title: Primary Intestinal Diffuse Large B-cell Lymphoma in Taiwan Showed a Relative Higher Rate of Perforation and EBV Association.
abstract: We retrospectively investigated 59 surgically resected primary intestinal diffuse large B-cell lymphomas (PI-DLBCL) including 31 males and 28 females with a median age of 66. Eleven (19%) tumors were perforated at presentation; 8 (14%) were multicentric. Ileum (n=24; 43%) and ileocecum (n=17; 30%) were most frequently involved. Twenty-one (36%) patients did not receive chemotherapy or radiotherapy including 6 with perforation and died in 0.2 to 7 months. The 1-, 2-, and 5-year overall survival rates were 68.4%, 56.5%, and 50.0%, respectively. Seven (12%) of 59 cases were positive for Epstein-Barr virus (EBV) by in situ hybridization. IGH, BCL2, BCL6, and MYC foci were rearranged in 22%, 3%, 17%, and 7% cases, respectively, with 14% exhibiting gain/amplification at the MYC locus. Perforation (P=0.009), high ECOG PS (≥2) (P=0.018), and no adjuvant chemotherapy (P<0.001) were poor prognostic factors but not immunophenotype including co-expression of bcl-2 and myc, EBV status, or chromosomal aberrations. Perforation and chemotherapy remained significant by multivariate analysis. PI-DLBCL in Taiwan carried a relatively higher rate of perforation, lower frequency of germinal center B-cell phenotype, and higher EBV association as compared with studies from other geographic areas. Furthermore, perforation was a poor prognostic factor.
authors.affiliation: Departments of *Radiology, Chi Mei Medical Center, Liouying †Pathology ∥Medical Research, Chi-Mei Medical Centre, Tainan, Taiwan ‡Department of Nursing, National Tainan Institute of Nursing, Tainan, Taiwan §Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital and School of Medicine, Kaohsiung Medical University ¶Department of Pathology, Kaohsiung Chang Gung Memorial Hospital-Kaohsiung Medical Centre #Chang Gung University College of Medicine **Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital and Centre for General Education, Yuh-Ing Junior College of Health Care and Management, Kaohsiung ††Department of Pathology, Chung Shan Medical University Hospital and School of Medicine, Chung Shan Medical University, Taichung ‡‡Department of Pathology and Laboratory Medicine, Koo Foundation Sun Yat-Sen Cancer Centre §§Department of Pathology, Taipei Medical University and National Taiwan University, Taipei, Taiwan.
authors.forename: Yi-Hsuan
authors.initials: YH
authors.lastname: Lu
authors.forename: Sheng-Tsung
authors.initials: ST
authors.lastname: Chang
authors.forename: Sheau-Fang
authors.initials: SF
authors.lastname: Yang
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.forename: Wan-Ting
authors.initials: WT
authors.lastname: Huang
authors.forename: Pin-Pen
authors.initials: PP
authors.lastname: Hsieh
authors.forename: Jeng-Dong
authors.initials: JD
authors.lastname: Hsu
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Tsou
authors.forename: Shih-Sung
authors.initials: SS
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020031:Epstein-Barr Virus Infections / Q000473:pathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007414:Intestinal Neoplasms / Q000150:complications / Q000473:pathology* / Q000821:virology; D007416:Intestinal Perforation / Q000150:complications*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013624:Taiwan; D055815:Young Adult