Non-Hodgkin's Lymphoma, Stage III-B-E: a Case Report

M.D. Luigi Pisani - Non-Hodgkin's Lymphoma, Stage III-B-E: a Case Report

Summary

I report the case of a patient with Non-Hodgkin's Lymphoma stage III-B-E (the location extranodal was represented by a lymphomatous infiltration of the skin in the nasal region).

The patient presented in addition to a bilateral lateral cervical and supraclavicular lymphadenopathy, night sweats and fever.

The clinical picture of the skin lesion, to my observation is represented by the photos:

Fig. 1: Beginning of treatment - 12/April/2005

Figure1

Fig. 2: Beginning of treatment - 12/April/2005

Figure2

Fig. 3: Beginning of treatment - 12/April/2005

Figure3

Fig. 4: Beginning of treatment - 12/April/2005

Figure4

Introduction

Malignant non-Hodgkin's lymphomas (NHL) are a very complex group of diseases, with an anatomical-clinical polymorphic framework, classification approaches in continual reworking and therapeutic strategy in constant evolution.

The NHL may occur preferentially affecting different anatomical sites, they debut involving more lymph nodes and then extend to the spleen, bone marrow and other tissues and organs.

Primitives extralymphatic locations are found in 20-30% of cases and preferentially affecting the gastrointestinal tract, the skin, the central nervous system and testicles.

Skin may be affected by the lymphomatous infiltration in the course of lymphomas originated elsewhere, which subsequently spread to the skin (secondary cutaneous lymphomas); more frequent are the primitive lymphomas of the skin which, eventually subsequently spread to the lymph nodes and/or to the internal organs. Basically all lymphomas may involve the skin.

NHLs like the other hematopoietic malignancies, should be considered systemic diseases: the treatment aims to the cure of the widespread and aggressive lymphomas since for these groups of malignancies is now possible to obtain a high percentage of durable complete remissions using modern schemes of intensive polychemotherapy, including high-dose treatment with support of circulating hematopoietic precursors.

In lymphomas of indolent manifestation does not seem currently possible to obtain a healing with the therapeutic means available today, probably due to one of the oncogenes of the drug resistance (bcl-2), accordingly the treatment aims primarily to a long control of the disease by using little aggressive therapies.

Method

In this particular case I began a treatment with Somatostatin analogs, All-trans Retinoic Acid, Melatonin, Cyclophosphamide, Cabergoline, Soothing V Paste and V10 Oleogel.

The aim of treatment has been to inhibit angiogenesis by exploiting the potential of Somatostatin analogs, while the application of Codex V soothing paste and Codex V10 Oleogel, over the whole area twice a day in abundant quantity, to rebalance and re-activate the immune response in the regional lymph nodes. In fact, the skin and mucosal cells have immune competence and primary importance in the healing process.

Outcome

The patient underwent the therapeutic treatment described above. The follow-up shows, in a meaningful way, the disappearance of the skin lesions, as documented by the pictures (see below), the absence of side effects and of drug toxicity.

Fig. 5: After 2 months - 12/June/2005

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Fig. 6: After 2 months - 12/June/2005

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Fig. 7: After 2 months - 12/June/2005

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Fig. 8: After 2 months - 12/June/2005

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Conclusions

The result achieved in this case appears very promising and therefore the therapy with Somatostatin analogs, associated to a cutaneous trophic, although it is not completely clear the mechanism by which they exert the antiproliferative effect, may be a viable alternative in the presence of these localizations, especially in relation to the fact that the antineoplastic chemotherapeutic agents are drugs with very narrow therapeutic index, whose toxicity is mostly due to the inability to discriminate between normal cells and tumor cells.

The direct consequences are: on the one hand the occurrence of adverse events, even serious, with a deterioration in the quality of life of patients treated with these drugs; on the other hand a reduced tumor control, because the appearance of toxicity limits the dose of the chemotherapeutic and may prevent the reaching of adequate therapeutic dosages.

Bibliography

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• Oomen SP, Hofland LJ, van Hagen PM, Lamberts SW, Touw IP. - Somatostatin receptors in the haematopoietic system. Eur J Endocrinol. 2000 Oct;143 Suppl 1:S9-14;
• Pollak MN, Schally AV. - Mechanisms of antineoplastic action of somatostatin analogs. Proc Soc Exp Biol Med. 1998 Feb;217(2):143-52;
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About this publication.

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