Adrian Dumitru

Case report. A rare case of triple-hit diffuse large B-cell lymphoma of the parotid gland in a patient with Sjogren’s syndrome

Abstract BACKGROUND. Primary malignant lymphomas of the salivary gland are rare, accounting for 2% of salivary gland tumors and 5% of all extranodal lymphomas. The clinical presentation is not particularly characteristic, a feature that usually leads to diagnostic and treatment delays. CASE REPORT. We report a case of a parotid gland triple-hit diffuse large B-cell (DLBCL) lymphoma associated with follicular lymphoma in a 76-year-old female patient with a unique personal history, which included a diagnosis of Sjogren Syndrome and exposure to a toxic working environment with pesticides. Diffuse large B-cell lymphomas are uncommon given the fact that most lymphoid malignancies are low-grade lymphomas, with MALT (mucosa associated lymphoid tissue) lymphomas being the most common. Triple-hit DLBCL are extremely rare and the diagnosis can be challenging. Parotidectomy, as the first step, must be followed by histopathology and immunohistochemistry for final diagnosis and treatment. CONCLUSION. This case highlights the fact that B-cell lymphoma in the salivary gland can be unrecognized due to unspecific symptoms and requires immunohistochemistry studies for confirmation. It is important to recognize triple-hit lymphoma due to its worse prognosis and differentiated treatment. Patients with Sjogren syndrome have additional risk factors for progression to lymphoma.

Diffuse Large B Cell Lymphoma in a Male Breast - A Rare Case Report.

Primary breast diffuse large B cell lymphoma (PBL) in male patients represents a rare clinical phenomenon and can imitate a breast carcinoma in its clinical presentation, so, therefore, the initial treatment for most patients remains surgery. Prompt diagnosis associating subsequent treatment combining chemotherapy and radiotherapy are of the utmost importance. We herein report a 56 years old male patient diagnosed with diffuse large B cell lymphoma, after clinically presenting with a visible tumor in the left breast and showing no axillary lymphadenopathy. Following clinical diagnosis we performed a breast biopsy with subsequent immunohistochemistry testing. The results showed that the malignant cells stained positive for CD 20, CD 10, and negative for BCL 2, myc and BCL 6, ER/PR with a high proliferation index (Ki 67 90%). The immunohistochemical tests were suggestive for primary large B cell lymphoma of the breast, germinal center type. The patient was submitted to three cycles of R-CHOP (cyclophosphamide, adryamicin, vincristine and prednisolone) and rituximab chemotherapy. Primary diffuse large B cell lymphoma is an extremely unique disease that involves a rather difficult differential diagnosis with a breast carcinoma. A strong index of clinical suspicion is necessary with early diagnosis and treatment.

A short-term retrospective analysis of the clinical, histopathological and immunohistochemical aspects in endometrial malignancy

Endometrial carcinoma is the most frequent malignancy of the female reproductive system and the 7th cause of death by cancer in women from Western Europe. This study aims to evaluate the clinical, histopathological and immunohistochemical aspects as well as the short-term evolution in a series of 52 cases of endometrial carcinoma investigated, diagnosed and treated at the University Emergency Hospital in Bucharest, Romania over a period of one year. Demographic analysis revealed that in our country the majority of women presenting with endometrial carcinoma and, in particular, early stages of disease, usually come from urban regions and from areas with higher socioeconomic status. This raises the problem of disproportionate cultural levels and social inequity regarding access to healthcare services. All patients were postmenopausal and the mean age at presentation was 60.83, ranging from 43 to 81 years. Almost one-quarter (24%) of the women who have undergone radical hysterectomy as treatment for endometrial carcinoma presented endometrial intraepithelial neoplasia (EIN) on a previous biopsy. Immunohistochemical comparison between EIN and EIN with concurrent endometrial carcinoma revealed that expression of PTEN was slightly higher in the first study group. Moreover, we were surprised to find that one of the 2 serous carcinomas presented diffuse estrogen receptor (ER) positivity within the papilary structure of the tumor, whereas the solid areas completely lost positivity for estrogen receptor (ER). Precise evaluation of the tumor type in endometrial cancers is one of the most frequent issues encountered in endometrial biopsies. Accurate diagnosis and distinction between type I and type II endometrial carcinoma is of critical importance for proper surgical planning and further clinical management.

Menstrual synchronizing: myth or reality?

Menstrual synchronizing (MS) represents the temporal correlation of the menstrual cycle debut among women living in spatial proximity. Possible mechanisms underlying some explanations for MS could be the interpolation of various factors of social interaction and/or of some biologic factors (pheromones). The present material aims to review the medical literature in the field. Although seductive as a hypothesis, MS could not be irrefutably proved by any study up until now. Studies attesting MS present important statistical defects which cancel the proof of MS. The analysis of the data obtained by these studies with an adequate statistical apparatus does not allow the demonstration of MS.