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Types of Lymphoma > Extranodal

Last updated: 06/21/2014

TOPICS  
 
 
Overview
| Cutaneous | Gastric | Hepatic | Eye: Conjunctival / Ocular / Eyelid / Orbital |
Osteo (bone)
| Oral | Testis 

Overview

Extranodal
Extranodal means that the primary area of presentation of the lymphoma is not in the lymph nodes. 
Extranodal can be further categorized as primary or secondary, with "primary" indicating that the lymphoma first presented itself in an extranodal site. 
 Some kinds of extranodal lymphomas are: bone, breast, eye, oral, skin, etc.
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In the News

bullet The ASCO Post, 2013: FDA Approves Mechlorethamine Gel for Cutaneous T-Cell Lymphoma  http://bit.ly/18Ultxa

This gel is the first and only FDA-approved topical formulation of mechlorethamine, which is commonly known as nitrogen mustard. The gel is applied topically once a day and dries on the skin.

Mechlorethamine was approved previously for intravenous treatment of mycosis fungoides, the most common type of CTCL. Topical mechlorethamine preparations are currently recommended for the treatment of early-stage CTCL. Prior to approval of the gel, there were no FDA-approved topical mechlorethamine products; only nonstandardized, pharmacy-compounded petroleum ointment or aqueous-based topical preparations were available.

 

Extranodal lymphomas: "Lymphomas do not only only arise in lymph nodes or other areas of the lymphatic system. Many arise [or present] in non-lymphoid sites such as the skin and gastrointestinal tract. The gastrointestinal tract is the most common extra-nodal site for follicular lymphomas, the most common nodal based type of lymphoma." thedoctorsdoctor.com 

What is lymphoma?   See Lymphoma simplified

Background Resources

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2013: Cutaneous B-cell lymphomas: 2013 update on diagnosis, risk-stratification, and management.
http://www.ncbi.nlm.nih.gov/pubmed/23379008

Approximately one-fourth of cutaneous lymphomas are B-cell derived and are generally classified into three distinct subgroups: primary cutaneous follicle-center lymphoma (PCFCL), primary cutaneous marginal zone lymphoma (PCMZL), and primary cutaneous diffuse large B-cell lymphoma, leg type (PCLBCL, LT).

Both PCFCL and PCMZL are indolent lymphomas that infrequently disseminate to extracutaneous sites and are associated with an excellent long-term prognosis. In contrast, PCLBCL, LT is an aggressive lymphoma with an inferior prognosis.
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Extranodal lymphomas  http://bit.ly/a6AhWt
Emanuele Zucca and Franco Cavalli
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What's New in Cutaneous Lymphomas?  (2006, Technical) http://cutaneouslymphoma.stanford.edu/  pdf 
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Questions for your doctor  PAL
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Prognostic Factors in Primary Cutaneous B-Cell Lymphoma: The Italian Study Group for Cutaneous Lymphomas. J Clin Oncol. 2006 Feb 21; PMID: 16492713
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Case analysis: Extranodal follicular lymphoma: a clinicopathological and genetic analysis of 15 cases arising at non-cutaneous extranodal sites. Histopathology. 2004 Mar;44(3):268-76. PMID: 14987231 | Related articles

The low incidence of t(14;18) and favourable outcome encountered in Extranodal Follicular Lymphoma ( ENFL) in this study is similar to that previously found for primary cutaneous FL. 

These results support the concept of a subtype of FL lacking t(14;18) involving the major breakpoint cluster region, and with a propensity to arise at extranodal sites. Despite a high relapse rate, patients with ENFL are more likely to achieve complete remission and may ultimately have a more favourable long-term prognosis than those with equivalent nodal disease.
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Extranodal nonorbital indolent lymphomas of the head and neck: relationship between tumor control and radiotherapy. Int J Radiat Oncol Biol Phys. 2004 Jul 1;59(3):788-95.  PMID: 15183482 | Related articles
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MR imaging of therapy-induced changes of bone marrow
http://1.usa.gov/1iurdY2

Radiotherapy for:

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2003 by American Society of Clinical Oncology

Localized Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy Has Excellent Clinical Outcome http://jco.ascopubs.org/content/21/22/4157.full
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Radiotherapy Suitable for Most Primary Cutaneous B-Cell Lymphomas  cancerpage.com 

NEW YORK JAN 02, 2008 (Reuters Health) - Radiotherapy is appropriate for most patients with primary cutaneous B-cell lymphomas (CBCL), according to a recent Dutch study, but more aggressive treatment is needed in patients presenting with lesions on the leg.

Common Extranodal Types:

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Breast 

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Cutaneous  skin

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Hepatic liver

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Ocular / orbital eye

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Osteo bone

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Oral mouth

UNCOMMON EXTRANODAL TYPES
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Follicular lymphoma of the salivary gland: a clinicopathological and molecular study of six cases. Int J Surg Pathol. 2001 Oct;9(4):287-93. PMID: 12574844

BREAST 

Primary malignant 
Lymphoma of the Breast
Also see 
MALT - Areas of Presentation

 

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TOPIC SEARCH: PubMed

"Primary lymphoma of the breast is rare, accounting for 1.7-2.2% of extranodal lymphomas and 0.38-0.7% of non-Hodgkin's lymphomas (NHL)." [1]
 

  1. Primary malignant lymphoma of the breast: clinicopathological study of nine cases. Leuk Lymphoma. 2004 Feb;45(2):327-30. PMID: 15101719
 

CUTANEOUS
 
(B- and T-cell Lymphomas presenting in the skin)

Images

 

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TOPIC SEARCH: Cutaneous lymphomas
PubMed: Review | Treatment | Rituxan

bullet The ASCO Post, 2013: FDA Approves Mechlorethamine Gel for Cutaneous T-Cell Lymphoma  http://bit.ly/18Ultxa

This gel is the first and only FDA-approved topical formulation of mechlorethamine, which is commonly known as nitrogen mustard. The gel is applied topically once a day and dries on the skin.

Mechlorethamine was approved previously for intravenous treatment of mycosis fungoides, the most common type of CTCL. Topical mechlorethamine preparations are currently recommended for the treatment of early-stage CTCL. Prior to approval of the gel, there were no FDA-approved topical mechlorethamine products; only nonstandardized, pharmacy-compounded petroleum ointment or aqueous-based topical preparations were available.

 

Classifications:

Cutaneous lymphomas present in the skin, and can have distinct clinical courses depending on the underlying pathology.

Briefly, cutaneous lymphomas can be divided into T and B cell lineage, with T cell lymphomas the most common. Within these divisions, further distinctions based upon the clinical behavior can be gleaned."  thedoctorsdoctor.com 

Overview: Lymphoma of the Skin
Joseph M. Connors, Eric D. Hsi and Francine M. Foss

asheducationbook.hematologylibrary.org

Published in 2002 … but still seems relevant and informative today.
 

Cutaneous Lymphomas in Alphabetical Order

Cutaneous T-cell lymphoma (CTCL)

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See Comparing types

Also see T-cell Lymphomas PAL

B-cell cutaneous lymphomas

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Follicular Center Cell Lymphomas of the Skin

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Intravascular large B-cell lymphoma 

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Large B-cell lymphoma of the leg

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T-Cell Rich B-Cell Lymphoma of the Skin 

Cutaneous pseudolymphoma (C-PSL), from Discussion:

"also called lymphoid infiltrates of the skin mimicking lymphoma, is defined as reactive polyclonal benign lymphoproliferative process predominantly composed of either B-cells or T-cells, localized or disseminated.

It heals spontaneously after cessation of the causative factor (e.g. drugs) or after non-aggressive treatment. It has many synonyms such as lymphocytoma cutis and lymphadenosis benigna cutis.

According to the dominant patterns, PSL were classified into B-cell PSL (B-PSL) and T-cell PSL (T-PSL).

However, there were no significant difference between B-PSL and T-PSL. C-PSL affects all age group with the predilection of Borrelia-induced B-PSL in children and young adults, while drug induced T-PSL more frequently are seen in adults.

Even though Borrelia-induced PSL may be precursor for B-cell neoplasms of the skin, in genera, C-PSLs are self-regressing and do not affect survival.

The etiology may involve microbial, physical, chemical, Borrelia burgdorferi infection, insect bite, tattoo, and drugs

Clinically, several variants of C-PSL exist. ....

In the author’s lymphoma experience the author have experienced several C-PSL, but have not published them because the author had been once concentrated on hepatobiliary pathology. Herein reported is a very interesting case of ordinary C-PSL with main points of differential pathological diagnosis."

Int J Clin Exp Pathol. 2013; 6(5): 966–972.
Cutaneous pseudolymphoma: a case report with an immunohistochemical study ncbi.nlm.nih.gov

Recommended reading:

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Lymphoma of the Skin Joseph M. Connors, Eric D. Hsi and Francine M. Foss Abstract- asheducationbook.org

"Describes the various ways in which the non-Hodgkin’s lymphomas can involve the skin, how these diseases should be assessed, standard treatments available in 2002, and new directions in research. 

The goal of the session is to succinctly review recent developments in lymphoma classification and treatment as they apply to the unique aspects of lymphoma when manifest in the skin. "
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NCCN: Cutaneous B-Cell Lymphoma Guidelines Debut medpagetoday.com/ 
 
Primary cutaneous B-cell lymphoma is unlikely to reduce a person's life expectancy, but even with definitive therapy, the disease is likely to recur, doctors said in unveiling new guidelines for treatment of the disease.

About 1,000 to 1,500 cases of cutaneous B-cell lymphoma occur each year in the U.S., said Steven M. Horwitz, M.D., of Memorial-Sloan Kettering Cancer Center in New York and a member of the guideline panel. But because the disease is rarely fatal, there are tens of thousands of people living with it.
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Standard and new treatments in cutaneous B-cell lymphomas. J Cutan Pathol. 2006 Feb;33 Suppl 1:47-51. Review. PMID: 16412212 | Related articles
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Lymphoma of the Skin (Nov_28_02)  asheducationbook.org 
 
Joseph M. Connors, Eric D. Hsi and Francine M. Foss Abstract- 
Scroll down to Section III for Cutaneous T-Cell Lymphoma
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T-Cell Lymphoma Presenting as Benign Dermatoses - includes images - aafp.org

 

Clinical trials for cutaneous lymphomas

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ClinicalTrials.gov
 

Related Abstracts

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Pilot Study: Zevalin for cutaneous lymphoma?   informahealthcare.com/

"Ten patients, all but one, with relapsed PCBCL were included and treated with rituximab (250 mg m−2/body surface) on days 1 and 8 followed by a single dose of 90Y IT (11–15 MBq kg−1). The overall response rate was 100%. The complete response rate was 100%. The median time to relapse was 12 months. Ongoing remissions were achieved in four patients (median follow-up 19 months). "
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Rituximab monotherapy for primary cutaneous B-cell lymphoma: response and follow-up in 16 patients  ingentaconnect.com

On the basis of our results, single-agent treatment with Rituxan appears to be feasible and safe and results in a high rate of durable remissions. Judging from our data, it appears to be an attractive treatment option and should be directly compared with local radiotherapy.
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Report: Zevalin® Effective for Treatment of Cutaneous B-Cell Lymphoma cancerconsultants.com 

100% CR rate in small study (10 patients);
40% (4 of 10 pts) remain in complete remission at 19 months. 
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NEW: Phase 2 Data for Romidepsin Showing Durable Response in Refractory CTCL businesswire.com 

"Romidepsin is a novel, cyclic peptide, pan-HDAC inhibitor under investigation for hematologic malignancies"
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Cutaneous B-cell lymphoma responds to rituximab: A report of five cases and a review of the literature. Leuk Lymphoma. 2006 Sep;47(9):1902-7. PMID: 17065004  | related articles

We treated five patients, each with either extensive lesions, severe comorbidities or who refused treatment with radiation therapy, with rituximab given as a single agent for four weekly intravenous infusions...
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Photopheresis Followed by Immunotherapy Improves Responses in Cutaneous T-Cell Lymphoma  - 411cancer.com
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Intralesional therapy with anti-CD20 monoclonal antibody rituximab in primary cutaneous B-cell lymphoma. Arch Dermatol. 2000 Mar;136(3):374-8. PMID: 10724200 
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Primary cutaneous diffuse large B-cell lymphoma: a clinicopathologic study of 15 cases. Am J Clin Pathol. 2002 Apr;117(4):574-80. PMID: 11939732 - PubMed
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Cutaneous follicle center lymphoma: a clinicopathologic study of 19 cases.
Mod Pathol. 2001 Sep;14(9):828-35. PMID: 11557777  - PubMed
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Cutaneous presentation of follicular lymphomas.
Mod Pathol. 2001 Sep;14(9):913-9. PMID: 11557789  - PubMed

 

Primary Gastric Lymphomas (PGL)

Primary Gastric Lymphoma

Also see
MALT lymphomas

 
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PubMed Topic Search: Primary Gastric Lymphomas

"Primary gastric lymphoma "account for 7% to 20% of all lymphoma, and the gastrointestinal tract is the most common extranodal site of lymphoma. PGL is the most common lymphatic tumor of the GI tract." [1]
 

  1. Chemotherapy Preferable to Surgery for Primary Gastric Lymphoma - Medscape (free login required)
  2. Primary gastric lymphoma.
    World J Gastroenterol. 2004 Jan;10(1):5-11. Review. PMID: 14695759
  3. 2003 by American Society of Clinical Oncology

    Localized Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy Has Excellent Clinical Outcome jco.ascopubs.org

Hepatic (Lymphomas presenting in the liver)

LIVER (HEPATIC)
Also see 
MALT - Areas of Presentation
 
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PubMed Topic Search: Primary hepatic lymphomas

"Primary hepatic lymphoma is extremely rare. Only around 110 cases have been reported in world literature." [1]
 

  1. Primary hepatic lymphoma, single institution experience Year: 2002 - Abstract No: 2643
  2. 2003 by American Society of Clinical Oncology

    Localized Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy Has Excellent Clinical Outcome jco.ascopubs.org

Intra-Vascular Lymphoma

Intra-Vascular
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About Intravascular large B-cell lymphoma 
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Intra-Vascular Large B-Cell Lymphoma Revealed by a Nephrotic Syndrome: A One Year Remission Induced by a High Frequency CHOP and Rituximab. Leuk Lymphoma. 2004;45(8):1703-1705. PMID: 15370230 | Related articles


Ocular / Orbital
(Lymphoma presenting in the eye)

Ocular/Orbital
Link to source
Eye Cancer - Health-news-and-information.com
Also see 
MALT - Areas of Presentation

adnexa - Appendages of the eyeball, which includes the eyelids, muscles and soft tissue.

Eye Cancer Network - 
Glossary:

eyecancer.com
 

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TOPIC SEARCH: PubMed: Secondary orbital
ocular adnexal
| radiotherapy for primary orbital

Types:

Ocular / Ocular Adnexa (eyelid) / Intraocular | Orbital | Conjunctival

"Depending on the site of involvement, ocular lymphoma can be
either intraocular or orbital and adnexal."

 

Important:  Ocular and orbital lymphomas can be effectively treated.  However, how either is best treated can vary significantly by the area effected, the grade, and the type. 

Since ocular lymphoma are uncommon, we feel it's very important to consult an expert experienced in these neoplasms for a second opinion at diagnosis and certainly prior to receiving therapy.

Radiotherapy:

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2003 by American Society of Clinical Oncology

Localized Mucosa-Associated Lymphoid Tissue Lymphoma Treated With Radiation Therapy Has Excellent Clinical Outcome jco.ascopubs.org

Dose per fraction varied from 1 to 3 Gy. Only involved-field RT was used, encompassing the involved organ, with or without the adjacent first-echelon lymph node region.
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Primary Radiation Therapy in Patients With Localized Orbital MALT Lymphoma http://bit.ly/9YUyKD May 2010

Forty-three patients (93%) achieved complete remission (CR), and three patients (7%) achieved partial remission (PR). Five-year relapse-free survival, cause-specific survival, and overall survival were 93%, 100%, and 100%, respectively.
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Curative radiotherapy for primary orbital lymphoma.
Int J Radiat Oncol Biol Phys. 2002 Nov 1;54(3):818-23. Review. PMID: 12377334 
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Radiotherapy for extranodal, marginal zone, B-cell lymphoma of mucosa-associated lymphoid tissue originating in the ocular adnexa: a multi-institutional, retrospective review of 50 patients. Cancer. 2003 Aug 15;98(4):865-71. PMID: 12910532 | Related abstracts
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Curative radiotherapy for primary orbital lymphoma.
Int J Radiat Oncol Biol Phys. 2002 Nov 1;54(3):818. PMID: 12377334

 

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Ocular Lymphomas:
 

"Depending on the site of involvement, ocular lymphoma can be either intraocular or orbital and adnexal." [1]

"Primary ocular lymphoma, an infrequent neoplasm, typically represents a diagnostic challenge masquerading as uveitis or vitritis." [2]

Ocular lymphoma - overview
 

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About emedicine.medscape.com

"
Orbital and adnexal lymphoma is associated with systemic lymphoma in 30-35% of cases. Hence, all patients with ocular lymphoma should have a complete workup to rule out systemic lymphoma. "

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Intra-ocular lymphoma:

A rare malignant form of eye cancer. Intraocular lymphoma may affect the eye secondarily from a metastasis from a non-ocular tumor or may arise within the eye primarily (primary intraocular lymphoma). 

Primary intraocular Lymphoma (PIOL) is a subset of primary central nervous system lymphoma (PCNSL). PCNSL (and PIOL) are most commonly a diffuse large B-cell immunohistologic subtype of non-Hodgkin's lymphoma according to the World Health Organization (WHO) classification of lymphomas.

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Ocul Immunol Inflamm. 2009
Primary Intraocular Lymphoma: Diagnosis and Differential Diagnosis http://1.usa.gov/1eXw2B4

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Ocular adnexa Lymphomas -
affecting the eyelid

TOPIC SEARCH: PubMed

This extranodal area of presentation is not very common but can occur in b-cell lymphomas, most often MALT.

Adnexa " [Add-Nex-ah] - Appendages. Structures around the eye that support and surround it (e.g. the eye lids)." eyecancer.com 

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About  related abstracts
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Clinical features associated with survival of patients with lymphoma of the ocular adnexa  http://bit.ly/6IoMsP
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The Role of Infectious Agents in the Etiology of Ocular Adnexal Neoplasia (full text) ncbi.nlm.nih.gov
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Linked to Chlamydia psittaci Infection (an infection common to pet birds and transmitted to humans)  Related PubMed abstracts
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Blood. 2009 July 16; 114(3): 501–510:
Extranodal marginal zone lymphoma of the ocular adnexa 

"Besides radiotherapy and chemotherapy, a variety of new treatment options have emerged in the management of patients with ocular adnexal MALT lymphoma, especially monoclonal antibody therapy and antibiotic therapy against Chlamydia psittaci"

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Orbital Lymphomas
 

"Lymphomas of the orbit may arise spontaneously, or may be associated with the development of systemic lymphoma.  These lesions may cause a painless, unilateral proptosis or may manifest as a salmon patch- like thickening protruding into the conjunctiva"

"Orbital lymphoma refers to a lymphoma occurring in the conjunctiva, lacrimal gland, eyelid and ocular musculature.

Primary non-Hodgkin's lymphoma of the orbit is a rare presentation, representing 8-10% of extranodal NHL and only 1% of all NHL. Generally, it has an indolent course.

Orbital lymphoma in contrast to ocular lymphoma is rarely associated with primary central nervous lymphoma." 4

  1. About Orbital Lymphoma  
    webeye.ophth.uiowa.edu/
      | annals.edu  .pdf   |
  2. Zevalin trial cancerwise.org 
  3. Linked to Chlamydia psittaci Infection (an infection common to 
    pet birds and transmitted to humans)  - ASCO 2003 (2273) 
    | Related PubMed abstracts
  4. Orbital lymphoma: Role of radiation ncbi.nlm.nih.gov
  5. The common antibiotic doxycycline effectively treats a type of lymphoma associated with chlamydia infection  biologynews.net  

    "The authors found that doxycycline treatment caused lymphoma to regress in both patients who did not test positive for the disease and those who did. They suggest that doxycycline may be a useful therapy even in patients where other treatments have failed, and it is a valid alternative to chemotherapy and radiation without causing the same toxic side-effects. Patients treated with doxycycline had a 66% rate of disease-free survival."
  6. Addition of a Short Course of Chemotherapy Did Not Improve Outcome in Patients with Localized Marginal B-Cell Lymphoma of the Orbit. Oncology. 2006 Jun 7;70(3):173-176 PMID: 16763405
  7. Primary radiotherapy for localized orbital MALT lymphoma.
    Int J Radiat Oncol Biol Phys. 2002 Mar 1;52(3):657-63. PMID: 11849787
  8. H. pylori molecular signature in conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma. Histol Histopathol. 2004 Oct;19(4):1219-26. PMID: 15375765
  9. Outcome and prognostic factors in orbital lymphoma: a Rare Cancer  Network study on 90 consecutive patients treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2003 Mar 15;55(4):892-8. PMID: 12605966 
  10. Indian J Ophthalmol. 2009: Orbital lymphoma: Role of radiation

    Available data support the acceptance of radiotherapy as a standard therapeutic option in patients with low to intermediate grade orbital lymphoma. Toxicity of radiotherapy is mild if delivered precisely.

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Conjunctival Lymphoma

"Lymphomas can also occur in the conjunctiva. These tumors look like salmon-colored patches on the eye and can be a sign of systemic lymphoma." [Eyecancer.com]
 

  1. Subconjunctival interferon-alpha for the treatment of conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma  biologictherapy.org
     

________________________
Extranodal marginal zone lymphoma of the ocular adnexa

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Blood. 2009 July 16; 114(3): 501–510.
Review Article: Extranodal marginal zone lymphoma of the ocular adnexa http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2713468/

"Various treatment modalities are available for the management of patients with OAML, including surgical resection, radiotherapy, single-agent or combination chemotherapy, and immunotherapy with monoclonal antibodies. However, no prospective clinical trials have been conducted to evaluate these therapeutic options or define the optimal treatment approach for these patients. Recently, antichlamydial antibiotic therapy was also proposed as a novel treatment option."

Research News:

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The common antibiotic doxycycline effectively treats a type of lymphoma associated with chlamydia infection biologynews.net  

"The authors found that doxycycline treatment caused lymphoma to regress in both patients who did not test positive for the disease and those who did. They suggest that doxycycline may be a useful therapy even in patients where other treatments have failed, and it is a valid alternative to chemotherapy and radiation without causing the same toxic side-effects. Patients treated with doxycycline had a 66% rate of disease-free survival."
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Topical therapy selective for neoplastic cells - iwant2020.com 
Is it an alternative to radiotherapy for Lymphomas?

Oral (Lymphomas presenting in the mouth)

Oral
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TOPIC SEARCH: PubMed: oral lymphomas

 "Extranodal lymphoma in the oral cavity may be the first manifestation of lymphoma or may be part of a disseminated process.  Extranodal oral lymphoma of soft tissue is typically a nontender, poorly circumscribed, compressible, soft tissue enlargement, sometimes with erythema and ulceration of the overlying mucosa."  [1]

  1. Malignant Neoplasms of Oral Mucosa dentalcare.com 
  2. Images  ama-assn.org | oralpathlab.com

Osteo (Lymphomas presenting in the bone)

OSTEO (Bone)
Regarding new involvement in bone: "A lot of times when follicular lymphoma involves bone, it does so locally, and it's an extension of lymph nodes growing into bone.
On the other hand, bone involvement in follicular lymphoma is generally uncommon, particularly if it's diffusely in many bones. I've got to watch those terms. Under those circumstances I always have a healthy suspicion about transformation, but I have seen patients with follicular lymphoma with multiple bone sites who did not transform. So you really have to try to get a biopsy that tells you the answer." Dr. Horning

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TOPIC SEARCH: PubMed:
Bone lymphoma: 67Ga scintigraphy | Primary NHL Of bone

"Malignant lymphoma of bone is rare. In many cases, its diagnosis is delayed because of unspecific clinical signs and equivocal radiographs." [1] "

"The data demonstrate that primary lymphoma involving the bone has an excellent prognosis. Patients with PBL treated with combined modality versus single modality therapy were found to have a superior outcome, with a significantly better survival. Cancer 2006. (c) 2006 American Cancer Society."

  1. About bonetumor.org
  2. Malignant lymphoma of bone. Arch Orthop Trauma Surg. 2002 Feb;122(1):10-6. PMID: 11995873 - PubMed | Related abstracts
  3. Excellent long-term survival in patients with early-stage primary bone lymphoma treated with doxorubicin-based chemotherapy and local radiotherapy. Am J Clin Oncol. 2002 Dec;25(6):603-5. 
    PMID: 12478009 - PubMed
  4. Importance of combined-modality therapy for primary bone lymphoma.
    Leuk Lymphoma. 2003 Oct;44(10):1837-9. PMID: 14692546 | Relate abstracts
  5. Primary bone lymphoma: Treatment results and prognostic factors with long-term follow-up of 82 patients. Cancer. 2006 May 12;  PMID: 16700039 | Related articles 

    "
    The data demonstrate that primary lymphoma involving the bone has an excellent prognosis. Patients with PBL treated with combined modality versus single modality therapy were found to have a superior outcome, with a significantly better survival. Cancer 2006. (c) 2006 American Cancer Society."

Testis

Testis
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Primary follicular lymphoma of the testis: excellent outcome following surgical resection without adjuvant chemotherapy. J Pediatr Hematol Oncol. 2004 Feb;26(2):104-7. Review. PMID: 14767197 | Related abstracts
 
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professional medical advice or to replace your relationship with a physician.
For all medical concerns,  you should always consult your doctor. 
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