Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.
Antineoplastic Agents/therapeutic use ; Carcinoma, Hepatocellular/complications/*diagnosis/radiotherapy ; Drug Therapy, Combination ; Embolization, Therapeutic ; Fluorodeoxyglucose F18 ; Gadolinium DTPA ; Genotype ; Hepatitis B virus/genetics ; Hepatitis C, Chronic/complications/*diagnosis/*virology ; Humans ; Liver Neoplasms/complications/*diagnosis/radiotherapy ; Lymph Nodes/pathology ; Lymphoma, Non-Hodgkin/complications/*diagnosis/drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed

Aged ; Castleman Disease ; complications ; Hepatitis B ; complications ; Humans ; Liver Neoplasms ; complications ; virology ; Lymphoma, Non-Hodgkin ; complications ; Male

OBJECTIVETo analyze the status of hepatitis B virus (HBV) infection in non-Hodgkin lymphoma (NHL) patients.

METHODSThe serum HBV markers in NHL patients were detected by enzyme-linked immunosorbent assay (ELISA). The infection rate of HBV in NHL patients was compared with that in nationwide general population.

RESULTSThe positive rates of HBsAg, anti-HBs and anti-HBc in 405 cases of NHL were 11.6%, 39.8% and 47.9%, respectively, which were statistically different from those in general population (P < 0.01). The positive rates of HBsAg, anti-HBs and anti-HBc in B-cell NHL and T-cell NHL were 13.3% vs 7.1% (P = 0.083), 40.6% vs 37.5% (P = 0.567), 53.2% vs 33.9% (P = 0. 001), respectively. The HBV DNA positive rate was 23.7% in 93 cases of NHL, and was 50.0% in 38 cases of HBsAg-positive NHL while 5.5% in 55 cases of HBsAg-negative but HBcAb-positive NHL.

CONCLUSIONSThe infection rate of HBV in NHL patients is higher than that in general population, in which occult hepatitis B virus infection can not be ignored. The positive rate of anti-HBc in B-cell NHL is significantly higher than that in T-cell NHL. For NHL patients infected with HBV, prophylactic anti-HBV therapy to prevent viral reactivation should be given before the anti-cancer treatment. Further study in the relationship between HBV and NHL should be carried out in the future.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; DNA, Viral ; blood ; Female ; Hepatitis B ; epidemiology ; Hepatitis B Antibodies ; blood ; Hepatitis B Surface Antigens ; blood ; Hepatitis B virus ; isolation & purification ; Humans ; Lymphoma, Non-Hodgkin ; virology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVETo study the clinicopathologic features and disease outcome of intravascular natural killer-cell lymphoma (IVNKL).

METHODSThe histologic features, immunohistochemical findings and results of in-situ hybridization for Epstein-Barr virus-encoded RNA (EBER) were analyzed in 2 novel cases of IVNKL. Seven cases of IVNKL previously reported in the literature were reviewed.

RESULTSThe patients were a 68-year-old woman and a 22-year-old man. They both presented with erythematous patches and nodules on their trunk and extremities. Skin biopsies confirmed the diagnosis of IVNKL. The tumor cells were positive for CD3, CD56, granzyme B and EBER. Both patients died 2 months after the diagnosis. Amongst the 9 reported cases, including those from the literature, the male was 4 cases, the female was 5 cases. The mean age of the patients was 45.7 years and the median age was 47 years. Skin lesions represented the commonest clinical manifestations. Multiple organ involvement was found in 7 cases and central nervous system was involved in 3 cases. Six patients died during 2 to 17 months of follow-up. The median survival was 9 months and the one-year survival rate was (35.6±18.6)%. The clinical outcome of the patients with multiple organ involvement was worse than that with skin manifestations only. The difference however was not statistically significant (P=0.083).

CONCLUSIONSIVNKL is a rare disease. Diagnosis should be made according to typical histologic findings, immunophenotype and EBER in-situ hybridization results. The overall prognosis of IVNKL is poor. Early diagnosis and treatment before multiorgan involvement may be helpful in improving the clinical outcome.

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; CD3 Complex ; metabolism ; CD56 Antigen ; metabolism ; Cyclophosphamide ; therapeutic use ; Doxorubicin ; therapeutic use ; Female ; Follow-Up Studies ; Granzymes ; metabolism ; Humans ; Killer Cells, Natural ; metabolism ; pathology ; virology ; Lymphoma, Non-Hodgkin ; drug therapy ; metabolism ; pathology ; virology ; Male ; Middle Aged ; Prednisone ; therapeutic use ; RNA, Viral ; metabolism ; Vascular Neoplasms ; drug therapy ; metabolism ; pathology ; virology ; Vincristine ; therapeutic use ; Young Adult

Increasing evidence suggests that multiple genes in the human leukocyte antigen(HLA) regions play an important role in development of cancers and immunity disorders. However, the biological mechanisms of the HLA associations are not well understood. We recently conducted a survey of all genome-wide association studies (GWAS) with significant findings in the HLA regions and concluded that diseases such as cancer and immune disorders are more likely to be associated with genetic variants located in the HLA regions than other diseases. This finding is suggestive for testing a hypothesis of a common etiology of infectious tumors and other immunity diseases.
Genetic Predisposition to Disease ; Genetic Variation ; Genome-Wide Association Study ; HLA Antigens ; genetics ; metabolism ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Immune System Diseases ; genetics ; immunology ; virology ; Lymphoma, Non-Hodgkin ; genetics ; immunology ; virology ; Nasopharyngeal Neoplasms ; genetics ; immunology ; virology

OBJECTIVETo study the clinical features and treatment of severe pneumonia due to novel influenza A (H1N1) virus in children with lymphoma during chemotherapy.

METHODThe clinical manifestations, radiologic features, reasons of misdiagnosis, experiences in treatment and prognosis of 4 children with lymphoma complicated with pneumonia due to novel influenza A (H1N1) virus during chemotherapy were analyzed retrospectively.

RESULTFour children out of the 54 patients with hematologic disorders who were receiving chemotherapy suffered from H1N1 influenza. Neutrophil counts were less than 0.5 × 10(9)/L in all 4 patients. The body temperature was higher than 39°C accompanied by chill and low blood pressure at the onset of the illness. Dyspnea and hypoxemia occurred quickly. Two of them developed acute respiratory distress syndrome (ARDS). C-reactive protein (CRP) was higher than 50 mg/L in all these cases, and was higher than 200 mg/L in 2 cases. Chest X-ray showed that there were extensive infiltrations in several lung lobes in all the 4 patients. The first patient was misdiagnosed as sepsis at the beginning. The results of 17 blood cultures for the 4 patients were all negative. Fungi were found in 2 of 20 sputum cultures in 2 patients and these 2 patients had been considered as having fungal pneumonias. All the 4 patients were treated with oseltamivir phosphate. The oseltamivir treatment started on the 5(th) day in patient number 1, whereas on the 1(st) day in the other 3 patients. Intravenous immunoglobulin (IVIG) was used in all 4 patients. Methylprednisolone was used in 3 patients. After treatment, 2 died and 2 were improved.

CONCLUSIONThe children with lymphoma who undergo chemotherapy are prone to develop severe pneumonia during epidemics of influenza A H1N1. The pneumonia may be aggravated very quickly and have a higher mortality. The patients might be easily misdiagnosed as sepsis at early stage. The pneumonia may be misdiagnosed as fungal infection. During H1N1 prevalent season when high fever occurred, H1N1 infection should be considered. Early detection of the virus and use of oseltamivir phosphate and high-dose IVIG and methylprednisolone might reduce the mortality.

Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Influenza A Virus, H1N1 Subtype ; Lymphoma, Non-Hodgkin ; complications ; virology ; Male ; Pneumonia, Viral ; complications ; diagnosis ; therapy ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the correlation of Epstein-Barr virus (EBV) infection and childhood lymphoma.

METHODSParaffin-embedded specimens of lymphoma collected between 1996 and 2005, including 36 Hodgkin lymphomas (HL) and 51 non-Hodgkin lymphomas (NHL), were included in this study. Paraffin-embedded specimens of reactive hyperplasia of lymph nodes (RL) collected during the same period were used as controls. Immunohistochemical (IHC) assay was used to detect EBV-LMP1 and in situ hybridization (ISH) to detect EBV-EBERs.

RESULTSEBV was detected in 72.2% (26/36) of the Hodgkin lymphomas, 15.7% (8/51) of the non-Hodgkin lymphomas and 33.3% (15/45) of the reactive hyperplasia of lymph nodes. There was a significant difference among Hodgkin lymphoma, non-Hodgkin lymphoma and RL (P = 0. 000).

CONCLUSIONChildhood Hodgkin lymphoma is closely correlated with Epstein-Barr virus infection. However, the low rate of EBV infection detected in childhood non-Hodgkin lymphoma might be due to heterogeneous distribution of pathological types in this study.

Child ; Child, Preschool ; Epstein-Barr Virus Infections ; complications ; metabolism ; Female ; Herpesvirus 4, Human ; isolation & purification ; Hodgkin Disease ; complications ; metabolism ; virology ; Humans ; Lymphoma, Non-Hodgkin ; complications ; metabolism ; virology ; Male ; Pseudolymphoma ; complications ; metabolism ; virology ; RNA, Viral ; metabolism ; Viral Matrix Proteins ; metabolism

OBJECTIVETo study the clinical features, immunophenotypes and the significance of Epstein-Barr virus infection in primary nasal and pharyngeal non-Hodgkin's lymphomas in Shenyang.

METHODSOne hundred and fifty eight cases of primary nasal and pharyngeal non-Hodgkin's lymphomas were included in this study. The samples were stained with haematoxylin and eosin for histological examination. Immunohistochemistry studies were performed using monoclonal antibodies, including CD3 for T-lymphocytes, CD20 for B-lymphocytes, and CD56 and CD57 for NK cells. All cases were reclassified according to the new WHO classification of lymphomas (2001). In situ hybridization detection of EBV-encoded small nuclear RNA (EBER-1) was performed in 99 cases.

RESULTSOverall, 101 (63.9%) of the 158 NHL were extranodal NK/T cell lymphomas (nasal type), 23 (14.6%) were nonspecific peripheral T cell lymphomas and the remaining 34 cases (21.5%) were B cell lymphomas. The primary sites of involvement were the nasal cavity (53.2%, 84/158), the tonsil (24.7%, 39/158) and the pharynx (22.1%, 35/158). Among 99 cases studied by EBER-1 in situ hybridization, a positive detection was seen in 70/71 cases (98.6%) of extranodal NK/T cell lymphoma (nasal type), 8/12 cases (66.7%) of T cell lymphoma, and 7/16 cases (43.8%) of B cell lymphoma.

CONCLUSIONSAmong primary nasal and pharyngeal NK lymphomas, extranodal NK/T cell lymphoma (nasal type) is the most common type and is strongly associated with EBV infection. The pathological diagnosis of nasal and pharyngeal lymphomas should take considerations of the anatomic sites and immunophenotypical features.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; CD3 Complex ; metabolism ; CD56 Antigen ; metabolism ; Child ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Lymphoma, B-Cell ; metabolism ; pathology ; virology ; Lymphoma, Extranodal NK-T-Cell ; metabolism ; pathology ; virology ; Lymphoma, Non-Hodgkin ; metabolism ; pathology ; virology ; Lymphoma, T-Cell, Peripheral ; metabolism ; pathology ; virology ; Male ; Middle Aged ; Nasal Cavity ; Nose Neoplasms ; metabolism ; pathology ; virology ; Pharyngeal Neoplasms ; metabolism ; pathology ; virology ; RNA, Viral ; metabolism ; Tonsillar Neoplasms ; metabolism ; pathology ; virology ; Young Adult

OBJECTIVESTo investigate the immunophenotypes of primary nasopharyngeal non-Hodgkin lymphoma (NPL) and their relationship to Epstein-Barr virus (EBV) infection.

METHODSThe clinical data and biopsies of 73 patients with NPL were collected in Guangzhou. In situ hybridization was performed to detect the EBV-encoded small non-polyadenylated nuclear RNAs (EBERs) on biopsy slides. Immunohistochemistry was used to classify the immunophenotypes of NPL and detect EBV antigen expression.

RESULTSForty-four (60.27%) of the 73 NPLs were of B cell lineage (CD79alpha(+)/CD3(-)/CD56(-)) while the 29 others (39.73%) were of non-B cell lineage. Seventy-three NPLs could be classified into 3 major immunophenotypes: B cell (CD79alpha(+)/CD3(-)/CD56(-), 44 cases), peripheral T cell (CD79alpha(-)/CD3(+)/CD56(-), 22) and NK/T cell (CD79alpha(-)/CD3(+)/CD56(+), 7). The percentages of EBV infection differed among the 3 major immunophenotypes (B cell: 11.36%, 5/44; peripheral T cell: 81.82%, 18/22; NK/T cell: 100%, 7/7). Both CD56(-) positive and CD56(-) negative immunophenotypes could further be divided into 4 subtypes: CD8(-)/CD4(-), CD8(+)/CD4(-), CD8(-)/CD4(+) and CD8(+)/CD4(+). All the CD8(-)/CD4(-) NPLs with CD56(-) positivity (7) or CD56(-) negativity (2) were infected with EBV. The neoplastic cells of a nasopharyngeal Burkitt's lymphoma expressed EBV nuclear antigen 1 (EBNA1) and EBV RNA (EBERs) only. In the other 29 EBV-infected NPLs, most of the lymphoma cells harboring EBV also expressed EBNA1 and EBERs; 21 of the 29 NPLs had a considerable number of neoplastic cells expressing latent membrane protein 1 (LMP1) (21/29, 72.41%) and 23 of 29 NPLs expressed latent membrane protein 2A (LMP2A) (23/29, 79.31%). A few lymphoma cells in 17 (17/29, 58.62%), 23 (23/29, 79.31%) and 22 NPLs (22/29, 75.86%) expressed Zta (Bam HI Z transactivator), viral capsid antigen (VCA) and membrane antigen (MA), respectively.

CONCLUSIONSThe prevalence ratio of the 3 immunophenotypes, namely, B cell, peripheral T cell and NK/T cell lymphoma, is about 6:3:1. However, the EBV infection ratio is reversed, 1:8:10. All the NK/T cell (CD56(+)) and peripheral immature T cell (CD3(+)/CD8(-)/CD4(-)) NPLs were EBV-infected. Except for one Burkitt's lymphoma, the EBV harbored in both B cell and non-B cell NPLs was mainly latent infection, type II, expressing EBNA1, LMP1 and LMP2A. However, the EBV found in a few lymphoma cells could become replicative, expressing lytic proteins.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; CD56 Antigen ; analysis ; Child ; Epstein-Barr Virus Infections ; complications ; Epstein-Barr Virus Nuclear Antigens ; analysis ; Female ; Herpesvirus 4, Human ; isolation & purification ; Humans ; Immunophenotyping ; Lymphoma, Non-Hodgkin ; etiology ; immunology ; virology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; etiology ; immunology ; virology ; RNA, Viral ; analysis

CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.
Adult ; Antiviral Agents/therapeutic use ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/complications* ; Disease-Free Survival ; Enteritis/virology ; Enteritis/surgery ; Enteritis/complications ; Ganciclovir/therapeutic use ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/etiology* ; Gastrointestinal Hemorrhage/diagnosis ; Human ; Jejunal Diseases/virology ; Jejunal Diseases/surgery ; Jejunal Diseases/complications* ; Lymphoma, Non-Hodgkin/drug therapy ; Lymphoma, Non-Hodgkin/diagnosis ; Lymphoma, Non-Hodgkin/complications* ; Male ; Opportunistic Infections/drug therapy ; Opportunistic Infections/diagnosis ; Opportunistic Infections/complications* ; Substances: Ganciclovir ; Substances: Antiviral Agents