Primary hepatic lymphoma (PHL) is an extremely rare disease without any unified diagnostic criterion.The symptoms are usually nonspecific.Liver biopsy remains the most valuable tool for diagnosis of PHL.The predominant histology of PHL is diffuse large B-cell lymphoma.The therapeutic modalities are variable,including surgery,chemotherapy,radiotherapy,or combination of the various processes.This article described a 33-year-old man with diffuse large B-cell PHL who was treated at the Affiliated Cancer Hospital of Shanxi Medical Univeitity Blood Disease Diagnosis and Treatment Center in February 2014.The patient benefited from eight-cycle chemotherapy.At present,the patient is disease-free and undergoes regular follow-up.

Objective To study the clinical characteristics and treatment of primary nasal B-cell lymphoma (PNBCL). Methods A retrospective analysis was performed based on the clinical records of 18 PNBCL cases who were treated from January 2009 to June 2015. The clinical manifestations, imaging features, diagnosis approaches and treatment of them were analyzed. Results The main symptoms were nasal obstruction and rhinorrhea. Of all patients, 15 cases were in Ann Arbor stageⅠE-ⅡE, and 3 cases were in Ann Arbor stageⅢE-Ⅳ. The median age was 51 years (12-76 years). The ratio of men to women was 11:7. Only 1 patient had B symptoms. Elevated LDH levels were observed in 4 patients. 13 patients were diffuse large B-cell lymphoma(DLBCL), 3 patients were mantle cell lymphoma, and 2 patients were Burkitt lymphoma. CT examination showed the abnormal nasal soft tissue shadow, with unilateral location and light to moderate enhancement. 14 patients received combination chemotherapy only, and 3 patients received chemotherapy and radiotherapy. Total effective rate was 82.3 % (14/17). At the time of last follow-up, 5 patients died, and the 3-year OS rate was 54.5%(6/11). Conclusions Most PNBCL patients are in Ann Arbor stageⅠE-ⅡE and B symptoms are rare, and the most common pathological types is DLBCL. The treatment for PNBCL is chemotherapy, radiotherapy can assist, but the prognosis is poor, and innovative chemotherapy regimens are necessary.

Objective To research correlation of serum protein spectrometry and lymphoma markers for diffuse large B cell lymphoma (DLBCL) patients. Whether there is relative between the protein and prognosis will be further researched. Methods Serum protein spectrometry of 62 DLBCL patients was detected by the SELDI-TOF-MS technique and Weak cation exchange 2 (WCX2) chip. Lactate dehydrogenase (LDH) was detected by biochemistry method. Beta-2-microglobulin (β2-MG) and cancer antigen125(CA125)were detected by enzyme-linked immunosorbent assay (ELISA). The level of LDH, β2-MG and CA125 for DLBCL patients between 11×103～12×103 protein expressed positively and negatively was analyzed. Meanwhile,correlation analysis and survival analysis were done. Results LDH, β2-MG and CA125 in 11×103～12×103protein expressed positive group were (523.30±435.96)U/L, (3.23±1.24)mg/L, (81.07±61.39)U/L respectively,and they were higher than that in negative group (P＜0.05). 11×103～12×103 protein was positive correlated to LDH, β2-MG and CA125 (P＜0.01). The survival time in 11×103～12×103 protein expressed in positive group,in which median survival time was 11 months, was shorter than that in negative group(P ＜0.01). The survival time in LDH normal group was longer than that in increased group(P ＜0.01). The survival time of β2-MG and CA125 had no significant difference between increased group and normal group. Conclusion LDH and 11×103～12×103 protein are expected to be prognosis indicators for DLBCL patients.

Objective:To investigate the prognosis and its influencing factors of elderly patients with diffuse large B-cell lymphoma (DLBCL), and to provide references for clinical treatment.Methods:The clinical data of 152 patients with DLBCL aged over 60 years old from January 2013 to June 2017 in Shanxi Provincial Cancer Hospital were retrospectively analyzed. Kaplan-Meier method was used for survival analysis, and the log-rank test was used for univariate analysis of factors affecting the prognosis of patients, and the Cox proportional hazard regression model was used for multivariate analysis.Results:The median overall survival (OS) time of 152 elderly patients with DLBCL was 36 months (32-40 months), and the 1, 2, and 3-year OS rates were 80.26%, 61.84%, and 57.24%, respectively. Univariate analysis showed that the differences in the 3-year OS rates of elderly DLBCL patients with different gender, clinical staging, lactate dehydrogenase (LDH), Ki-67, β 2-microglobulin (β 2-MG) levels, smoke history, use of rituximab and CHOP regimens were statistically significant (all P < 0.1). The results of multivariate Cox regression analysis showed that male, late clinical staging, elevated LDH, and elevated β 2-MG were risk factors for the OS of elderly DLBCL patients (all P < 0.05). The use of rituximab and CHOP regimens were the protective factors for the OS of elderly patients with DLBCL (all P < 0.05). Conclusions:The elderly male DLBCL patients with late clinical staging, elevated LDH and elevated β 2-MG have a poor prognosis, and the elderly DLBCL patients treated with CHOP regimen and rituximab have a better prognosis.

Objective To study the incidence of positive t(14;18) and myc gene rearrangement, and the clinical features and prognosis of concurrent positive t ( 14;18 ) and myc gene rearrangement“ double-hit lymphoma” (DHL) in diffuse large B cell lymphoma.Me thods The positive t(14;18) and myc gene rearrangement in 106 cases of DLBCL were analyzed using interphase fluorescent in situ hybridization ( FISH ) technique. The expression of myc and bcl-2 proteins was determined by immunohistochemistry.The relationship of positive t ( 14;18) and myc gene rearrangement with clinical features, pathogenesis and prognosis for the patients was analyzed.SPSS 16.0 software was used for statistical analysis.Results Among the 106 cases, there were 27 (25.5%) cases with positive t(14;18) and 13 (12.3%) cases with myc gene rearrangement, and 7 cases (6.6%) of DLBCL with concurrent t(14; 18)-positive and myc gene rearrangement.A relationship was observed between positive t ( 14;18 ) and myc gene rearrangement ( P=0.019) .The follow-up data showed that the 7 DHL patients were in age of 528-4 years, the International Prognostic Index (IPI) scores were 3 in two cases, 4 in four cases and 5 in one case, and the ECOG scores were 3 in all the7 cases .Four patients had bone marrow involvement and were combined with leukemia.The survival time ranged from 0.5 to 6 months, with a median survival of 4 months.The univariate analysis showed that B symptom, Ann Arbor stage, ECOG score, LDH level, IPI score, immunophenotype, bcl-2 protein expression, myc protein expression,and myc gene rearrangement were all associated with poor prognosis ( P<0.05 for all) .The multivariate analysis using a COX proportional hazard model confirmed that ECOG score, bcl-2 protein expression, myc protein expression , myc gene rearrangement, and immunophenotype were independent prognostic factors affecting survival ( P<0.05 for all) , among them, the myc gene rearrangement was the strongest prognostic factor ( OR=4.337,P<0.001) . Conclusions “Double-hit” DLBCL is rare and can be mainly identified only by molecular detection.Perhaps positive t(14;18) and myc gene rearrangement play concurrent role in its “double-hit” pathogenesis.DHL are highly invasive, and most of DHL patients have poor prognosis.Further studies of larger case number are required to determine the pathologic features and the therapeutic strategy of this subgroup.

Objective To evaluate the clinical value of PET-CT and DWI for the detection of bone marrow infiltration of lymphoma .Methods The bone marrow samples of 93 untreated patients with pathologically diagnosed lymphoma were retrospectively analyzed . 61 patients underwent PET-CT examination, and other 32 underwent DWI examination .With bone marrow biopsy results as “gold standard”, the rates and sites of bone marrow infiltration of various lymphoma subtypes were analyzed , and the detection rates of the two imaging techniques were compared according to different lymphoma subtypes . Results 39 patients were diagnosed as bone marrow infiltration based on pathological examination of bone marrow biopsies from routine sampling sites and bone marrow pathological examination of biopsies guided by PET-CT and DWI.The sensitivity, specificity, accuracy, positive and negative predictive values of PET-CT for lymphoma bone marrow infiltration were 80.8%, 88.6%, 85.3%, 84.0%and 86.1%, respectively; for DWI examination, these rates were 84.6%, 89.5%, 87.5%, 84.6%and 89.5%, respectively.The detection rates of the two imaging techniques for aggressive lymphoma were 37.5%(18/48) and 38.1%(8/21), respectively, which were slightly higher than those for the indolent lymphoma [23.1%(3/13) and 27.3%(31/1)], although the differences were not statistically significant (P=0.521, P=0.660).For both aggressive lymphoma and indolent lymphoma , the detection rates of DWI were numerically slightly higher than those of PET-CT(P=0.963, P=1.000).Conclusions PET-CT and DWI have important and similar diagnostic value for bone marrow infiltration of lymphoma .None of PET-CT and DWI can replace bone marrow biopsy (BMB).However, image-guided bone marrow biopsies can improve the detection rate of bone marrow infiltration of lymphoma .

Objective To study the incidence of positive t(14;18) and myc gene rearrangement, and the clinical features and prognosis of concurrent positive t ( 14;18 ) and myc gene rearrangement“ double-hit lymphoma” (DHL) in diffuse large B cell lymphoma.Me thods The positive t(14;18) and myc gene rearrangement in 106 cases of DLBCL were analyzed using interphase fluorescent in situ hybridization ( FISH ) technique. The expression of myc and bcl-2 proteins was determined by immunohistochemistry.The relationship of positive t ( 14;18) and myc gene rearrangement with clinical features, pathogenesis and prognosis for the patients was analyzed.SPSS 16.0 software was used for statistical analysis.Results Among the 106 cases, there were 27 (25.5%) cases with positive t(14;18) and 13 (12.3%) cases with myc gene rearrangement, and 7 cases (6.6%) of DLBCL with concurrent t(14; 18)-positive and myc gene rearrangement.A relationship was observed between positive t ( 14;18 ) and myc gene rearrangement ( P=0.019) .The follow-up data showed that the 7 DHL patients were in age of 528-4 years, the International Prognostic Index (IPI) scores were 3 in two cases, 4 in four cases and 5 in one case, and the ECOG scores were 3 in all the7 cases .Four patients had bone marrow involvement and were combined with leukemia.The survival time ranged from 0.5 to 6 months, with a median survival of 4 months.The univariate analysis showed that B symptom, Ann Arbor stage, ECOG score, LDH level, IPI score, immunophenotype, bcl-2 protein expression, myc protein expression,and myc gene rearrangement were all associated with poor prognosis ( P<0.05 for all) .The multivariate analysis using a COX proportional hazard model confirmed that ECOG score, bcl-2 protein expression, myc protein expression , myc gene rearrangement, and immunophenotype were independent prognostic factors affecting survival ( P<0.05 for all) , among them, the myc gene rearrangement was the strongest prognostic factor ( OR=4.337,P<0.001) . Conclusions “Double-hit” DLBCL is rare and can be mainly identified only by molecular detection.Perhaps positive t(14;18) and myc gene rearrangement play concurrent role in its “double-hit” pathogenesis.DHL are highly invasive, and most of DHL patients have poor prognosis.Further studies of larger case number are required to determine the pathologic features and the therapeutic strategy of this subgroup.

Objective To evaluate the clinical value of PET-CT and DWI for the detection of bone marrow infiltration of lymphoma .Methods The bone marrow samples of 93 untreated patients with pathologically diagnosed lymphoma were retrospectively analyzed . 61 patients underwent PET-CT examination, and other 32 underwent DWI examination .With bone marrow biopsy results as “gold standard”, the rates and sites of bone marrow infiltration of various lymphoma subtypes were analyzed , and the detection rates of the two imaging techniques were compared according to different lymphoma subtypes . Results 39 patients were diagnosed as bone marrow infiltration based on pathological examination of bone marrow biopsies from routine sampling sites and bone marrow pathological examination of biopsies guided by PET-CT and DWI.The sensitivity, specificity, accuracy, positive and negative predictive values of PET-CT for lymphoma bone marrow infiltration were 80.8%, 88.6%, 85.3%, 84.0%and 86.1%, respectively; for DWI examination, these rates were 84.6%, 89.5%, 87.5%, 84.6%and 89.5%, respectively.The detection rates of the two imaging techniques for aggressive lymphoma were 37.5%(18/48) and 38.1%(8/21), respectively, which were slightly higher than those for the indolent lymphoma [23.1%(3/13) and 27.3%(31/1)], although the differences were not statistically significant (P=0.521, P=0.660).For both aggressive lymphoma and indolent lymphoma , the detection rates of DWI were numerically slightly higher than those of PET-CT(P=0.963, P=1.000).Conclusions PET-CT and DWI have important and similar diagnostic value for bone marrow infiltration of lymphoma .None of PET-CT and DWI can replace bone marrow biopsy (BMB).However, image-guided bone marrow biopsies can improve the detection rate of bone marrow infiltration of lymphoma .