INTRODUCTION

Parotid lymphoma is a rare occurrence, let alone a diagnosis of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). Salivary gland tumors commonly affect the parotid gland, although a primary malignant lesion rarely occurs, with an incidence of 0.5 to 3.0/100,000 population/year worldwide. This case report describes the presentation of this rare lymphoma. This also demonstrates the efficacy of standard of care chemotherapy with doxorubicin, vincristine, bleomycin, and dacarbazine with an anti-CD20 monoclonal antibody, rituximab (R-ABVD).

CASE

This is a case of a 44-year-old male with a gradually enlarging right preauricular mass. Biopsy and immunohistochemical staining confirmed a diagnosis of NLPHL Stage IIA. A total of six cycles of chemotherapy with R-ABVD was given. Follow-up PET CT showed resolution of FDG avid nodes localized near the surgically removed parotid gland, confirming complete remission.

DISCUSSION

Parotid malignancy only accounts for 5% of all head and neck tumors. NLPHL is even more rare, with an incidence of 1.5/1,000,000 population per year. The rarity of the case limits clinical trials for its treatment. Because of this, R-ABVD has been employed as a treatment of choice for intermediate-staged NLPHL. Overall response showed an 85% five-year progression-free survival and 99% overall survival.

CONCLUSION

This case report highlights the significance of early lymphoma detection despite its rarity among parotid tumors and prompt initiation of chemotherapy.

Human ; Male ; Adult: 25-44 Yrs Old ; Lymphocytes ; Hodgkin Disease

Rationale: COVID-19 is a new, rapidly emerging zoonotic infectious disease. Addressing the cytokine storm and coagulopathy associated with this disease can minimize its severity and complications. Therapeutic plasma exchange (TPE) can be potentially used to remove these deleterious cytokines and procoagulant proteins. Objective: This study aims to assess the effectiveness and safety of TPE as an adjunctive treatment for COVID-19 patients. Research Design and Methodology: A systematic search of databases was conducted utilizing PubMed and Cochrane databases to identify relevant literature until December 31, 2020. All publications were included if they use TPE in COVID- 19 patients. The exclusion was applied in publications written in language other than English, review papers, or on-going clinical trials. No restrictions on age, sex, or clinical setting were applied. The eligible studies were reviewed in full text independently by two authors. Methodological quality and risk of bias assessment were done. The findings from the individual studies were summarized. Results: A total of 21 studies were included. Overall risk of bias was high within and across the studies. All studies reported marked improvement of clinical status and laboratory results after receiving the TPE. The use of TPE among COVID-19 patients resulted in no serious or life-threatening adverse events. Conclusion The available studies on the use of TPE for COVID-19 patients is still limited and evidence is of low certainty. However, based on the available data, it has an encouraging result to be used as effective and safe adjunctive treatment in COVID-19 patients.
COVID-19 ; Cytokine Release Syndrome