الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 215 |  |  |
| | | from | 215 | | |
Abstract
Diffuse large B-cell lymphoma is the most common non – Hodjkin lymphoma, accounting for 25 -35 %of all new non–Hodjkin lymphoma. DLBCL is an aggressive lymphoma, In contrast to indolent (low-grade) lymphoma; the survival curve typically shows an initial downward slope followed by a plateau, indicating the potential curability of a significant proportion of patients who achieve remission.
DLBCL is a diffuse proliferation of large or medium-sized neoplastic B cells with a nuclear size greater than or equal to that of a histiocyte nucleus, or more than twice the size of a small lymphocyte.
Malignant lymphoma is an important oncologic problem in Egypt ranking the third among cancers, following Egyptian patients present with special features that are distinctly different from those reported in western literature. The Egyptian patients present at advanced stages, with 85% of cases in stage III and IV of Ann Arbor classification. They also present with bulky disease which is invariably associated with high level of lactate dehydrogenase.
The clinical presentation of patients with hepatitis C virus (HCV)-positive diffuse large B-cell lymphoma (DLBCL) is different from their HCV-negative counterparts, but the underlying molecular and pathological characteristics are largely under investigated. The virus has a role in lymphomagenesis, as witnessed by the curative potential of antiviral therapy in HCV-related low-grade B-cell lymphomas.
A significant association between hepatitis C virus (HCV) infection and B-cell lymphoma has been reported by epidemiological studies, most of them describing a strong relationship between indolent lymphomas and HCV. Furthermore, the curative potential of antiviral therapy on HCV related indolent lymphomas supports a specific role for the virus in lymphomagenesis. These observations are reinforced by numerous laboratory experiments that led to several hypothetical models of B-cell transformation by HCV.
Diffuse large B-cell lymphoma, the most common lymphoma subtype in the western countries, has been associated to HCV infection despite its aggressive nature. This association seems particularly prominent in some geographical areas. Clinical presentation of HCV-associated DLBCL has consistently been reported to differ from the HCV-negative counterpart.
Although lymphoma is a very heterogeneous group of biologically complex malignancies, tumor cells across all B cell lymphoma subtypes share a set of underlying traits that promote the development and sustain malignant B cells. One of these traits, the ability to evade apoptosis, is essential for lymphoma development. An alteration in the Bcl-2 family of proteins, the key regulators of apoptosis, is a hallmark of B cell lymphoma. Significant efforts have been made over the last 30 years to advance knowledge of the biology, molecular mechanisms, and therapeutic potential of targeting Bcl-2 family members.
The main objectives of the present study were to determine the diagnostic and prognostic significance of BCL-2 in DLBCL patients and to evaluate the prognostic implication of BCL-2 in patients with HCV and non-HCV DLBCL in correlation with the viral load.
This was a case control study that was carried out on 30 patients diagnosed with Diffuse Large B-cell lymphoma, of which 15 patients are hepatitis C positive and 15 patients are hepatitis C negative, Patients were be recruited from Alexandria Main University Hospitals, and we tested for detection of BCL-2 from biopsy material of all patients either HCV positive or negative.
The main results of this study revealed that:
The age of the HCV positive DLBCL patients (n=15) ranged between 25 to 60 years with a mean of 44.93 years. On the other hand those who were HCV negative DLBCL (n=15) ranged from 25 to 60 years with a mean of 42.13 years. In the positive HCV group males were (53.3%) and females were (46.7%), while the HCV negative group the males were (66.7%) and females were only (33.3%).
Splenomegaly was the most common clinical finding which was detected in 86.7 % of our cases. B symptoms were detected in 9 cases (60.0%). Symptoms of anemia were evident in 5 cases (33.3%). Fatigue was also a common complaint detected in 7 cases (46.7%). Hepatomegaly was detected in 7 cases (46.7%) as compared to their HCV –ve counterpart, which presented with hepatomegaly in 26.7% of cases. Other complaints included; DVT and pulmonary embolism in one case (3.33%), bleeding per rectum and abdominal pain in one case (3.33%) and one patient complained of dysphagia and odynophagia (3.33%).
As regards thromboembolic events, one patient presented with pulmonary embolism, while the other one presented with renal vein thrombosis.