Lege Artis Medicinae

[The role of hepatitis C virus in the development of non-Hodgkin lymphomas]

SULYOK Mihály, MAKARA Mihály, ÚJHELYI Eszter, VÁLYI-NAGY István

MARCH 20, 2014

Lege Artis Medicinae - 2014;24(03)

[There is a growing body of evidence for the association between chronic hepatitis C virus infection and certain subtypes of Bcell non-Hodgkin lymphoma. The development of a lymphoid malignancy is usually preceded by cryoglobulinaemia. Here, we summarise the most important epidemiologic data, and the possible molecular mechanisms of HCV-associated lymphomagenesis. The direct oncogenic effect of the virus has not been proven, but chronic antigenic stimulation maintained by replication and viral lymphotropism might both contribute to the development of lymphomas. It should be emphasised that elimination of the hepatitis C virus can halt this process in case of cryoglobulinaemia and low-grade malignity (usually marginal zone lymphomas). In these cases, antiviral therapy might be a useful alternative of conventional immune-chemotherapy. Thus, a collaboration between haematologists and hepatologists might be a great step forward in the treatment of these diseases. It is still not established whether interferon-based short-course therapies and interferon-free regimens are also effective in the treatment of associated lymphomas.]

COMMENTS

0 comments

Further articles in this publication

Lege Artis Medicinae

[The Artist and their Era]

NAGY Zsuzsanna

Lege Artis Medicinae

[Analysis of the knowledge on cervical cancer and attendance indicators of cervical screening]

VAJDA Réka, KARAMÁNNÉ Pakai Annamária, ÉLIÁS Zsuzsanna, SÉLLEYNÉ Gyuró Mónika, TAMÁS Péter, VÁRNAGY Ákos, KÍVÉS Zsuzsanna

[OBJECTIVE - The study aims to explore knowledge on cervical cancer and cervical screening among women with 9-14 yearold daughters, and learning the attitudes towards screening, the motivation of attendance at or absence from screening. DATA AND METHODS - A quantitative, cross-sectional study was conducted using our own questionnaire in the town Nagyatád in 2012. Study participants included women who had 9-14 year-old daughters and a registered home address in Nagyatád. We received valid responses from 186 people (response rate: 75.3%). RESULTS - The interviewed women’s knowledge on cervical cancer differed significantly depending on their age, education, marital status, and economic activity. Only 45 women with higher education (p=0.043) were considered to be well informed on the subject. However, their willingness to participate in cancer screening was more favorable than their knowledge, 96.2% of the women claimed to attend an annual cancer screening. The average age of respondents was 20.92 years at first visit. CONCLUSIONS - Although the participation rate was much higher compared with that in previously published studies, it is of great importance to increase the mothers’ knowledge on cervical cancer and the factors that promote its development, so that they can pass their knowledge to their children and strengthen their protection against one of the most common sexually transmitted viral infection and the development of cervical cancer.]

Lege Artis Medicinae

[Once Again about the Cathedral of the Heart – Paradigms for the Symbolism of the Heart ]

LOZSÁDI Károly, KIRÁLY László

Lege Artis Medicinae

[Resection of colonic polypoid cavernous hemangioma with help of rubber rings]

ÁCSNÉ Tóth Andrea, LUKOVICH Péter, LAKATOS Péter László, KARDOS Magdolna, ARANY Andrea Szilvia, HARSÁNYI László

[INTRODUCTION - Cavernous hemangioma is a benign, rare disorder, usually localized in the distal part of the gastrointestinal system. CASE REPORT - In a 19-year-old woman treated for Crohn’s disease localized to the colon, a polypoid lesion was found during routine colonoscopy. The lesion appeared to be vascularized, purple in color and could be localized 25 cm above the anal sphincter. MSCT examination confirmed vascularization of the lesion. Considering the high risk for severe bleeding, resection was performed with surgical assistance. At first, two rubber rings were placed around the polypoid lesion. Thereafter 1 ml of epinephrine was injected into the neck of the lesion above the rubber rings, followed by polypectomy with a standard hook. No complications were present during the observation period. Histological examination of the polypoid lesion confirmed it to be cavernous hemangioma. CONCLUSION - On the basis of previous cases and the present case there might be a connection between inflammatory bowel disease and the development of cavernous hemangioma. We have not found any previous reports of a similar application of rubber rings. However, in cases where the risk of bleeding is high, this method is safe and easy to apply.]

Lege Artis Medicinae

[In memoriam dr. András Szalka]

PRINCZ Gyula

All articles in the issue

Related contents

Lege Artis Medicinae

[Crucial points in the therapy of hepatitis C]

MAKARA Mihály, HUNYADY Béla

[The first generation of direct acting antivirals represented a milestone in the therapy of hepatitis C but other breakthroughs are on the way with imminent authorization of new antiviral drugs and interferon-free combinations. The prices of these new agents necessitate the rational use of limited financial capacities: relatively cheaper interferon-based treatments could be used first for those who can be cured with these combinations, while the most expensive treatments are to be reserved for those with no other options. In the future, interferonfree regimens will likely be used first in those patients who did not respond to firstgeneration interferon-based regimens and in whom interferon therapy is contraindicated. To avoid complications of the disease, currently it is reasonable to treat all eligible patients with advanced fibrosis, particularly those with compensated cirrhosis, with interferon-based treatments. In some instances other medical or social conditions warrant prompt treatment. The triage of treatments is based on the Priority Index in Hungary. Current triple therapies with protease inhibitors are complicated by drug and food interactions as well as by frequent (sometimes severe) side effects. General practitioners and other specialists need to be involved in managing these issues. It is of utmost importance to refer patients to hepatology care before decompensation or development of hepatocellular carcinoma. The key of timely and accurate diagnosis is organized anti-HCV screening in populations at risk and in the age group with the highest prevalence.]

Clinical Oncology

[Mediastinal tumours and their therapy]

AGÓCS László

[Due to the tissue structure of the mediastinum a large variety of tumours and multiple systemic malignant disease may occur in the region. The tumours show a variation depending upon age and localization besides their signifi cant alterations. Based on the most accepted Shield classifi cation, the author discusses the types, characters and therapeutic discipline of the tumours in the mediastinal region. The author focuses on the surgical indications, their options and forms, highlighting on the minimal invasive methods.]

LAM Extra for General Practicioners

[Treatment of hepatits C virus infected patients with cirrhosis in real-life conditions in Hungary with the two pegylated interferons]

[AIMS - In this trial we have analyzed the data of cirrhotic naiv as well as treatment experienced patients with chronic hepatitis C, treated in the East-Hungarian hepatology centers, between 2004 and 2010, because in the era of triple combinations, we mostly treat cirrhotic patients. PATIENTS AND METHODS - We have found 272 patients and in most of them the cirrhosis was proven by biopsy. These patients were treated with pegylated interferon (pegIFN) alpha plus ribavirin in combination, 172 were naiv and 100 patients were treatment experienced. Data were collected retrospectively and the pretreatment parameters like age, sex, body weight, transaminase level, genotype, initial viral load, comorbidities, and proportion of first and repeated treatments have been analyzed. We have investigated the influence of the initial parameters as well as the type of pegIFN on the complete early virologic response (cEVR) and on the sustained virological response (SVR). RESULTS - The cEVR was 27% (74/272) and the SVR was 21% (58/272) in the whole patient population. With pegIFN a-2a, 32% (45/141) cEVR and 28% (39/141) SVR, whereas with pegIFN a-2b 22% (29/131) cEVR and 15% (19/131) SVR were achieved. Among this patient population the largest subgroup was the naiv patients with high viral load (HVL). In this subgroup the SVR was 21% (28/132). However, with pegIFN a-2a SVR was 29% (21/73), whereas with pegIFN a-2b SVR was only 12% (7/59). The above differences found between the two pegIFNs proved to be statistically significant. Age <40 years, low viral load (LVL) and treatment with pegIFN a-2a proved to be independent positive factors influencing cEVR as well as SVR, by multiple logistic regression analysis. CONCLUSION - According to these results, cirrhotic patients with hepatitis C may benefit if pegIFN a-2a is used as backbone therapy in triple combinations. ]

Lege Artis Medicinae

[NEUROFIBROMATOSIS, MALIGNANT MELANOMA AND HYPERTHYREOIDISM IN A HCV POSITIVE PATIENT]

FOLHOFFER Anikó, HORVÁTH Andrea, CSÁK Tímea, NÉBENFÜHRER László, TELKES Márta, IVÁNYI András, SZALAY Ferenc

[INTRODUCTION - Similar occirrence of neurofibromatosis and malignant melanoma is rare. We report a patient with neurofibromatosis, cutaneous melanoma, hyperthyreoidism and HCV positivity. CASE REPORT - A 43-year-old woman has been under care for neurofibromatosis for 16 years when she presented with increased serum ?- glutamyltransferase, alkaline phosphatase activity and anti-HCV antibody positivity at regular checkup. A pigmented lesion removed from her back histologically proved to be cutan melanoma. Interferon treatment was applied. She lost 8 kilograms in half a year which was caused not by the tumor progression, but hyperthyreoidism. A rapid clinical and laboratory improvement was observed for thyreostatic treatment and she regained her bodyweight. One year later she presented with a cough caused by pulmonary tumor. The tumor was surgically removed and histologically diagnosed as metastasis of melanoma. Cytostatic treatment was applied and she became asymptomatic. Four years after the diagnosis of melanoma she died of apoplexy. During the autopsy there was no sign of either melanoma or liver disease. CONCLUSIONS - The careful investigation of skin should be emphasised even in case of long established neurofibromatosis. The presented case shows an association of malignant melanoma and neurofibromatosis. In the background of loss of bodyweight even in a patient with history of malignant disease other causes should also be searched such as hyperthyreoidism especially during interferon therapy.]

Lege Artis Medicinae

[“War of numbers” and the facts about pegylated interferon based treatment of chronic hepatitis C]

MAKARA Mihály, HUNYADY Béla

[Further to the traditional pegylated interferon and ribavirin products, used since 2001 in the treatment of chronic hepatitis C, two new direct antiviral protease inhibitors were licensed in 2011: telaprevir and boceprevir. Added to the traditional dual combination either of these drugs increase significantly the rate of sustained viral response. Discussions over the relative efficacy of two different bands of interferons with different pharmacokinetic properties as well as of the different protease inhibitors are arising regularly. After critical review of the relevant literature the authors did not identify any clinically meaningful differences in efficacy of the two pegylated interferons (α 2a or α 2b) neither in dual nor in triple combination therapies. There has been no convincing evidence found to support superiority of one protease inhibitor over the other, either: Generally both drugs can be recommended for patients previously or actually not responding to dual therapy. However, there is a tendency towards a potential difference between the relapse rates after treatments with the two pegylated interferons in dual therapy, attributable potentially to the difference of their pharmacokinetic profiles. In special cases the choice of protease inhibitors can be influenced by cost-effectiveness and side effect profile.]