In this paper,we analyzed one case of primary multifocal extranodal non-Hodgkin's lymphoma and reviewed the related literatures.We investigated the clinical data of this case with primary multifocal extranodal lymphoma and retrospected the related references.The key words,primary extranodal lymphoma and multifocal,were used to search Pubmed and Wanfang Database,and finally only three cases were found.The 68-yea-old woman was confirmatively diagnosed as primary multifocal extranodal B cell non-Hodgkin's lymphoma.The positron emission tomography/computed tomography (PET/CT) scan showed multiple hypermetabolic lesions in the left humerus,both kidneys and ileum.The confirmative diagnosis was based on clinical manifestations and serological tests,imaging features of CT and PET/CT,and especially on the histopathological and immunohistochemical studies.After one cycle chemotherapy (rituximab,Vincristine and prednisone) and another cycle (rituximab,Vincristine,cyclophosphamide and prednisone),a repeat PET/CT scan showed a complete metabolic resolution of the lesions in the kidneys and ileum,and a partial metabolic resolution of the left humerus.After four cycles of chemotherapy,there were new extensive involvements of the right supraclavicular and intrapulmonary lymph nodes,bilateral pleural and pericardium,and the patient gave up chemotherapy.This case demonstrated the imaging findings of an uncommon primary multifocal extranodal lymphoma in left humerus,both kidneys and ileum,and highlighted the usefulness of CT and PET/CT scan in identifying the extent of disease involvement,in guiding a biopsy,and in assessing the treatment response of lymphoma.It is essential to differentiate between primary multifocal extranodal lymphoma and lymphoma extensive metastases.

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Objective To strengthen the understanding of granulocytic sarcomas(GS)by investigating the clinical characteristics of GS of spine. Methods The clinical data of 2 GS patients were retrospectively analyzed, and the related literature was reviewed. Results Because of the double lower limbs numbness, the 2 GS patients came to orthopedics department of the 306th Hospital of PLA. Magnetic resonance imaging (MRI) of the 2 patients showed an epidural mass located at the 9th-11th and 2nd-4th thoracic levels. Their histopathological examination and immunohistochemistry revealed GS.For example 1,she was diagnosed with acute promyelocytic leukemia(APL)and has been morphologic complete commission(CR) from 1995 to 2015. Chemotherapy and all-trans retinoic acid (ATRA) were performed after extramedullary relapse in thoracic spine,breast,ovary,sternum bone and lymph nodes.So far,the patient is still in follow-up.For example 2,he was diagnosed as isolated GS by morphology, immune phenotype, chromosome and gene examinations. Because he refused chemotherapy, radiotherapy was performed after surgical intervention. So far, he is loss of follow-up. Conclusions Spinal epidural of GS is rare. Surgery can reduce or remove nerve compression symptoms, and help clear diagnosis. The current recommended treatment regimen in patients presenting with isolated GS or GS presenting concomitantly with AML is conventional AML-type chemotherapeutic protocols. The differences in prognosis of GS patients may be partially attributed to different characteristics of patient.

Objective: To investigate the clinical characteristics, diagnosis, treatment and prognosis of discordant lymphoma. Methods: The clinical data of one patient with discordant lymphoma at the PLA Strategic Support Force Characteristic Medical Center were retrospectively analyzed, and the related literatures were reviewed. Results: The patient was treated for thrombocytopenia and the examination showed splenomegaly. After hormone treatment, the platelet rebounded and thrombocytopenia occurred during hormone reduction. Splenectomy was performed. Postoperative pathological diagnosis of splenic marginal lymphoma was made and observed. Axillary lymph node enlargement occurred nine months later. Pathological diagnosis of diffuse large B-cell lymphoma was made by using lymph node biopsy, and the disease condition was alleviated after immunotherapy combined with chemotherapy. Conclusions Discordant lymphoma is rare and shows no special clinical manifestations. Its diagnosis should rely on pathological examination. Immunotherapy combined with chemotherapy may be more effective.