 hasAuthorship W1480517072A5020421276 @default.
• W1480517072 hasAuthorship W1480517072A5031600864 @default.
• W1480517072 hasAuthorship W1480517072A5081516283 @default.
• W1480517072 hasBestOaLocation W14805170721 @default.
• W1480517072 hasConcept C121608353 @default.
• W1480517072 hasConcept C126322002 @default.
• W1480517072 hasConcept C142724271 @default.
• W1480517072 hasConcept C16005928 @default.
• W1480517072 hasConcept C2777546739 @default.
• W1480517072 hasConcept C2777740455 @default.
• W1480517072 hasConcept C2779338263 @default.
• W1480517072 hasConcept C2992879611 @default.
• W1480517072 hasConcept C71924100 @default.
• W1480517072 hasConcept C86803240 @default.
• W1480517072 hasConceptScore W1480517072C121608353 @default.
• W1480517072 hasConceptScore W1480517072C126322002 @default.
• W1480517072 hasConceptScore W1480517072C142724271 @default.
• W1480517072 hasConceptScore W1480517072C16005928 @default.
• W1480517072 hasConceptScore W1480517072C2777546739 @default.
• W1480517072 hasConceptScore W1480517072C2777740455 @default.
• W1480517072 hasConceptScore W1480517072C2779338263 @default.
• W1480517072 hasConceptScore W1480517072C2992879611 @default.
• W1480517072 hasConceptScore W1480517072C71924100 @default.
• W1480517072 hasConceptScore W1480517072C86803240 @default.
• W1480517072 hasIssue "6" @default.
• W1480517072 hasLocation W14805170721 @default.
• W1480517072 hasLocation W14805170722 @default.
• W1480517072 hasOpenAccess W1480517072 @default.
• W1480517072 hasPrimaryLocation W14805170721 @default.
• W1480517072 hasRelatedWork W1522371372 @default.
• W1480517072 hasRelatedWork W1768003048 @default.
• W1480517072 hasRelatedWork W1979517391 @default.
• W1480517072 hasRelatedWork W1979556594 @default.
• W1480517072 hasRelatedWork W2051937887 @default.
• W1480517072 hasRelatedWork W2364249728 @default.
• W1480517072 hasRelatedWork W2394089175 @default.
• W1480517072 hasRelatedWork W2397946386 @default.
• W1480517072 hasRelatedWork W2411223721 @default.
• W1480517072 hasRelatedWork W2467090235 @default.
• W1480517072 hasVolume "153" @default.
• W1480517072 isParatext "false" @default.
• W1480517072 isRetracted "false" @default.
• W1480517072 magId "1480517072" @default.
• W1480517072 workType "article" @default.