title: Favorable response to treatment of a child with T-cell-rich large B-cell lymphoma presenting with liver failure.
abstract: The authors describe the successful management of a child with T-cell-rich large B-cell lymphoma (TCRBCL) involving the lymph nodes and liver, causing severe hepatic dysfunction. After immunohistochemical confirmation of the diagnosis, the patient was treated initially with low-dose, non-hepatotoxic chemotherapy and irradiation to the porta hepatis. Chemotherapy was gradually escalated to intensified B cell-lymphoma treatment regimens (CHOP, CYVE, COPAdM) as liver function improved. Despite prompt and notable response in the lymph nodes, the intrahepatic nodular lesions persisted radiologically. Liver function tests normalized during the course of treatment. However, radiologic studies of the liver showed abnormal regeneration with a predominant left lobe overshadowing a tiny right lobe. The patient remains in remission more than a year after completion of treatment. Judicious use of chemotherapeutic agents with or without local radiotherapy may influence the outcome and survival in children with TCRBCL involving the liver and causing abnormal hepatic function.
authors.affiliation: Department of Pediatric Hematology/Oncology, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia. rajeevsat@hotmail.com
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Sathiapalan
authors.forename: Bo
authors.initials: B
authors.lastname: Hainau
authors.forename: Khalid
authors.initials: K
authors.lastname: Al-Mane
authors.forename: Asim F
authors.initials: AF
authors.lastname: Belgaumi
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000150:complications* / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D013601:T-Lymphocytes / Q000276:immunology*; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone