1. Hem/Onc Tumor Board Presentation
Advanced Topics in Cancer Biology
Katy Van Hook
June 3, 2009

2. 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

3. MA 32 y/o female CT
Multiple lesions in the spleen
Flow cytometry of peripheral blood lymphocytes was normal suggesting that it is not lymphoma
Just watch

4. 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
Encapsulated organism is a general term for a group of polysaccharide coated bacteria including: pneumococcus, meningococcus (meningitis) and salmonella typhi (thyphoid fever)
Thrombocytopenia can be caused by a lot of different things: vitamin imbalance, leukemia, liver failure, sepsis, dengue fever, and many more.
Echinococcus granulosus
Marginal zone lymphoma is typically associated with heliobacter pylori
Surgery—larger procedure that will leave her with the risk of sepsis and other types of infection
Biopsy—run the risk of not getting a good sample (decide on CT guided) but she would still have her spleen

5. 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
D2-40: monoclonal antibody for lymphatic endothelial cells. Antibody against podoplanin, a mucin-type transmembrane protein
Internet Journal of Pathology vol 8 no. 1

6. Hemangioma Hemangioma Splenic hemangiomas
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
<100 patients reported in medical literature

7. Lymphangioma Childhood 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?
Splenic lymphangiomas/hemangiomas are often discovered incidentally

8. Mechanisms are relatively unknown
Lymphangioma
Elevated expression of VEGR2/3, and VEGF-C
Hemangioma
Elevated expression of VEGF and fibroblast growth factor (FGF)
BMC Cancer (2007) 7:105

9. Treatment options No treatment-monitor patient Splenectomy
Risk of rupture
Compression of other organs
Splenectomy
Embolization
Polyvinyl alcohol calibrated spheres
Vascular growth inhibitors
VEGF inhibition has been suggested studies are ongoing

10. 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:
Disler DG and Chew FS. (1991) AJR 157:44
Internet Journal of Pathology. Vol. 8 no. 1