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CORRESPONDENCE
Year : 2013  |  Volume : 9  |  Issue : 3  |  Page : 532-533

Co-occurrence of diffuse large B cell non-hodgkin lymphoma and chronic hepatitis C in Algerian patients: Two case reports


1 Section of Cancer Information, International Agency for Research on Cancer, 150 Cours A, Thomas, Lyon Cedex, France
2 Department of Internal Medecine, Touhami Benflis University Teaching Hospital, Route de Tazoult, Batna, Algeria
3 Department of Hematology, Touhami Benflis University Teaching Hospital, Route de Tazoult, Batna, Algeria
4 Laboratory of Virology, Hospices Civils de Lyon, Croix Rousse Hospital, 103; U851, Inserm, 103, Grande rue de la Croix-Rousse; University of Lyon, University of Lyon 1, 43, Boulevard du 11 Novembre 1918, Villeurbanne Cedex, Lyon, France
5 University of Lyon, University of Lyon 1, 43, Boulevard du 11 Novembre 1918, Villeurbanne Cedex; Department of Hygiene, Epidemiology and Prevention, Edouard Herriot Hospital, Hospices Civils de Lyon; Laboratory of Epidemiology and Public Health, CNRS, UMR, 5 Place d'Arsonval, Lyon, France

Date of Web Publication8-Oct-2013

Correspondence Address:
Karima Chaabna
International Agency for Research on Cancer, Cancer Information Section, 150 Cours Albert Thomas, Lyon Cedex
France
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DOI: 10.4103/0973-1482.119372

PMID: 24126002

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 > Abstract 

For the first time in Algeria, we report on the presentation, diagnosis and management of two cases of diffuse large B cell NHL with chronic HCV infection. Both Algerian patients came for medical consult without HCV-related symptoms. Systematic serological tests to identify HIV and hepatitis B and C infections which performed on all patients led to HCV diagnosis. Chemotherapy was given to both patients without exacerbation of the HCV infection. These observed cases shed new light on the possible pathogenesis of NHL in Algerian population. Indeed, in Algeria, HCV may partly been responsible of the unexplained increase of NHL incidence in Eastern region of Algeria especially among those who are frequently exposed to HCV risk factors (haemodialysis and dental care). Furthermore, our observations underscore the importance of prevention programmes including screening to control HCV in Algeria.

Keywords: Algeria, cancer, hepatitis C, infection, non-hodgkin lymphoma


How to cite this article:
Chaabna K, Soerjomataram I, Rouabhia S, Chichoune S, Scholtes C, Vanhems P, Saidi M, Forman D. Co-occurrence of diffuse large B cell non-hodgkin lymphoma and chronic hepatitis C in Algerian patients: Two case reports. J Can Res Ther 2013;9:532-3

How to cite this URL:
Chaabna K, Soerjomataram I, Rouabhia S, Chichoune S, Scholtes C, Vanhems P, Saidi M, Forman D. Co-occurrence of diffuse large B cell non-hodgkin lymphoma and chronic hepatitis C in Algerian patients: Two case reports. J Can Res Ther [serial online] 2013 [cited 2014 Oct 22];9:532-3. Available from: http://www.cancerjournal.net/text.asp?2013/9/3/532/119372


 > Introduction Top


In Batna, Algeria Non-Hodgkin lymphoma (NHL, C82-C85; C96) incidence has increased between 1995 and 2008. [1] The causes of this increase remain unknown. Extra-hepatic cancers, related to hepatitis C Virus (HCV), have only recently been identified. [2] This is the first report presenting the occurrence of B-cell NHL with HCV in patients in Algeria; aiming to suggest hypothesis on the increasing incidence of NHL in Eastern region of Algeria.


 > Clinical Presentation and Intervention Top


Patient 1: The patient was a 66-year-old woman admitted to the hematological service for treatment of diffuse large-cell lymphoma in 2010. A fever accompanied by intense fatigue and profuse night sweats led her to consult. During physical examination, lower left cervical lymphadenopathy was detected. Lymph node biopsy followed by histological study and completed by immunohistochemistry led to the diagnosis of large B-cell non-Hodgkin lymphoma (CD45 and CD20 positive).

Blood viral test were negative for human immunodeficiency virus (HIV) and hepatitis B (HBV), but positive for HCV (subsequently confirmed by polymerase chain reaction). The virus was genotyped as 1b using the Versant Lipa genotype assay. [3] Several potential HCV transmission factors were identified in this patient. She has had seven births, one induced abortion and several dentist visits. The presence of traditional piercings and tattoos was also noted. However, there was no history of dialysis, intravenous drug use, blood transfusion, hospitalization, surgery, endoscopy or occupational exposure.

Clinically, the patient had a lower left cervical lymphadenopathy and a left axillary lymphadenopathy 4cmx4cm and splenomegaly with a 16cm overhang. A computed tomography - scan (CT-scan) showed hetero-nodular splenomegaly, hepatomegaly and hilar lymphadenopathy of the liver and the spleen. The chest radiology was normal. The blood count showed leukocytosis (13,500/mm 3 ) predominantly granulocytic (10,400/mm 3 ), moderate anemia (haemoglobin Hb: 9.4g/dl), normochromic, normocytic and normal platelet count. Furthermore, the presence of inflammation was observed with erythrocyte sedimentation 117mm/min; high fibrinogen 5.33g/l. Lactate dehydrogenase (LDH) level was elevated (1125 UI/l) and aminotransferase were normal. Gamma GT and alkaline phosphatase were not quantified. Moreover, blood analyses showed hypoalbuminemia (31g/l) but normal glucose, urea and creatinine level.

The patient received 8 cycles of R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine and Prednisolone) which achieved a complete remission of NHL. Maintenance treatment with quarterly monoclonal anti-CD20 antibody Rituximab is underway. No clinical sign of progression of hepatitis C was observed during treatment of the NHL i.e. No jaundice nor liver tenderness on palpation and normal level of aminotransferases. For economic reason patient received no treatment for the HCV infection.

Patient 2: The patient was a 63-year-old woman who has had type II diabetes since the age 59 years and hypertension for 23 years. The first symptoms began in 2009, including sore throat with tonsillar hypertrophy, fever, dysphagia, dysphonia and snoring, and finally the patient came for medical consult in 2010.

Upper jugulo-carotid lymphadenopathy and a significant increase in the volume of the right amygdala (tumour-like) were found during Ear, Nose and Throat (ENT) consultation. Biopsy and histological study of the amygdala led to a diagnosis of diffuse large B cell non-Hodgkin lymphoma, with intense and diffuse expression of CD20 and CD45.

Viral serologies showed that the patient was HIV- and HBV-negative but HCV-positive (subsequently confirmed by PCR). Identified HCV transmission factors included nine deliveries, one induced abortion, dental care, and piercings and traditional tattoos. No history of dialysis, intravenous drug use, blood transfusion, hospitalization, surgery, endoscopy or occupational exposure was noted.

The patient's hemogram was within normal limits with no signs of inflammation. Furthermore, renal function and level of protein and albumin were normal. CT-scan of the oropharynx showed a right tonsillar tumour tissue thickening with large compressive carotid-jugular lymphadenopathy and a heterogeneous densification of the thymic lodge. The thoracic and abdominal scans were normal, as was the bone marrow biopsy.

After six cycles of R-CHOP, patient had a complete remission of lymphoma. Maintenance treatment has been scheduled but not performed because of patient refusal. During the induction treatment, no progression of hepatitis C was observed i.e. No clinical sign of hepatitis activity (jaundice or liver tenderness on palpation). No treatment against HCV infection was planned due to patient' psychiatric problem.


 > Discussion Top


We report two cases of large B cell NHL with complete remission after R-CHOP treatment, who concurrently had a chronic hepatitis C. Chemotherapy did not increase HCV ribonucleic acid (RNA) levels nor aggravate hepatic lesions in these patients. Unfortunately, due to co-existing disease and economic reason, patients did not receive treatment for the HCV infection i.e. pegylated interferon alpha and Ribavirin.

In Algeria, the prevalence of HCV in the general population was low; [4],[5] although much higher prevalence in haemodialysis patients has been described (40.7%). [6] In this report both patients have very similar risk factors for HCV transmission; exposure to blood products, supporting previous studies which have highlighted the importance of nosocomial transmission in Algeria. [5],[7] Our observations emphasize the importance of preventive programmes including screening to control HCV spread in this country.

The aetiology of NHL is complex and has been associated with different viruses including EBV, HHV-8, HIV, HTLV-1 as well as HCV. [2],[8] These observed cases shed new light on the possible pathogenesis of NHL and they may partly explain the emergence of NHL especially among those who are frequently exposed to medical procedures in Algerian population.

HCV is an established cause of NHL; however our case study raises the concern whether it is the major factor behind the recent increase of haematological malignancy in Algeria.

 
 > References Top

1.Bouhidel M. Registre du cancer de la Wilaya de Batna de 2008. Report. Batna, Algeria: CHU de Batna; 2011.  Back to cited text no. 1
    
2.Bouvard V, Baan R, Straif K, Grosse Y, Secretan B, El Ghissassi F, et al. A review of human carcinogens--Part B: Biological agents. Lancet Oncol 2009;10:321-2.  Back to cited text no. 2
[PUBMED]    
3.Siemens. Versan HCV genotype assay 2.0 (LiPA) [Internet]. [update: 2011 cited: 2011 accessed 2011]. Available from: http://www.swe.siemens.com/france/web/fr/diagnostics/produits/specialites/biologie_moleculaire/instruments/Pages/versant_HCV_genotype2_0.aspx.   Back to cited text no. 3
    
4.Ayed Z, Houinato D, Hocine M, Ranger-Rogez S, Denis F. Prevalence of serum markers of hepatitis B and C in blood donors and pregnant women in Algeria. Bull Soc Pathol Exot 1995;88:225-8.  Back to cited text no. 4
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5.Berkane S. Etude prospective anatomo-clinique des hepatites chroniques d′origine virale de l′adulte [Thesis]. Algiers, Algeria: Algiers University, Faculty of Medecine; 2003.  Back to cited text no. 5
    
6.Bensalem A, Soltani M, Hihi N, Mostefaoui F, Dahmani O, Kerioui C, et al. Prevalence of Hepatitis B and C in Algerian Center of Dialysis. La 4ème Journée Nationale d′Hygiène Hospitalière et de Lutte Contre les Infections Associées aux Soins. Algiers, Algeria. 2011.  Back to cited text no. 6
    
7.Zemouli N, Gourari S, Ousser F, Ziane H, Djennane F, Neggazi M, et al. Hepatitis C and Haemodialysis, Experience of Mostapha Teaching Hospital. La 4ème Journée Nationale d′Hygiène Hospitalière et de Lutte Contre les Infections Associées aux Soins. Algiers, Algeria. 2011.  Back to cited text no. 7
    
8.Dal ML, Franceschi S. Hepatitis C virus and risk of lymphoma and other lymphoid neoplasms: A meta-analysis of epidemiologic studies. Cancer Epidemiol Biomarkers Prev 2006;15:2078-85.  Back to cited text no. 8
    




 

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