Ognerubov NA, Antipova TS, Poddubnaya IV. Peritoneal lymphomatosis as the only manifestation of diffuse B-cell large cell lymphoma: A clinical case. Journal of Modern Oncology. 2024;26(4):484–488. DOI: 10.26442/18151434.2024.4.203082
Перитонеальный лимфоматоз как единственное проявление диффузной В-клеточной крупноклеточной лимфомы. Клинический случай
Ognerubov NA, Antipova TS, Poddubnaya IV. Peritoneal lymphomatosis as the only manifestation of diffuse B-cell large cell lymphoma: A clinical case. Journal of Modern Oncology. 2024;26(4):484–488. DOI: 10.26442/18151434.2024.4.203082
Неходжкинская лимфома может возникать в любом месте человеческого тела. Диффузное обширное поражение брюшины необычно и встречается редко. При этом диффузная крупноклеточная В-клеточная лимфома является превалирующим гистологическим вариантом экстранодальной лимфомы при перитонеальном лимфоматозе.
Представлен клинический случай изолированного перитонеального лимфоматоза. Пациентка Н. 23 лет поступила с жалобами на снижение аппетита, вздутие, боли и увеличение живота в объеме на протяжении 4 мес. В последнее время отмечала повышение температуры тела до 38,4°С, потливость по ночам, снижение массы тела. При объективном обследовании: живот увеличен в объеме, при пальпации напряжен, болезненный в эпигастрии, при перкуссии во всех отделах определяется притупление. Периферические лимфатические узлы – без признаков специфических изменений. Отмечается тахикардия, артериальное давление – в пределах нормы. Пятью неделями ранее выполнена лапароскопия, при которой выявлено инфильтративное массивное поражение париетальной и висцеральной брюшины брюшной полости и малого таза, большого сальника с наличием мезентериальных лимфоузлов. Произведена биопсия брюшины и большого сальника. Цитологическое заключение асцитической жидкости – картина неходжкинской лимфомы. При гистологическом исследовании выявлена диффузная крупноклеточная В-клеточная лимфома с экспрессией CD20+. Результаты позитронно-эмиссионной и рентгеновской компьютерной томографии с 18-фтордезоксиглюкозой (ФДГ) показали диффузное утолщение париетальной и висцеральной брюшины, брыжейки и сальника с субтотальным заполнением опухолевой массой брюшной полости и малого таза с повышенной фиксацией радиофармпрепарата. В паренхиме печени и селезенки ФДГ-активных очагов поражения не обнаружено. Поставлен диагноз «диффузная крупноклеточная В-клеточная лимфома стадии IVB; перитонеальный лимфоматоз, IPI 3». Назначена полихимиотерапия по схеме R-CHOP. От предложенного лечения пациентка отказалась в связи со сменой места жительства.
Изолированный перитонеальный лимфоматоз является редким проявлением экстранодального поражения неходжкинской лимфомой. Специфические клинические симптомы отсутствуют. Позитронно-эмиссионная и рентгеновская компьютерная томография с 18-ФДГ является альтернативным методом диагностики перитонеального лимфоматоза.
Ключевые слова: перитонеальный лимфоматоз, неходжкинская лимфома, диагностика, позитронно-эмиссионная и рентгеновская компьютерная томография, описание случая
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Non-Hodgkin's lymphoma can occur anywhere in the human body. A diffuse extensive peritoneal lesion is uncommon and rare. Diffuse large B-cell lymphoma is the most common histological type of extranodal lymphoma in peritoneal lymphomatosis.
A case of isolated peritoneal lymphomatosis is presented. A 23-year-old female patient N. presented with decreased appetite, bloating, pain, and abdominal enlargement. The symptoms persisted for 4 months. Recently, she reported a fever (38.4°C), sweating at night, and decreased body weight. On physical examination, the abdomen was enlarged, tense on palpation, tender in the epigastrium, and dull to percussion in all parts. No signs of specific changes in peripheral lymph nodes were observed. Tachycardia was noted, and blood pressure was within normal range. Five weeks ago, a laparoscopy was performed, which revealed an extensive infiltrative lesion of the parietal and visceral peritoneum of the abdomen and pelvis and the greater omentum with the presence of mesenteric lymph nodes. A biopsy of the peritoneum and greater omentum was performed. Cytological examination of ascitic fluid showed a pattern of non-Hodgkin's lymphoma. Histological examination revealed diffuse large B-cell lymphoma with CD20+ expression. Positron-emission and X-ray computed tomography with 18-fluorodeoxyglucose (FDG) showed diffuse thickening of the parietal and visceral peritoneum, mesentery and omentum with subtotal filling of the abdominal and pelvic cavities with masses with increased radiopharmaceutical uptake. No FDG-active lesions were detected in the liver and spleen parenchyma. Diagnosis: diffuse large B-cell lymphoma, stage IVB; peritoneal lymphomatosis, IPI 3. Polychemotherapy was recommended according to the R-CHOP regimen. The patient refused the proposed treatment due to the change of domicile.
Isolated peritoneal lymphomatosis is a rare manifestation of extranodal non-Hodgkin's lymphoma. There are no specific clinical symptoms. Positron emission and X-ray computed tomography with 18-FDG are an alternative method for diagnosing peritoneal lymphomatosis.
Keywords: peritoneal lymphomatosis, non-Hodgkin lymphoma, diagnosis, positron emission and X-ray computed tomography, case report
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12. Flores E, Aydin N, Vu D, Misra S. A Case Series of diffuse large B-cell lymphoma and burkitt lymphoma presenting with peritoneal lymphomatosis. Int J Surg Case Rep. 2016;28:262-5. DOI:10.1016/j.ijscr.2016.10.007
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27. Kim Y, Cho O, Song S, et al. Peritoneal lymphomatosis: CT findings. Abdom Imaging. 1998;23:87-90. DOI:10.1007/s002619900292
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DOI:10.1007/s00247-008-1063-y
________________________________________________
1. Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today (version 1.1). Lyon, France: International Agency for Research on Cancer, 2024. Available at: https://gco.iarc.who.int/today. Accessed: 20.09.2024.
2. Rossiiskiie klinicheskiie rekomendatsii po diagnostike i lecheniiu zlokachestvennykh limfoproliferativnykh zabolevanii. Pod red. IV Poddubnoi, VG Savchenko. Moscow. 2018 (in Russian).
3. Lee WK, Lau EW, Duddalwar VA, et al. Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. AJR Am J Roentgenol. 2008;191:198-206. DOI:10.2214/AJR.07.3146
4. Curakova E, Genadieva-Dimitrova M, Misevski J, et al. NonHodgkin's Lymphoma with Peritoneal Localization. Case Rep Gastrointest Med. 2014;2014:723473. DOI:10.1155/2014/723473
5. Runyon BA, Hoefs JC. Peritoneal lymphomatosis with ascites. A characterization. Arch Intern Med. 1986;146(5):887-8.
6. Fujimi A, Nagamachi Y, Yamauchi N, et al. High-grade B-cell lymphoma, not otherwise specified, presenting as primary peritoneal lymphomatosis and successfully treated with dose-adjusted EPOCH-R. J Clin Exp Hematop. 2024;64(1):37-44. DOI:10.3960/jslrt.23044
7. Elged BA, Karam R, Khaled R, et al. Intestinal and peritoneal lymphoma complicating Chron’s disease. Egypt J Radiol Nucl Med. 2024;55:51. DOI:10.1186/s43055-024-01218-x
8. Singh V, Kumar A, Singh P, et al. Extensive Extranodal Involvement in a case of Non-Hodgkin's Lymphoma with sparing of lymph nodes and lymphatic organs. Asia Ocean J Nucl Med Biol. 2021;9(1):39-44. DOI:10.22038/AOJNMB.2020.47774.1324
9. Cunningham N, Ffrench-Constant S, Planche K, Gillmore R. Peritoneal lymphomatosis: a rare presentation of follicular lymphoma mimicking peritoneal carcinomatosis. BMJ Case Rep. 2015;2015:bcr2014207136. DOI:10.1136/bcr-2014-207136
10. Shaikh DH, Gongati S, Salman SH, et al. Peritoneal Lymphomatosis: The Great Mimicker. Cureus. 2021;13(4):e14508. DOI:10.7759/cureus.14508
11. Zhu M, Wu Z, Yang Z, et al. Non-Hodgkin's Lymphoma Presenting as Isolated Peritoneal Lymphomatosis: A Case Report and Literature Review. Front Oncol. 2021;11:719554. DOI:10.3389/fonc.2021.719554
12. Flores E, Aydin N, Vu D, Misra S. A Case Series of diffuse large B-cell lymphoma and burkitt lymphoma presenting with peritoneal lymphomatosis. Int J Surg Case Rep. 2016;28:262-5. DOI:10.1016/j.ijscr.2016.10.007
13. Kareff S, Yin C, Feigert J. High-grade B-cell lymphoma masquerading as peritoneal lymphomatosis. BMJ Case Rep. 2019;12(8):e231238. DOI:10.1136/bcr-2019-231238
14. Feng B, Ma Q, Wang H, et al. A case of peritoneal Burkitt's lymphoma mimic of peritoneal tuberculosis. Respir Med Case Rep. 2024;47:101979. DOI:10.1016/j.rmcr.2024.101979
15. Choi WY, Kim JH, Choi SJ, et al. Peritoneal lymphomatosis confused with peritoneal carcinomatosis due to the previous history of gastric cancer: a case report. Clin Imaging. 2016;40:837-9. DOI:10.1016/j.clinimag.2016.03.006
16. O’Neill AC, Shinagare AB, Rosenthal MH, et al. Differences in CT features of peritoneal carcinomatosis, sarcomatosis, and lymphomatosis: retrospective analysis of 122 cases at a tertiary cancer institution. Clin Radiol. 2014;69;1219-27. DOI:10.1016/j.crad.2014.06.019
17. Cabral FC, Krajewski KM, Kim KW, et al. Peritoneal lymphomatosis: CT and PET/CT findings and how to differentiate between carcinomatosis and sarcomatosis. Cancer Imaging. 2013;13(2):162-70. DOI:10.1102/1470-7330.2013.0018
18. Glazer HS, Lee JK, Balfe DM, et al. Non-Hodgkin lymphoma: computed tomographic demonstration of unusual extranodal involvement. Radiology. 1983;149(1):211-7. DOI:10.1148/radiology.149.1.6225145
19. Sharifah M, Zamzami N, Rafeah TN. Diuse peritoneal lymphomatosis simulating peritoneal carcinomatosis. Med J Malaysia. 2011;66:270-2.
20. Karaosmanoglu D, Karcaaltincaba M, Oguz B, et al. CT findings of lymphoma with peritoneal, omental and mesenteric involvement: peritoneal lymphomatosis. Eur J Radiol. 2009;71:313-7. DOI:10.1016/j.ejrad.2008.04.012
21. Chic Acevedo C, Ruiz Molina I, Contreras De Miguel E, Solís García E. Peritoneal lymphomatosis. A case report. Hematol Transfus Cell Ther. 2022;44(3):433-6. DOI:10.1016/j.htct.2020.12.003
22. Cronin CG, Swords R, Truong MT, et al. Clinical utility of PET/CT in lymphoma. Am J Roentgenol. 2010;194:W91-103. DOI:10.2214/AJR.09.2637
23. Paes FM, Kalkanis DG, Sideras PA, Serafini AN. FDG PET/CT of extranodal involvement in non-Hodgkin lymphoma and Hodgkin disease. Radiographics. 2010;30:269-91. DOI:10.1148/rg.301095088
24. Dirisamer A, Schima W, Heinisch M, et al. Detection of histologically proven peritoneal carcinomatosis with fused 18F-FDG-PET/MDCT. Eur J Radiol. 2009;69:5365-41. DOI:10.1016/j.ejrad.2007.11.032
25. Yoo E, Kim JH, Kim MJ, et al. Greater and lesser omenta: normal anatomy and pathologic processes. Radiographics. 2007;27:707-20. DOI:10.1148/rg.273065085
26. Baram DV, Asaulenko ZP, Spiridonov IN, Krivolapov YuA. WHO classification of tumors of hematopoietic and lymphoid tissues, 2022 (5th edition): lymphoid tumors. Russian Journal of Archive of Pathology. 2023;85(4):24-31 (in Russian). DOI:10.17116/patol20238504124
27. Kim Y, Cho O, Song S, et al. Peritoneal lymphomatosis: CT findings. Abdom Imaging. 1998;23:87-90. DOI:10.1007/s002619900292
28. Wong S, Sanchez TRS, Swischuk LE, Huang FS. Diffuse peritoneal lymphomatosis: atypical presentation of Burkitt lymphoma. Pediatr Radiol. 2009;39:274-6.
DOI:10.1007/s00247-008-1063-y
Авторы
Н.А. Огнерубов*1, Т.С. Антипова2, И.В. Поддубная1
1ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия; 2Федеральная сеть центров ядерной медицины «ПЭТ-Технолоджи», Москва, Россия
*ognerubov_n.a@mail.ru
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Nikolai A. Ognerubov*1, Tatiana S. Antipova2, Irina V. Poddubnaya1 1Russian Medical Academy of Continuous Professional Education, Moscow, Russia; 2Federal Network of Nuclear Medicine Centers "PET-Technology", Moscow, Russia
*ognerubov_n.a@mail.ru