Lymphoma of the ankle. Really? (cont)

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Continued from the previous part …


Since I don't subscribe to the Journal of the American Podiatric Medical Association, I plunked down $5 to gain 24-access to the paper because the abstract gave up little information and frankly I wanted to know how it ended.


Answer: Not well.

First, they surgically removed the ankle tumor, which weighed an impressive 60 grams (see pic above, if you're willing). A sample went straight to pathology where they learned it was a lymphoma. Further testing revealed it to be DLBCL, and later testing showed that it had completely metastasized—the poor woman was drowning in lesions. Despite chemo and radiation, the patient died seven months after surgery.

Not what I was expecting, especially considering that this massive ankle tumor was the woman's first indication of any trouble. Not only that, but eight months before the surgery, her ankle looked normal.


So how could it be diffuse large B-cell lymphoma?

Because on its face DLBCL is, like all lymphomas, just a histological description that barely transcends the most basic of information:

diffuse = widely spread through a tissue sample (not localized)
large = large cell size, as in larger than surrounding healthy cells
b-cell = the lymphocyte in question
lymph— = grammatical prefix indicating the lymphatic system, part of the immune system.
—oma = grammatical suffix indicating cancer (sarcoma, carcinoma, melanoma etc).

The potentially enormous cytogenetic disparity between any two cases of DLBCL is likely the reason why standard treatment for the subtype—six cycles of R-CHOP followed by radiation—is ineffective for some patients.

As a microbiologist recently said to me, a single protein expression on the surface of a cancer cell can mean the difference between one of us beating cancer and the other not beating cancer.

Finally, there was no evidence in the paper that doctors ever determined the true primary site. Cancer of unknown primary origin currently constitutes one of the most prevalent cancers in the world, accounting for as much as 5% of all diagnoses.

This person's cancer very likely could have started anywhere, since the lymph system traverses the entire body, and the body features hundreds of lymph nodes, it becomes possible for lymphoma—for cancerous lymphocytes I mean—to develop anywhere and become trapped in any one of those nodes.

Her lymphoma just happened to first present itself in the ankle.

Hence, DLBCL of the ankle.


Fortunately, researchers are slowly moving away from approaching cancer as an anatomical disease—breast, liver, bone, lung—and toward cancer as a molecular one, few places better illustrated than in the recent story of a Vancouver man whose resilient tongue cancer turned out to be, after sequencing the tumor's genome, a lot less like oral cancer and a whole lot more like renal cell carcinoma.

i.e. kidney cancer.

By Ross Bonander

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