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      Le lymphome primitif de la vessie: un cas clinique Translated title: Primary lymphoma of the bladder: a case report

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          Abstract

          Les tumeurs de vessie constituent les tumeurs les plus fréquentes de l'appareil uro-génital chez l'homme, le type histologique est dominé par le carcinome urothéliale, la localisation primitive du lymphome malin est extrêmement rare et constitue souvent une surprise diagnostique quand elle est retrouvée. Nous rapportons à travers cette observation le cas d'un patient pris en charge au sein de notre formation qui a bénéficié, suite a un bilan d'hématurie objectivant une formation bourgeonnante intra vésicale a l’échographie abdominale, d'une résection transurétrale de la vessie d'un polype géant dont les résultats anapathologies sont revenus en faveur d'un lymphome primitif de la vessie, le patient a bénéficié d'une chimiothérapie adjuvante a base de RCHOP, les suites étaient simples et une surveillance cystoscopique et scannographique n'a pas objectivé de récidive avec un recul de 18 mois. Le lymphome primitif de la vessie est une entité rare, sa chimio sensibilité fait de ce type de tumeur une maladie curable, le diagnostic est histologique et vu la rareté de l'affection aucun consensus n'est standardisé.

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          Most cited references16

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          Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin.

          To study the main clinicobiologic features, response, and outcome of patients with diffuse large B-cell lymphoma (DLBCL) according to the primary site, lymph node, or different extranodal organs of the disease. We included 382 patients consecutively diagnosed with DLBCL in a single institution during a 13-year period. Morphology, immunophenotyping, proliferation index, differentiation profile, bcl-2/JH rearrangement, and clinical characteristics were analyzed according to the primary site of the lymphoma. Sites of the disease were: lymph node, 222 cases (58%); Waldeyer's ring (WR), 42 (11%); and extranodal sites, 118 (31%), including GI tract in 45 cases. Primary extranodal cases, particularly GI, showed a bcl-6 expression more frequently than nodal cases. Patients with primary WR or GI lymphomas presented with early-stage disease, no marrow infiltration, normal serum lactate dehydrogenase, and low- to low/intermediate-risk international prognostic index (IPI) more frequently than the remainder. Complete response (CR) rate was 63%, with WR and GI lymphomas having a higher CR rate (85% and 80%, respectively) than the other groups. In the whole series, 5-year overall survival (OS) was 52%. Patients with WR or GI lymphomas showed better OS (5-year OS: 77% and 68%, respectively) than patients with nodal or other extranodal sites. In the multivariate analysis, IPI, bulky disease, and beta2-microglobulin were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value. In the present series, the primary site of disease was associated with particular clinicopathologic features and outcome, though the latter largely depended on other factors.
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            Malignant lymphoma of bladder. Report of three cases and review of the literature.

            The significance of long-standing cystitis has been postulated as a causal factor in malignant lymphoma of bladder. The authors reviewed 3 cases of primary malignant lymphoma of the urinary bladder and an additional 27 cases described in the literature (25 from Western countries and 2 from Japan). Clinical and pathologic findings in the total 30 cases are summarized. The majority of patients presented with gross hematuria and were between 20 and 85 years of age (median age, 64 years). Marked female preponderance was found (male to female ratio, 1:6.5). Six patients (20%), all of whom were women, out of 30 had a history of chronic cystitis. Macroscopic findings showed a solitary mass (22 cases), multiple masses (6 cases), or a diffuse lesion without nodule formation (2 cases). The vast majority of bladder lymphoma were non-Hodgkin lymphoma (NHL) of B-cell type; among them, 14% were follicular lymphomas. Follow-up indicated that NHL of bladder had a favorable prognosis. Malignant lymphoma of bladder is characterized by a preponderance in women, who are occasionally affected by chronic cystitis.
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              Treatment of extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) with mitoxantrone, chlorambucil and prednisone (MCP).

              Mucosa-associated lymphoid tissue (MALT) lymphoma is a relatively common type of lymphoma arising in various tissues throughout the human body. Currently, there is no standard chemotherapy for advanced stage MALT lymphoma. This has prompted us to retrospectively analyse our experience with the MCP regimen (mitoxantrone, chlorambucil and prednisone) in patients with MALT lymphoma. Patients with histologically verified MALT lymphoma undergoing chemotherapy with MCP were evaluated retrospectively. The MCP regimen consists of mitoxantrone 8 mg/m(2) intravenously on days 1 and 2, chlorambucil 3 x 3 mg/m(2) per os (p.o.) on days 1-5 and prednisone 25 mg/m(2) p.o. on days 1-5. Information analysed included localisation of the lymphoma, clinical stage, pretreatment, number of chemotherapy cycles administered, toxicity, response to treatment, follow-up time, relapse and survival. A total of 15 patients (six females and nine males aged between 34 and 88 years) with histologically ascertained MALT lymphoma undergoing treatment with the MCP regimen were identified from our records. Ten patients had extragastric lymphoma, while five patients suffered from gastric MALT lymphoma. All patients were chemotherapy-naïve, while two had been locally irradiated before application of MCP for recurrent disease. A total of 74 cycles was administered to our patients, with a median number of five cycles per patient. Eight (53%) patients achieved complete remission, six (40%) patients partial response and only one (7%) patient had progressive disease. Subjective tolerance was excellent, and toxicities were mainly haematological, including granulocytopenia World Health Organisation grade 3 and 4 in three patients each. In two patients, this was accompanied by single episodes of uncomplicated herpes simplex infection. At the time of analysis, all patients are still alive. No relapses have occurred after a median follow-up time of 16 (range 12-29) months. Our data suggest that MCP is an effective and well-tolerated regimen for treatment of patients with MALT lymphoma irrespective of localisation. Judging from our data, MCP also appears to be a feasible regimen in elderly patients.
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                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                17 June 2014
                2014
                : 18
                : 148
                Affiliations
                [1 ]Service d'Urologie B, CHU Ibn Sina Rabat, Maroc
                [2 ]Service d'Oncologie Médicale, Institut National D'Oncologie Chu Ibn Sina, Rabat, Maroc
                Author notes
                [& ]Corresponding author: Mouad Statoua, service d'urologie B CHU Ibn Sina Rabat, Maroc
                Article
                PAMJ-18-148
                10.11604/pamj.2014.18.148.4365
                4236778
                25419286
                7b63010a-117e-47e7-86de-2bfb9173b776
                © Mouad Statoua et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 April 2014
                : 10 June 2014
                Categories
                Case Report

                Medicine
                lymphome,vessie,histologie,chimiothérapie,surveillance,lymphoma,bladder,histology,chimiotherapy
                Medicine
                lymphome, vessie, histologie, chimiothérapie, surveillance, lymphoma, bladder, histology, chimiotherapy

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