Letters to Editor
of the entire bladder are very rare.[5] Mucosa associated lymphoid tissue (MALT)‑ type lymphomas are the most common form of primary involvement of the bladder. The prognosis of these cases is usually good, and most series do not report deaths associated with the disease. These lesions can be single or multiple, and irritative bladder symptoms occur because of them. Nearly 20% of these cases may present with a history of chronic cystitis.[5] Patients with non‑localized bladder lymphoma tend to present with fewer lower urinary tract symptoms. The occurrence of secondary involvement of the bladder by a systemic lymphoma is more common than primary involvement. Necropsy studies show that 10-20% of cases of systemic non‑Hodgkin lymphoma can involve the bladder secondarily.[2] Usually such patients are treated with salvage chemotherapy, and mean survival can range from five to eight years.[5] The role of Rituximab in the treatment of non‑Hodgkin lymphoma has evolved significantly since its introduction. Several randomized clinical trials (RCTs) of rituximab based therapy have revealed consistent and clinically important benefits in progression‑free and overall survival.[6] Nerli RB*1, Guntaka AK1, Das S2, Hiremath MB1 Department, Urology, KLES Kidney Foundation, KLE University’s JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, 2AV D’Costa Memorial Hospital, Margoa, Goa, India 1
Massive ascites as an presenting feature of plasma cell leukemia Sir, Ascites is rarely seen in patients with plasma cell dyscrasias such as waldenstrom macroglobulenemia and myeloma. [1,2] Ascites has never been reported as a presenting feature of primary plasma cell leukemia (PCL). Here, we present a 64‑year‑old lady with PCL with ascites. A 64‑years diabetic female presented with the history of fatigue, gradual is tension of abdomen for 2 months and fever and intermittent epistaxis is for 1 month. On examination, she had severe pallor and massive ascites. Investigations revealed hemoglobin 7.2 g/dL, white blood count 2.6 × 109/L, platelet count 40 × 109/L, peripheral smear showed 30% immature plasma cell, serum creatinine 1.2 mg/dL, uric acid 8.6 mg g/dL, calcium 10.2 mg/dL (8.4‑10.2), total serum protein 9.4 g/dl, albumin 3.5 g/dL, bone marrow revealed Indian Journal of Cancer | October–December 2013 | Volume 50 | Issue 4
Correspondence to: Dr. RB Nerli, E‑mail: [email protected]
References 1. 2.
3. 4. 5.
6.
Mourad WA, Khalil S, Radwi A, Peracha A, Ezzat A. Primary T‑cell lymphoma of the urinary bladder. Am J Surg Pathol 1998;22:373‑7. Bates AW, Baithun SI. Secondary neoplasms of the bladder are histological mimics of non‑transitional cell primary tumors: Clinicopathological and histological features of 282 cases. Histopathology 2000;36:32‑40. Kuhara H, Tamura Z, Suchi T, Hattori R, Kinukawa T. Primary malignant lymphoma of the urinary bladder: A case report. Acta Pathol Jpn 1990;40:764‑9. Arda K, Ozdemir G, GunesZ, Ozdemir H. Primary malignant lymphoma of the bladder: A case report and review of literature. Int Urol Nephrol 1997;29:319‑22. Kempton CL, Kurtin PJ, Inwards DJ, Wollan P, Bostwick DG. Malignant lymphoma of the bladder: Evidence from 36 cases that low grade lymphoma of the MALT‑type is the most common primary bladder lymphoma. Am J Surg Pathol 1997;21:1324‑33. Cheung MC, Haynes AE, Meyer RM, Stevens A, Kevin R. Imrie Rituximab in lymphoma: A systematic review and consensus practice guideline from Cancer Care Ontario. Cancer Treat Rev 2007;33:161‑76. Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.123593 PMID: *******
80% plasma cells including immature forms, skeletal survey normal, serum beta 2 microglobulin 11045 mg/L (670‑1310), serum Mspike 2.5 g/dL: Immunoglobulin A lambda, urine Mspike: Negative, serum Immunoglobulin A 1822 mg/dL (85‑450), Immunoglobulin M6.7 mg/dL (50‑320), Immunoglobulin G 470 mg/dL (800‑1000) and serum lactate dehydrogenase 815 IU/L (230‑460). Abdominal paracentas is showed straw colored ascitic fluid with the serum/ascetic fluid albumin radient ratio of
of the entire bladder are very rare.[5] Mucosa associated lymphoid tissue (MALT)‑ type lymphomas are the most common form of primary involvement of the bladder. The prognosis of these cases is usually good, and most series do not report deaths associated with the disease. These lesions can be single or multiple, and irritative bladder symptoms occur because of them. Nearly 20% of these cases may present with a history of chronic cystitis.[5] Patients with non‑localized bladder lymphoma tend to present with fewer lower urinary tract symptoms. The occurrence of secondary involvement of the bladder by a systemic lymphoma is more common than primary involvement. Necropsy studies show that 10-20% of cases of systemic non‑Hodgkin lymphoma can involve the bladder secondarily.[2] Usually such patients are treated with salvage chemotherapy, and mean survival can range from five to eight years.[5] The role of Rituximab in the treatment of non‑Hodgkin lymphoma has evolved significantly since its introduction. Several randomized clinical trials (RCTs) of rituximab based therapy have revealed consistent and clinically important benefits in progression‑free and overall survival.[6] Nerli RB*1, Guntaka AK1, Das S2, Hiremath MB1 Department, Urology, KLES Kidney Foundation, KLE University’s JN Medical College, KLES Dr. Prabhakar Kore Hospital and MRC, Belgaum, Karnataka, 2AV D’Costa Memorial Hospital, Margoa, Goa, India 1
Massive ascites as an presenting feature of plasma cell leukemia Sir, Ascites is rarely seen in patients with plasma cell dyscrasias such as waldenstrom macroglobulenemia and myeloma. [1,2] Ascites has never been reported as a presenting feature of primary plasma cell leukemia (PCL). Here, we present a 64‑year‑old lady with PCL with ascites. A 64‑years diabetic female presented with the history of fatigue, gradual is tension of abdomen for 2 months and fever and intermittent epistaxis is for 1 month. On examination, she had severe pallor and massive ascites. Investigations revealed hemoglobin 7.2 g/dL, white blood count 2.6 × 109/L, platelet count 40 × 109/L, peripheral smear showed 30% immature plasma cell, serum creatinine 1.2 mg/dL, uric acid 8.6 mg g/dL, calcium 10.2 mg/dL (8.4‑10.2), total serum protein 9.4 g/dl, albumin 3.5 g/dL, bone marrow revealed Indian Journal of Cancer | October–December 2013 | Volume 50 | Issue 4
Correspondence to: Dr. RB Nerli, E‑mail: [email protected]
References 1. 2.
3. 4. 5.
6.
Mourad WA, Khalil S, Radwi A, Peracha A, Ezzat A. Primary T‑cell lymphoma of the urinary bladder. Am J Surg Pathol 1998;22:373‑7. Bates AW, Baithun SI. Secondary neoplasms of the bladder are histological mimics of non‑transitional cell primary tumors: Clinicopathological and histological features of 282 cases. Histopathology 2000;36:32‑40. Kuhara H, Tamura Z, Suchi T, Hattori R, Kinukawa T. Primary malignant lymphoma of the urinary bladder: A case report. Acta Pathol Jpn 1990;40:764‑9. Arda K, Ozdemir G, GunesZ, Ozdemir H. Primary malignant lymphoma of the bladder: A case report and review of literature. Int Urol Nephrol 1997;29:319‑22. Kempton CL, Kurtin PJ, Inwards DJ, Wollan P, Bostwick DG. Malignant lymphoma of the bladder: Evidence from 36 cases that low grade lymphoma of the MALT‑type is the most common primary bladder lymphoma. Am J Surg Pathol 1997;21:1324‑33. Cheung MC, Haynes AE, Meyer RM, Stevens A, Kevin R. Imrie Rituximab in lymphoma: A systematic review and consensus practice guideline from Cancer Care Ontario. Cancer Treat Rev 2007;33:161‑76. Access this article online Quick Response Code:
Website: www.indianjcancer.com DOI: 10.4103/0019-509X.123593 PMID: *******
80% plasma cells including immature forms, skeletal survey normal, serum beta 2 microglobulin 11045 mg/L (670‑1310), serum Mspike 2.5 g/dL: Immunoglobulin A lambda, urine Mspike: Negative, serum Immunoglobulin A 1822 mg/dL (85‑450), Immunoglobulin M6.7 mg/dL (50‑320), Immunoglobulin G 470 mg/dL (800‑1000) and serum lactate dehydrogenase 815 IU/L (230‑460). Abdominal paracentas is showed straw colored ascitic fluid with the serum/ascetic fluid albumin radient ratio of
