Hem/Onc Tumor Board Presentation

Advanced Topics in Cancer BiologyKaty Van HookJune 3, 2009

MA 32 y/o female

• 12/08 she is seen for epigastric pain, night sweats, and nausea– 28 weeks pregnant

• Symptoms persist and she receives an abdominal ultra sound – Enlarged spleen (14 x 12.7 x 5.7 cm)– Innumerable variable-sized relatively well

circumscribed hyperechoic lesions

• CT– Multiple lesions in the

spleen• Flow cytometry of

peripheral blood lymphocytes was normal suggesting that it is not lymphoma– Just watch

MA 32 y/o female

• Delivers baby (#9!) on 3/5/09• 3/28/09 her condition improves but is still having

night sweats• History of malaria, + PPD, parasites, etc…– Normal labs except for mild thrombocytopenia (low

platelet count)– She is immunized for an encapsulated organism

• Infection? Marginal zone lymphoma? Metastatic disease?

• Surgery vs. Biopsy

MA 32 y/o female

Pathology• No evidence of lymphoma– CD3 (T cell) CD20 (B cell) are

normal– Weakened D2-40

• Dilated vascular spaces lined by flattened endothelial cells

• Lots of red blood cells• Vascular lesion– Hemangioma or

lymphangioma • Looks benign• Splenic lesions– 57% lymphoma– 7% benign of malignant

vascular neoplasm

Internet Journal of Pathology vol 8 no. 1

HemangiomaHemangioma• Benign tumor of endothelial cells that

line the blood vessels• Most common childhood tumor

affecting 10% of Caucasians • Most common sites are face and neck

Splenic hemangiomas• The most common primary splenic

neoplasm• Incidence between 0.03%-14% at

autoposy• Malginant transformation is extremely

rare

LymphangiomaChildhood Lymphangioma• Benign hyperplasia of lymphatic vessels• 6% of benign tumors in children• Most common sites are face and neck • Thought to be a developmental malformation

Adult Lymphangioma• VERY rare in adults• Lymphatic vessel with

proliferative behavior• Initial lymphatics that

never fully form• Initiated by injury or

infection? Dysregulated GF?

Mechanisms are relatively unknownLymphangioma• Elevated expression of

VEGR2/3, and VEGF-C

Hemangioma• Elevated expression of

VEGF and fibroblast growth factor (FGF)

BMC Cancer (2007) 7:105

Treatment options• No treatment-monitor patient– Risk of rupture– Compression of other organs

• Splenectomy• Embolization– Polyvinyl alcohol calibrated spheres

• Vascular growth inhibitors– VEGF inhibition has been suggested studies are

ongoing

References

• Fagen K, et al. (2008) JVIR 20:559-560• Wiegand S., et al. (2008) Virchows Arch 453:1• Norgall S., et al. (2007) BMC Cancer 7:105• Willcox TM. et al. (2000) J Gastrointest Surg

4:611-613• Disler DG and Chew FS. (1991) AJR 157:44• Internet Journal of Pathology. Vol. 8 no. 1