Splenic Marginal Zone Lymphoma in a Chronic Hepatitis B Patient: A Rare Case Report and a Literature Review

Alma Barbullushi (Rucaj); Anila Kristo; Jovan Basho

doi:10.3889/oamjms.2022.11116

Authors

Alma Barbullushi (Rucaj) Department of Paraclinical Subjects, Faculty of Medical Technical Sciences, University of Medicine, Tirana, Albania
Anila Kristo Department of Morphology, Faculty of Medicine, University of Medicine, Tirana, Albania
Jovan Basho Service of Hepatology and Gastroenterology, Faculty of Medicine, University of Medicine, UHC “Mother Teresa”, Tirana, Albania

DOI:

https://doi.org/10.3889/oamjms.2022.11116

Keywords:

Chronic hepatitis B, Non-Hodgkin lymphoma, Splenic marginal zone lymphoma

Abstract

BACKGROUND: Hepatitis B virus (HBV) is an important global public health problem with significant morbidity and mortality. Chronic HBV infection is a dynamic process with the risk of progression to cirrhosis and hepatic carcinoma (HCC). Although HCC is currently the main concern for diagnosed chronic hepatitis B (CHB), these patients are also considered in high risk for developing B-cell non-Hodgkin lymphoma (B-NHL). The increased risk for B-NHL is well- documented in chronic hepatitis C patients, while in HBV patients are still subject of studies and the most common form of B-NHL reported in these studies is diffuse large B-cell lymphoma (DLBCL).

CASE REPORT: We are reporting the case of a patient with chronic HBV infection complicated with a rare type of B-NHL, a splenic marginal zone lymphoma (SMZL) and through a literature review aim to assess the importance of being aware of the increased risk of lymphoproliferative disorders in chronic HBV patients, asses the role of laboratory follow-up for the early diagnose of this complication, and also recommend testing for HBV infection in all patients diagnosed with B-NHL not only in DLBCL forms but also in rare forms like SMZL.

CONCLUSION: CHB infection has an increased risk for B-NHL not only for the aggressive DLBCL form which is the most common form encountered but also for SMZL which is a rare indolent form of B-NHL with a better prognosis. Laboratory monitoring has a great value to the early detection of B-cell clonal expansion. In all SMZL, patients are recommended screening for HBV, because treatment with antivirals may regress lymphoma and also prevent reactivation of HBV in case of chemotherapy, especially rituximab.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systematic review of data published between 1965 and 2013. Lancet. 2015;386(10003):1546-55. https://doi.org/10.1016/s0140-6736(15)61412-x PMid:26231459

Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2095-128. https://doi.org/10.1016/S0140-6736(12)61728-0 PMid:23245604

Jefferies M, Rauff B, Lam T, Rafiq S. Update on global epidemiology of viral hepatitis and preventive strategies. World J Clin Cases. 2018;6(13):589-99. https://doi.org/10.12998/wjcc.v6.i13.589 PMid:30430114

European Association for the Study of the Liver. EASL 2017 Clinical Practice Guidelines on the management of hepatitis B virus infection. J Hepatol. 2017;67(2):370-98. https://doi.org/10.1016/j.jhep.2017.03.021 PMid:28427875

Varbobitis I, Papatheodoridis GV. The assessment of hepatocellular carcinoma risk in patients with chronic hepatitis B under antiviral therapy. Clin Mol Hepatol. 2016;22(3):319-26. https://doi.org/10.3350/cmh.2016.0045 PMid:27729632

Deng L, Song Y, Young KH, Hu S, Ding N, Song W, et al. Hepatitis B virus-associated diffuse large B-cell lymphoma: Unique clinical features, poor outcome, and hepatitis B surface antigen-driven origin. Oncotarget. 2015;6(28):25061-25073. https://doi.org/10.18632/oncotarget.4677 PMid:26314957

Wang Y, Wang H, Pan S, Hu T, Shen J, Zheng H, et al. Capable infection of hepatitis B virus in diffuse large B-cell lymphoma. J Cancer. 2018;9(9):1575-81. https://doi.org/10.7150/jca.24384 PMid:29760795

Kim JH, Bang YJ, Park BJ, Yoo T, Kim CW, Kim TY, et al. Hepatitis B virus infection and B-cell non-Hodgkin’s lymphoma in a hepatitis B endemic area: A case-control study. Jpn J Cancer Res. 2002;93(5):471-7. https://doi.org/10.1111/j.1349-7006.2002.tb01280.x PMid:12036441

Yood MU, Quesenberry CP Jr., Guo D, Caldwell C, Wells K, Shan J, et al. Incidence of non‐Hodgkin’s lymphoma among individuals with chronic hepatitis B virus infection. Hepatology. 2007;46(1):107-12. https://doi.org/10.1002/hep.21642 PMid:17526021

Fujimoto K, Endo T, Nishio M, Obara M, Yamaguchi K, Takeda Y, et al. Complete remission of splenic marginal zone lymphoma after an acute flare-up of hepatitis B in a hepatitis B virus carrier. Int J Hematol. 2009;90(5):601-4. https://doi.org/10.1007/s12185-009-0426-y PMid:19802732

Christou L, Kalambokis G, Bai M, Kamina S, Tsianos EV. Splenic marginal zone lymphoma in a patient with chronic hepatitis B. J Gastrointestin Liver Dis. 2009;18(4):511-2. PMid:20076834

Mathew J, Aldean I. Splenic marginal zone lymphoma associated with hepatitis B virus infection: A case report. Internet J Surg. 2002;5:3.

Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: International Agency for Research on Cancer (IARC); 2008. p. 439.

Troussard X, Valensi F, Duchayne E, Garand R, Felman P, Tulliez M, et al. Splenic lymphoma with villous lymphocytes: Clinical presentation, biology and prognostic factors in a series of 100 patients. Br J Haematol. 1996;93(3):731-6. https://doi.org/10.1046/j.1365-2141.1996.d01-1711.x PMid:8652403

Morton LM, Slager SL, Cerhan JR, Wang SS, Vajdic CM, Skibola CF, et al. Etiologic heterogeneity among non-Hodgkin lymphoma subtypes: The InterLymph Non-Hodgkin Lymphoma Subtypes Project. J Natl Cancer Inst Monogr. 2014;2014(48):130-44. https://doi.org/10.1093/jncimonographs/lgu013 PMid:25174034

Matutes E, Oscier D, Montalban C, Berger F, Callet-Bauchu E, Dogan A, et al. Splenic marginal zone lymphoma proposals for a revision of diagnostic, staging and therapeutic criteria. Leukemia. 2008;22(3):487-95. https://doi.org/10.1038/sj.leu.2405068 PMid:18094718

Arcaini L, Rossi D, Paulli M. Splenic marginal zone lymphoma: From genetics to management. Blood. 2016;127(17):2072-81. https://doi.org/10.1182/blood-2015-11-624312 PMid:26989207

Behdad A, Bailey NG. Diagnosis of splenic B-cell lymphomas in the bone marrow: A review of histopathologic, immunophenotypic, and genetic findings. Arch Pathol Lab Med. 2014;138(10):1295-301. https://doi.org/10.5858/arpa.2014-0291-CC PMid:25268192

Mendes LS, Du MQ, Matutes E, Wotherspoon A. Splenic marginal zone lymphoma: A review of the clinical presentation, pathology, molecular biology, and management. Blood Lymphat Cancer Targets Ther. 2014;4:29-38. https://doi.org/10.2147/BLCTT.S49373

Cacoub P, Comarmond C, Domont F, Savey L, Desbois AC, Saadoun D. Extrahepatic manifestations of chronic hepatitis C virus infection. Ther Adv Infect Dis. 2016;3(1):3-14. https://doi.org/10.1177/2049936115585942 PMid:26862398

Zignego AL, Ferri C, Pileri SA, Caini P, Bianchi FB, Italian Association of the Study of Liver Commission on Extrahepatic Manifestations of HCV infection. Extrahepatic manifestations of Hepatitis C Virus infection: A general overview and guidelines for a clinical approach. Dig Liver Dis. 2007;39():2-17. https://doi.org/10.1016/j.dld.2006.06.008 PMid:16884964

Ferri C, Pileri S, Zignego AL. Hepatitis C virus infection and non-Hodgkin’s lymphoma. In: Geodert J, (NIH) NCI, editor. Infectious Causes of Cancer Targets for Intervention. Totowa, New Jersey: The Human Press Inc.; 2000. p. 349-68.

Eclache-Saudreau V, Delmas B, Valensi F, Cacoub P, Brechot C, Varet B, et al. Regression of splenic lymphoma with villous lymphocytes after treatment of hepatitis C virus infection. N Engl J Med. 2002;347(2):89-94. https://doi.org/10.1056/NEJMoa013376 PMid:12110736

Saadoun D, Suarez F, Lefrere F, Valensi F, Mariette X, Aouba A, et al. Splenic lymphoma with villous lymphocytes, associated with Type II cryoglobulinemia and HCV infection: A new entity? Blood. 2005;105(1):74-6. https://doi.org/10.1182/blood-2004-05-1711 PMid:15353484

Hermine O, Lefre`re F, Bronowicki JP, Mariette X, Jondeau K, Eclache-Saudreau V, et al. Regression of splenic lymphoma with villous lymphocytes after treatment of hepatitis C virus infection. N Engl J Med. 2002;347:89-94. https://doi.org/10.1056/NEJMoa013376

Ababou M, Mahtat EM, Jennane S, Elmaaroufi H, Mikdame M, Doghmi K. Splenic marginal zone lymphoma associated with hepatitis B virus infection, remission after viral treatment, and splenectomy: A case report and review of the literature. Hematol Oncol Stem Cell Ther. 2021;14(2):153-5. https://doi.org/10.1016/j.hemonc.2019.05.007 PMid:31306619

Xiong W, Lv R, Li H, Li Z, Wang H, liu W, et al. Prevalence of hepatitis B and hepatitis C viral infections in various subtypes of B-cell non-Hodgkin lymphoma: Confirmation of the association with splenic marginal zone lymphoma. Blood Cancer J. 2017;7(3):e548. https://doi.org/10.1038/bcj.2017.28 PMid:28362442

Fetica B, Pop B, Blaga ML, Fulop A, Dima D, Zdrenghea MT, et al. High prevalence of viral hepatitis in a series of splenic marginal zone lymphomas from Romania. Blood Cancer J. 2016;6(11):e498. https://doi.org/10.1038/bcj.2016.102 PMid:27834940

Koot AW, Visscher AP, Huits RM. Remission of splenic marginal zone lymphoma in a patient treated for hepatitis B: A case of HBV associated lymphoma. Acta Clin Belg. 2015;70(4):301-3. https://doi.org/10.1179/2295333715Y.0000000005 PMid:25977147

Mulligan SP, Matutes E, Dearden C, Catovsky D. Splenic lymphoma with villous lymphocytes: Natural history and response to therapy in 50 cases. Br J Haematol. 1991;78(2):206-9. https://doi.org/10.1111/j.1365-2141.1991.tb04417.x PMid:2064958

Kelling M, Sokol L, Dalia S. Hepatitis B reactivation in the treatment of non-Hodgkin lymphoma. Cancer Control. 2018;25(1):1073274818767879. https://doi.org/10.1177/1073274818767879 PMid:29606020