Non-Hodgkin's lymphoma developing in a pacemaker pocket.
A 29-year-old man developed diffuse large B-cell lymphoma in a subpectoral pacemaker pocket that 6 years previously had been created in the chest for a titanium-covered pulse generator. The patient had an 8-cm-diameter dark red tumor with necrotic tissue on a keloidal surgical scar in the left side of the chest. Left axillary lymphadenopathy also was present. Laboratory studies showed an increased level of soluble interleukin 2 receptor and a normal level of lactose dehydrogenase. A biopsy specimen showed a diffuse large B-cell phenotype and monoclonal immunoglobulin H gene rearrangement. A gallium scintigraphy study showed abnormal accumulation in the left chest and left axilla. On the basis of these findings, we diagnosed diffuse large B-cell lymphoma, stage II. The patient received THP-COP chemotherapy (pirarubicin, cyclophosphamide, vincristine, and prednisolone) and radiotherapy, achieved complete remission, and was free of disease for 16 months after treatment. This case suggests that there was a relationship between the development of non-Hodgkin's lymphoma and the presence of chronic inflammation in the pulse generator pocket.
Hojo
Nobumasa
N
First Department of Internal Medicine, Ehime University School of Medicine, Onsen-Gun, Ehime, Japan. hojo@m.ehime-u.ac.jp
Yakushijin
Yoshihiro
Y
Narumi
Hiroshi
H
Minamoto
Yoko
Y
Sakai
Ikuya
I
Takada
Kiyonori
K
Hato
Takaaki
T
Yasukawa
Masaki
M
Fujita
Shigeru
S
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001344:Autopsy; D005838:Genotype; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D007249:Inflammation / Q000150:complications / Q000209:etiology; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D008297:Male; D009336:Necrosis; D010138:Pacemaker, Artificial / Q000009:adverse effects*
D000970:Antineoplastic Agents