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CD20-positive primary gastric T-cell lymphoma poorly responding to initial treatment with rituximab plus CHOP, and a literature review

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Abstract

There have been rare reported cases of peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) that co-expressed CD20. A 44-year-old Japanese male was initially misdiagnosed as CD20-positive diffuse large B-cell lymphoma with a background of reactive CD3-positive T-cells in the stomach. After four cycles of R-CHOP [rituximab plus cyclophosphamide (CY), doxorubicin, vincristine, and prednisolone (PSL)], total gastrectomy with regional lymph node dissection was performed due to the poor response to R-CHOP. A final diagnosis of CD20-positive primary gastric PTCL-NOS was made based on the immunohistochemical, flow cytometric, and molecular genetic findings. In the present case, CD20 immunostaining for T-cell lymphoma cells in tumor tissue varied; in a large part, these were strong to weak-positive, and in some parts, absent. We additionally reviewed the literature focusing on CD20-positive PTCL-NOS treated with rituximab. The administration of rituximab has been performed as an initial treatment in 11 cases, including the case reported here. The response was good in cases with high expression of CD20, while it was poor in cases with variable intensity in CD20 staining, which is consistent with our experience in the present case. The efficacy of rituximab may be associated with intensity of CD20 expression in T cells and its homogeneity in the tumor tissue.

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Acknowledgments

We acknowledge Dr. Akio Takada, a pathologist at Asahikawa City Hospital, who contributed to the immunohistochemical study. We also state that this report has original material and there have been no previous reports or publications to disclose. This case was presented in 75th Annual Meeting of Japanese Society of Hematology, Sapporo, Japan, 11–13 October 2013.

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Authors and Affiliations

  1. Department of Hematology, Asahikawa City Hospital, 1-65, Kinseicho-1, Asahikawa, 070-8610, Japan

    Yasutaka Kakinoki, Takashi Ishio & Koji Chiba

  2. Department of Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Junichi Hashiguchi

  3. Department of Pathology, School of Medicine, Kurume University, Kurume, Japan

    Daisuke Niino & Koichi Ohshima

Authors
  1. Yasutaka Kakinoki
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  2. Junichi Hashiguchi
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  3. Takashi Ishio
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  4. Koji Chiba
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  5. Daisuke Niino
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  6. Koichi Ohshima
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Correspondence to Yasutaka Kakinoki.

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Kakinoki, Y., Hashiguchi, J., Ishio, T. et al. CD20-positive primary gastric T-cell lymphoma poorly responding to initial treatment with rituximab plus CHOP, and a literature review. Int J Hematol 102, 702–708 (2015). https://doi.org/10.1007/s12185-015-1841-x

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  • DOI: https://doi.org/10.1007/s12185-015-1841-x

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