Pediatric Hodgkin lymphoma(HL)is curable by using chemoradiotherapy mostly.However,radiotherapy-related toxicity,endocrine dysfunction as well as the secondary neoplasms have adverse effects on the life quality of pediatric HL patients.There is an increasing concern about the reduction of radiotherapy-related toxicity on the basis of the cure for HL in childhood.This paper reviews the progress of radiotherapy for pediatric HL,including indications,treatment volume,dose and physical techniques.

Primary cutaneous anaplastic large cell lymphoma(PC-ALCL)is a kind of T cell lymphoma that occurs in the skin,which is composed of anaplastic and pleomorphic or immunoblast-like large cells.Most tumor cells(>75%)express CD30.This paper reviews PC-ALCL in the epidemiology,biological characteristics,clinical manifestation,diagnosis and differential diagnosis,treatment and prognosis.

Primary central nervous system lymphoma(PCNSL)is a kind of primary intracranial extranodal non-Hodgkin lymphoma,which is highly aggressive with rare incidence and poor prognosis.There is no consensus as to the standard regimen for treatment of PCNSL.The traditional regimen include surgery,radiotherapy and chemotherapy.However,the comprehensive treatment is regarded as the optimal therapy for the improvement of the survival rate,meanwhile,the combiantion of chemotherapy drugs and preventively intrathecal injection also play an important role in the therapy of PCNSL.

In recent years,the incidence of non-Hodgkin's lymphoma(NHL)is on the rise,and diffuse large B-cell lymphoma(DLBCL)is the main type.Rituximab combined with chemotherapy has significantly improved the curative effect,but only 10% patients with relapsed and refractory DLBCL(R/R DLBCL)have the chance to cure by using limited methods.This article summarizes the pathogenesis and resistance mechanism of R/R DLBCL,individual selection in second-line therapy,the curative effect of new drugs and drugs combination,the application of targeted drug in different subtypes and different resistance mechanisms,immune checkpoint inhibitors and chimeric antigen receptor(CAR)-T cells,as well as the monitoring recurrence of R/R DLBCL.

This article describes the basic pathological diagnosis of lymphoma.The tips should be followed.Firstly,to correctly observe the HE sections of lymph nodes; Secondly,to determine the reference cells of each cell type with different volumes; Thirdly,to properly assess the four elements of pathological diagnosis of benign and malignant hyperplasia in lymphoid tissues.The above three points must be paid attention to improve the accuracy of lymphoma pathological diagnosis.

Objective To investigate the clinical features,diagnosis,treatment and prognosis of disseminated aspergillosis in children with leukemia after chemotherapy.Methods The clinical features and treatment of 3 leukemia children after chemotherapy complicated with disseminated aspergillosis were retrospectively analyzed.Results The underlying diseases of all recruited cases were leukemia,which occurred many high-risk predisposing factors for invasive fungal diseases.The major clinical features of disseminated aspergillosis in children with leukemia were prolonged and antibiotics uncontrollable fever,subcutaneous solid nodules,nodules or cavities in pulmonary CT,spread low density lesions in hepatosplenic and kidney in abdominal MR(T2 weighted)and positive serum aspergillus galactomannan(GM).The diagnosis of invasive fungal disease was proven by histopathologic examination.Amphotericin B lipid complex was selected in antifungal therapy for 2 patients and the course of treatment was more than 4 weeks.Moreover,chemotherapy was advised for the 2 patients when clinical manifestations of disseminated aspergillosis improved significantly,neutrophil counts recovered and images did not deteriorate.The patients received voriconazole treatment with follow-up from 6 months to 12 months,and then disseminated aspergillosis was cured up to the standard.1 case received complete remission and was still alive until follow-up period,1 case was died of leukemia relapse because of suspension demand from the family members,and the other 1 case was died of no response or serious adverse drug reactions,uncontrolled infection,and leukemia relapse because of long-term chemotherapy suspension.Conclusions Patients with leukemia after chemotherapy may present with the following manifestations,including fever,subcutaneous solid nodules,pulmonary nodules or cavities,spread low density lesions in hepatosplenic and kidney and serum aspergillus GM antigen positive,which may indicate disseminated aspergillosis.The improvement of prognosis depends on effective and adequate antifungal treatment and chemotherapy for leukemia at the right time.

Objective To investigate the clinical characteristics,efficacy and prognostic factors of primary bone lymphoma(PBL).Methods The clinicopathologic characteristics and prognostic factors of 19 PBL patients from January 2012 to February 2016 were retrospectively analyzed.Results Nineteen PBL patients included 11 males,8 females,and the median age was 51 years old.It occurred mainly in cuboid(5 cases)and spine(5 cases).8 patients received chemoradiotherapy and 11 patients received chemoradiotherapy only.The overall response rate was 89.5%,including 12 cases with complete remission(CR)and 5 cases with partial remission.The 2-year overall survival(OS)and the 2-year progression-free survival(PFS)rates of 19 patients with completed follow-up were 61.0% and 48.3%,respectively.Further analysis of 15 patients with primary bone diffuse large B-cell lymphoma(PB-DLBCL)subgroup showed that their 2-year OS and PFS rates were 59.2% and 45.5% respectively.Univariate analysis indicated that the international prognostic index(IPI)score(≤2),no soft tissue invasion and CR in initial treatment could be treated as the favorable prognostic factors of both OS and PFS; Eastern Cooperative Oncology Group(ECOG)score(≤2)could improve OS; the addition of rituximab could improve PFS.Multivariate analysis indicated that the IPI score was the only independent factor of OS and soft tissue invasion was the only independent factor of PFS.Conclusions For PB-DLBCL patients,low IPI score(≤2)and local soft tissue without invasion indicate better prognosis,furthermore,a more appropriate IPI model should be explored based on local soft tissue invasion.

Objective To investigate the mutations of epigenetic regulation factor ASXL1 gene in myelodysplastic syndrome(MDS).Methods Mutation analysis of ASXL1 gene in 53 de novo MDS patients and 20 healthy persons was performed by using polymerase chain reaction(PCR)followed by sequence analysis at DNA level.The clinical and laboratory characteristics were compared in MDS patients with ASXL1 gene mutation and ASXL1 wild type.ASXL1 mutation in mRNA level was detected by using reverse transcription PCR(RT-PCR)followed by sequence analysis.Results ASXL1 gene mutations were observed in 9 cases(16.9%)of 53 MDS patients.6 mutation types were detected,including 4 frameshift mutations types(2 cases with p.Glu635ArgfsX15,3 cases with p.Gly646TrpfsX12,1 case with p.Ala640GlyfsX14 and 1 case with p.Gly790TrpfsX10)and 2 nonsense mutation types(1 case with p.Gln1063X and 1 case with p.Gln695X).All the mutations were heterozygous,and p.Gly790TrpfsX10 and p.Gln695X were new mutation types.In addition,a single nucletide polymorphism(SNP)p.Gly652Ser was also detected in 4 cases with MDS.5 cases of p.G652S SNP and 1 case of p.Leu1173Leu SNP were detected in 20 healthy people.Frameshift mutation(p.Gly646TrpfsX12)could be detected at mRNA level by using RT-PCR.Differences were not observed in red blood cell counts,white blood cell counts,platelet counts,hemoglobin levels,reticulocyte,neutrophil granulocyte,the peripheral blood lymphocytes percentage,T-cell subsets in the peripheral blood,the proportion of primitive cell in the marrow and MDS types between the patients with ASXL1 gene mutation and ASXL1 wild type patients(P >0.05).Conclusion There is a high frequency of ASXL1 gene mutation in MDS patients,which can be detected at mRNA level.

Since all-trans retinoic acid (ATRA) and arsenic trioxide (As2O3) have become front-line drugs in treatment of acute promyelocytic leukemia (APL), cure rates of APL patients have improved dramatically. However, resistance to ATRA and/or As2O3has been a critical problem which has hampered the effect of treatment. In this review, some emerging mechanisms of resistance to ATRA and/or As2O3in recent years, such as genetic mutations, disorders of cellular signal transduction, disorders of chromatin remodeling complex, abnormal regulation of cell apoptosis, and micro-environment mediated drug resistance are summarized.

The immunohistochemistry is an useful method for pathological diagnosis and differential diagnosis of lymphoproliferative lesions,but it must be used correctly and its immunophenotypic results should be evaluated. The following points should be paid attention: (1) Similar antibodies must be reasonable compatibility; (2) the pseudo-positive and pseudo-negative of immunophenotype must be distinguished; (3) the immunophenotypica site must be distinguished; (4) the specify of the antibody expression must be distinguished; (5) the immunophenotype in the tumor cells or reactive cells must be distinguished; (6) the immunophenotype must be used correctly in differential diagnosis between the benign and malignant of hyperplastic lymphoid tissues. The author emphasizes that immunohistochemical techniques need to be combined with other diagnostic features of lymphoproliferative lesions,in order to obtain satisfactory results.