PURPOSE: Although radiation therapy had been the treatment of choice for localized non-Hodgkin's lymphoma(NHL), recent studies have revealed that treatment result after radiation therapy alone is not successful for localized aggressive NHL, if it is not pathologically but clinically staged. A prospective phase II trial was conducted to evaluate the therapeutic results of 4 cycles of CHOP chemotherapy followed by involved field radiation therapy in clinically staged localized aggressive NHL. MATERIALS AND METHODS: Patients with a diagnosis of aggressive NHL(all intermediate grade and immunoblastic histology in NCI working formulation), Ann Arbor stage I or II without poor prognostic factors(presence of B symptoms, bulky diseases, or 2 or more extranodal involvement) were treated with 4 cycles of CHOP(cyclophosphamide, doxorubicin, vincristine, prednisolone) followed by involved field radiation therapy of 3,000~6,000(median: 4,500) cGy. RESULTS: Between April 1990 and March 1995, 62 consecutive patients entered this trial. Forty six patients with measurable diseases were evaluable for response. Complete response was achieved in 41(89.1%) patients after CHOP chemotherapy and 4 more patients after subsequent radiation therapy, making total CR rate of 98%. Progression free survival(PFS) of all 62 patients were 2.2+~73+ months and 5 year PFS rate was 64.6%. Overall survival(OS) were 2.4+~75+ months and 5 year OS rate was 75.2%. Old age (> 60) was the only significant prognostic factor, which-affected overall survival negatively. Treatment was relatively well tolerated, but 3 patients died associated with treatment. CONCLUSIONS: Four cycles of CHOP chemotherapy followed by involved field radiation therapy is highly curative and safe treatment for clinically staged, localized aggressive NHLs.
Diagnosis ; Doxorubicin ; Drug Therapy* ; Humans ; Lymphoma, Non-Hodgkin* ; Prospective Studies ; Vincristine

Lymphomatous involvement of the heart is extremely rare at initial diagnosis and presentation of malignant lymphoma. Worldwide, only a few cases have been diagnosed and treated during life and only four cases were diagnosed before death in Korea. We report a case of non-Hodgkin's lymphoma with two right atrial masses detected by chest computed tomography and transesophageal echocardiography. The patient was an 80 year- old man and the presenting symptoms included generalized weakness, weight loss, constipation and low abdominal pain. For diagnosis, the mass of the perinephric area was biopsied under ultrasonographic guidance, and pathologically it was determined to be malignant lymphoma, diffuse large B cell type. The patient was treated with continuous low dose cyclophosphamide and prednisolone vice standard chemotherapy because of advanced age and renal dysfunction. After 2 months of treatment the masses in the atrium and the intraabdominal masses disappeared.
Abdominal Pain ; Constipation ; Cyclophosphamide ; Diagnosis ; Drug Therapy ; Echocardiography, Transesophageal ; Heart ; Humans ; Korea ; Lymphoma* ; Lymphoma, Non-Hodgkin* ; Prednisolone ; Thorax ; Weight Loss

Although in the past two decades there has been a sharp rise in the incidence of extranodal primary lymphomas, non-Hodgkin's lymphoma (NHL) of the female genital tract is still rare. There is still no consensus on the management of cervical lymphomas. The malignant lymphoma localized in uterine cervix is rare and characteristically symptom free expressed. A 26-year-old woman presented in March 2004 with uterine bleeding. After the patient underwent punch biopsy, primary cervical malignant lymphoma was diagnosed. Six courses of chemotherapy were administered in an adjuvant setting. Thirty-nine months (May 2007) after the diagnosis the patient was alive and without signs of recurrent disease. In this report, one case of primary cervical lymphoma diagnosed by punch biopsy is reported and associated literature is discussed.
Adult ; Biopsy ; Cervix Uteri* ; Consensus ; Diagnosis ; Drug Therapy ; Female ; Humans ; Incidence ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Uterine Cervical Neoplasms ; Uterine Hemorrhage

BACKGROUND: Several reports have documented the association of avascular necrosis (AVN) of bone and the treatment of malignant lymphoma with steroid-containing chemotherapy. It is important to recognize these conditions, as they can be mistaken for those of lymphomatous involvement.Cases: This report describes the experience at the Severance hospital over a 10-year period with 6 patients in whom AVN developed during or following treatment of malignant lymphoma. Four patients of non-Hodgkin's lymphoma and two of Hodgkin's disease were treated with steroid-containing chemotherapy. The predominant symptom is pain on motion or weight bearing. Symptoms leading to diagnosis of AVN developed between 5 and 27 months after starting prednisolone (mean 17.8 months), and the mean cumulative dose of prednisolone to the onset of AVN was 4,447 mg (range, 1,800~9,490 mg). All but one were involved in both hip joint. Diagnosis was based on the radiologic appearance, and in the majority radiographic changes consistent with AVN were present at the time of presentation of symptoms. Four patients received total hip replacement and two had conservative care. CONCLUSION: Patients with malignant lymphoma who developed pain on joint during or after the use of steroid-containing chemothearpy should be carefully investigated with MRI and radionuclear bone scan for early diagnosis and proper management.
Arthroplasty, Replacement, Hip ; Diagnosis ; Drug Therapy ; Early Diagnosis ; Hip Joint ; Hodgkin Disease ; Humans ; Joints ; Lymphoma* ; Lymphoma, Non-Hodgkin ; Magnetic Resonance Imaging ; Necrosis ; Osteonecrosis* ; Prednisolone ; Weight-Bearing

BACKGROUND: The purpose of this study was to evaluate the clinical features and treatment outcome of patients with primary non- Hodgkin's lymphoma (NHL) of bone. METHODS: A survey of 1,050 NHL patients who had been diagnosed at Korea Cancer Center Hospital between 1989 and 2001 identified 32 patients with NHL involving bone. Of these 32 patients, 22 patients were diagnosed as primary NHL of bone. The clinical data were available in 17 of the patients, and analyzed retrospectively. RESULTS: The male to female ratio was 3.3:1 and the median age was 31 years (range, 16- 52 years). The most common presenting symptom was bone pain of involved site (76.5%) and the most commonly involved site was tibia. Stages at diagnosis were as follows: stage I in 6 patients; stage II in 2 patients; stage III in 2 patients; stage IV in 7 patients. According to the REAL classification, the most common histologic subtype was diffuse large B cell lymphoma. Of evaluable 16 patients, 5 patients had B symptoms. The risk groups accord-ing to International Prognostic Index (IPI) were as follows: low risk in 9 patients, low-intermediate risk in 4 patients, high-intermediate risk in 1 patient, high risk in 2 patients, not evaluable in 1 patient. The first-line treatment modalities were as follows: combined radiation and chemotherapy in 8 patients (1 for palliative aim, 7 for curative aim); chemotherapy only in 4 patients; radiation only in 2 patients; surgery and chemotherapy in 1 patient. Objective response rate to treatment was 93.3% (95% confidence interval; 80.9~100%) and five-year survival rate was 57% (95% confidence interval; 30.5~83.4%). CONCLUSION: Most patients complained bone pain at involved site. The histologic subtype was diverse, but the most common subtype was diffuse large B cell lymphoma. The prognosis is similar to other non- Hodgkin's lymphomas.
Classification ; Diagnosis ; Drug Therapy ; Female ; Hodgkin Disease ; Humans ; Korea ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin* ; Male ; Prognosis ; Retrospective Studies ; Survival Rate ; Tibia ; Treatment Outcome

The occurrence of Non-Hodgkin's lymphoma (NHL) during pregnancy is very rare and this malignancy is most commonly associated with aggressive histology and dissemination. Treatment in pregnant women with low-grade lymphoma may be delayed until after delivery but women with an aggressive lymphoma must have a immediate initiation of standard chemotherapy whether to have a therapeutic abortion or not. A-32-year-old woman with NHL stage IIb complicating pregnancy is presented. The diagnosis was made aggressive lymphoma. The baby weighting 1,830 gm was delivered by normal spontaneous vaginal delivery. Following delivery, the patient received combination chemotherapy with cyclophosphamide, adriamycin, vincristine, prednisone regimen but magnetic resonance imaging undertaken during follow-up showed leptomeningeal involvement, indicating poor prognosis. She wanted discharge ten months later from disseminated disease. We experienced a case of rapid growing Non-Hodgkin's lymphoma developed on anterior mediastineum that diagnosed during pregnancy and treated following delivery. We report this case with a brief review of literature.
Abortion, Therapeutic ; Cyclophosphamide ; Diagnosis ; Doxorubicin ; Drug Therapy ; Drug Therapy, Combination ; Female ; Follow-Up Studies ; Humans ; Lymphoma ; Lymphoma, Non-Hodgkin* ; Magnetic Resonance Imaging ; Prednisone ; Pregnancy* ; Pregnant Women ; Prognosis ; Vincristine

Primary lymphomas of the prostate are extremely rare and can mimic other more common prostatic lesions. We report a case of a primary diffuse large B-cell lymphoma of the prostate in a 59 years old man, who presented with lower urinary tract symptoms, gross hematuria and enlargement of the prostate on digital rectal examination. On microscopic examination, the tumor, composed of diffuse large cells, with B cell immunophenotypes, was diagnosed as a non-Hodgkin's lymphoma. After the histological diagnosis, the patient underwent 6 cycles of combination chemotherapy, with cyclophosphamide, doxorubicin, vincristine and prednisone, followed by involved-field radiation therapy. He is followed well for 5 months without any problem.
Cyclophosphamide ; Diagnosis ; Digital Rectal Examination ; Doxorubicin ; Drug Therapy, Combination ; Hematuria* ; Humans ; Lower Urinary Tract Symptoms ; Lymphoma* ; Lymphoma, B-Cell ; Lymphoma, Non-Hodgkin ; Middle Aged ; Prednisone ; Prostate* ; Vincristine

Extraskeletal Ewing's sarcoma is a rare primary malignant soft tissue tumor that has the same pathological characteristics of skeletal Ewing's sarcoma. It is known that the differential diagnosis of Ewing's sarcoma from undifferentiated rhabdomyosarcoma, neuroblastoma, reticulum cell sarcoma, and malignant lymphoma by the histologic studies only are not easy because their histologic findings are nearly similar each other. Therefore, immunohistochemical method, electron microscopic examination, cytogenetic study, or molecular gene study are used together to confirm the diagnosis. It chiefly involves the lower extremity, soft tissues of the paravertebral region, and adjacent chest wall. We recently experienced a case of extraskeletal Ewing's sarcoma of duodenum in a 21-year old female. The patient underwent Whipple's operation and postoperative combined chemotherapy were done.
Cytogenetics ; Diagnosis ; Diagnosis, Differential ; Drug Therapy ; Duodenum* ; Female ; Humans ; Lower Extremity ; Lymphoma ; Lymphoma, Non-Hodgkin ; Neuroblastoma ; Rhabdomyosarcoma ; Sarcoma* ; Sarcoma, Ewing ; Thoracic Wall ; Young Adult

OBJECTIVENon-Hodgkin's lymphoma (NHL) presenting as mediastinal mass is usually progressive and may cause severe respiratory distress and death. This study aimed to summarize the clinical features and prognosis of NHL arising from mediastinum.

METHODSTotally 36 patients with NHL arising from mediastinum reported herein were diagnosed between 1999 and 2007. Their clinical characteristics, pathologic classification, diagnosis, outcome of different treatment protocol were retrospectively analyzed. Of these 36 patients, 25 were male, 11 were female (2.2:1). The mean age was 7.9 (range 1 - 12) years. Diagnosis was established on pathology that was achieved by mediastinal mass or peripheral lymph nodes biopsy, while some were diagnosed based on bone marrow or pleural effusion cytology study and immunophenotyping. For staging, the St. Jude system was applied. Patients received T-NHL-CCCG97, T-NHL-2002 or B-NHL-2001 protocol according to morphology and immunophenotyping. Patients who experienced superior vena cava syndrome (SVCS) and/or superior mediastinum syndrome (SMS) received induction chemotherapy with cyclophosphamide (C), vincristine (O) and prednisone (P) for one week.

RESULTSTwenty-seven cases experienced mediastinal mass or peripheral lympho nodes biopsy and were diagnosed by histopathology and immunohistochemistry. Of them, 24 were lymphoblastic lymphoma and 3 were anaplastic large cell lymphoma. Nine patients were diagnosed by cytological study of bone marrow aspiration or pleural fluid. All the 36 cases were T-cell type. Twenty-four cases were in stage III, 12 in stage IV. Twenty-four patients had urgent situation of SVCS and airway obstruction, 22 patients reached good response after emergency management including COP induction chemotherapy and pleural effusion suction. Twenty-nine cases achieved complete remission (CR) while in 6 patients the disease relapsed. Thirteen patients died from disease progression, relapse or severe infection during chemotherapy. The Kaplan-Meier estimate of 5-year progression-free survival (PFS) was 61% +/- 8% (median follow up 35 months) for these 36 patients.

CONCLUSIONEstablishment of a diagnosis as soon as possible was important to reduce the mortality and improve long term survival of patients. Induction chemotherapy for emergency situation was efficacious. The regimen of T-NHL-CCCG97, T-NHL-2002, and B-NHL-2001 for NHL arising from mediastinum based on pathological classification is feasible.

Child ; Child, Preschool ; Disease-Free Survival ; Female ; Humans ; Infant ; Lymphoma, Non-Hodgkin ; diagnosis ; drug therapy ; Male ; Mediastinal Neoplasms ; diagnosis ; drug therapy ; Prognosis ; Retrospective Studies

A retrospective study was conducted to investigate the effects of CNS prophylaxis with 1,800 cGy cranial irradiation on standing height growth of children with acute lymphoblastic leukemia (ALL). Seventeen longterm survivors (DFS over 5 years ) of ALL and Non-Hodgkins Lymphoma who had been admitted at pediatric department of Inje University Seoul Paik Hospital from January 1982 to September 1988 were studied. The long term survivors were divided into two groups by prophylactic treatment modality; intrathecal chemotherapy alone (Group I, 7 cases), intrathecal chemotherapy with cranial irradiation (Group II, 10 cases). The heights of each groups were compared normal standard growth of the sane aged children by mean SD score (The SD score was calculated with the use of the following formula). SD score=(x-x)/SD (x; height measurement, x; mean height for age of the normal population SD; standard deviation). The results were as follows; 1) The mean SD scores of Group I and Group II at diagnosis were -0.30 and -0.17, which were smaller than height of normal child. 2) In Group 1, the mean SD scores after the end of treatment were -0.14 of 1 year, 0.03 at 2 years and 0.01 at 5 years, which suggests that were normal height velocity and catch-up growth in these patients (P<0.05). The height of 1 year after the beginning of treatment were particularly smaller than that of the normal children (P<0.05). 3) The mean SD scores 5 years after the end of treatment were 0.10 in Group I and -0.17 in Group II, which shows strong tendency to statistical difference among these two groups. If larger numbers of patients are evaluated, it, however, may turn significant. In conclusion, 1,800 cGy cranial irradiation in ALL children significantly affects on height growth. We recommend to evaluate growth hormone for patient with 1,800 cGy cranial irradiation and to treat them with growth hormone.
Child* ; Cranial Irradiation* ; Diagnosis ; Drug Therapy ; Growth Hormone ; Humans ; Lymphoma, Non-Hodgkin ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Retrospective Studies ; Seoul ; Survivors