Double-hit primarni limfom nadbubrežne žlezde sa povoljnim ishodom

  • Olivera Marković Clinical Hospital Center “Bežanijska kosa”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Dragomir Marisavljević Clinical Hospital Center “Bežanijska kosa”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Svetlana Jelić Clinical Hospital Center “Bežanijska kosa”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Biljana Mihaljević Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic of Hematology, Clinical Center of Serbia, Belgrade, Serbia
  • Taamara Martinović Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • Vesna Čemerikić Beolab, Belgrade, Serbia
DOI: https://doi.org/10.2298/3401
Ključne reči: lymphoma, non-hodkin||, ||limfom, nehodžkinov, adrenal gland neoplasms||, ||nadbubrežne žlezde, neoplazme, drug therapy||, ||lečenje lekovima, surgical procedures, operative||, ||hirurgija, operativne procedure, prognosis||, ||prognoza,

Sažetak


Uvod. Primarni adrenalni nehočkinski limfom izuzetno je redak oblik limfoma i odlikuje se lošom prognozom. Sa druge strane, double-hit limfomi sa BCL2 i MYC translokacijom karakterišu se uznapredovalom bolešću u vreme postavljanja dijagnoze, često prisutnom ekstranodalnom lokalizacijom bolesti i lošom prognozom. Prikaz bolesnika. Prikazali smo bolesnika starog 73 godine sa double-hit primarnim limfomom nadbubrega sa očuvanom adrenalnom funkcijom i povoljnim kliničkim tokom. Kompjuterizovanom tomografijom abdomena registrovana je tumorska promena leve adrenalne žlezde, veličine 9 ´ 7 cm, dok nije utvrđeno prisustvo bolesti na drugim lokalizacijama. Učinjeno je kompletno hirurško ukljanjanje tumorske promene i na osnovu histološkog pregleda postavljena je dijagnoza difuznog B krupnoćelijskog limfoma, (DLBCL) non-GCB podtipa. Nakon hirurškog lečenja primenjen je R-CHOP protokol sa redukovanim dozama adriablastina zbog smanjene ejekcione frakcije leve komore. I pored veoma lošeg prognostičkog profila bolesti (non-GCB tip, bulky bolesti, visokih vrednosti laktat dehidrogenaze, visokog komorbiditetnog skora i double-hit fenotipa) bolesnik je već 20 meseci u kompletnoj remisiji. Conclusion. Imunohemioterapija (R-CHOP) u kombinaciji sa hirurškim lečenjem je efikasna prva linija terapije kod bolesnika sa primarnim adrenalnim difuznim B-krupnoćelijskim limfomom i pored nepovoljnog prognostičkog profila i double-hit fenotipa bolesti.

Biografija autora

Olivera Marković, Clinical Hospital Center “Bežanijska kosa”, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Department of Hematology

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Objavljeno
2015/04/23
Broj časopisa
Vol. 71 Br. 7 (2014)
Rubrika
Prikaz bolesnika