Antineoplastics
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Reactions 1274 - 17 Oct 2009 S Antineoplastics Xanthomatous pseudotumour in elderly patients: 2 case reports Two men developed xanthomatous pseudotumours following treatment with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP; patient 1) or CHOP * (patient 2) for lymphoma [dosages not stated]. Initially, residual lymphoma was suspected, and both patients underwent splenectomy. Patient 1, a 74-year-old man, had a history of prostatectomy for prostatic adenocarcinoma. He developed diffuse large B cell lymphoma (DLBCL) with multiple metabolically active metastases including in his spleen. He was treated with five cycles of R-CHOP for a period of 2 months. One month after chemotherapy, a PET/ CT scan showed complete response in all sites except for the spleen, where a metabolically active mass was still evident. Repeat PET/CT scan, performed 1 month later, showed the mass to have mildly increased in size with more extensive uptake. Progression of residual lymphoma was suspected and he underwent splenectomy. Seven well- circumscribed nodules were found, which consisted of sheets of histiocytes surrounding central necrotic foci comprised of intermediate–large eosinophilic ghosts of cells. The histiocytes were mostly round to polygonal, clear or more eosinophilic, with abundant pale or foamy cytoplasm. Some histiocytes were spindle in shape, with ovoid to spindle nuclei which were relatively uniform and small. Immunohistochemical analysis of the necrotic foci was strongly suggestive of necrotic B cell lymphoma cells. No viable lymphoma cells were found. However, 4 months after splenectomy, he developed recurrent generalised DLBCL; he received two cycles of rituximab, ifosfamide, carboplatin and etoposide and underwent stem cell transplantation. At last follow-up there was no evidence of disease. Patient 2, a 67-year-old man, had DLBCL including two lesions in his spleen; he received six cycles of CHOP. CT scan, performed 3 months after chemotherapy completion, revealed two low-attenuation lesions in his spleen. Repeat CT scan 1 month later showed the lesions to be stable. He underwent splenectomy to exclude residual lymphoma. Two yellow nodules were observed. The centres of the nodules were composed of medium–large eosinophilic ghosts of cells surrounded by multiple foamy histiocytes associated with cholesterol clefts and granulomas. Immunohistochemical analysis suggested the necrotic cells were necrotic B cell lymphoma cells. At last follow-up, the patient was well with no sign of lymphoma. Author comment: "As a response to tumour necrosis and presumed release of chemotactic substances, circulating monocytes are recruited to the site and differentiate into histiocytes (macrophages). Histiocytes then become activated and increase in size, with increased levels of lysosomal enzymes and phagocytic capability. Chemokines produced by activated histiocytes stimulate the recruitment of additional monocytes from the circulation, and, consequently, histiocyte accumulation in response to tumour necrosis can be abundant." * CHOP was not defined in this patient so it is uncertain whether they received prednisone or prednisolone. Chandra P, et al. Postchemotherapy histiocyte-rich pseudotumor involving the spleen. American Journal of Clinical Pathology 132: 342-348, No. 3, Sep 2009 - USA 801150930 1 Reactions 17 Oct 2009 No. 1274 0114-9954/10/1274-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1274 - 17 Oct 2009
SAntineoplastics
Xanthomatous pseudotumour in elderly patients:2 case reports
Two men developed xanthomatous pseudotumoursfollowing treatment with rituximab, cyclophosphamide,doxorubicin, vincristine and prednisone (R-CHOP;patient 1) or CHOP* (patient 2) for lymphoma [dosages notstated]. Initially, residual lymphoma was suspected, andboth patients underwent splenectomy.
Patient 1, a 74-year-old man, had a history ofprostatectomy for prostatic adenocarcinoma. Hedeveloped diffuse large B cell lymphoma (DLBCL) withmultiple metabolically active metastases including in hisspleen. He was treated with five cycles of R-CHOP for aperiod of 2 months. One month after chemotherapy, a PET/CT scan showed complete response in all sites except forthe spleen, where a metabolically active mass was stillevident. Repeat PET/CT scan, performed 1 month later,showed the mass to have mildly increased in size withmore extensive uptake. Progression of residual lymphomawas suspected and he underwent splenectomy. Seven well-circumscribed nodules were found, which consisted ofsheets of histiocytes surrounding central necrotic focicomprised of intermediate–large eosinophilic ghosts ofcells. The histiocytes were mostly round to polygonal, clearor more eosinophilic, with abundant pale or foamycytoplasm. Some histiocytes were spindle in shape, withovoid to spindle nuclei which were relatively uniform andsmall. Immunohistochemical analysis of the necrotic fociwas strongly suggestive of necrotic B cell lymphoma cells.No viable lymphoma cells were found. However, 4 monthsafter splenectomy, he developed recurrent generalisedDLBCL; he received two cycles of rituximab, ifosfamide,carboplatin and etoposide and underwent stem celltransplantation. At last follow-up there was no evidence ofdisease.
Patient 2, a 67-year-old man, had DLBCL including twolesions in his spleen; he received six cycles of CHOP. CTscan, performed 3 months after chemotherapy completion,revealed two low-attenuation lesions in his spleen. RepeatCT scan 1 month later showed the lesions to be stable. Heunderwent splenectomy to exclude residual lymphoma.Two yellow nodules were observed. The centres of thenodules were composed of medium–large eosinophilicghosts of cells surrounded by multiple foamy histiocytesassociated with cholesterol clefts and granulomas.Immunohistochemical analysis suggested the necrotic cellswere necrotic B cell lymphoma cells. At last follow-up, thepatient was well with no sign of lymphoma.
Author comment: "As a response to tumour necrosis andpresumed release of chemotactic substances, circulatingmonocytes are recruited to the site and differentiate intohistiocytes (macrophages). Histiocytes then become activatedand increase in size, with increased levels of lysosomalenzymes and phagocytic capability. Chemokines produced byactivated histiocytes stimulate the recruitment of additionalmonocytes from the circulation, and, consequently, histiocyteaccumulation in response to tumour necrosis can beabundant."
* CHOP was not defined in this patient so it is uncertain whetherthey received prednisone or prednisolone.
Chandra P, et al. Postchemotherapy histiocyte-rich pseudotumor involving thespleen. American Journal of Clinical Pathology 132: 342-348, No. 3, Sep 2009 -USA 801150930
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Reactions 17 Oct 2009 No. 12740114-9954/10/1274-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
