Lymphoma can present with either lymphadenopathy or extranodal involvement. There are limited clinicopathological data pertaining to the occurrence of primary extranodal lymphoma (pENL) in Thailand. This was a retrospective study conducted at Chiang-Mai University Hospital from 2012 to 2016. Patients 18 years of age and over and with a diagnosis of pENL were enrolled onto study. Data related to clinical presentations, histology, stage, treatment and response were collected. There were 104 pENL patients with a median age of 63 years included. The most common presentation was gastrointestinal symptoms (41%), followed by ear, nose, and throat symptoms (35%). Diffuse large B-cell lymphoma (DLBCL) was the most common morphological subtype (60%), followed by marginal zone lymphoma (15%). The majority of patients presented with stage II disease (55%). The five-year overall survival rate was 71%. The factors associated with mortality were hemoglobin <7 g/dL, B-symptoms and LDH above upper normal limits. This study illustrated that lymphoma can present at various extranodal sites. Gastrointestinal symptoms were the most common presentations and DLBCL was the most common subtype of pENL.

Establishment and analysis of mean platelet volume (MPV) may be helpful in the discrimination between underproduction or over-destruction of platelets as the causes of thrombocytopenia. The primary objective is to find the cut-off point of MPV for distinguishing causes of thrombocytopenia. The secondary objective is to validate the cut-off value of the MPV by using bone marrow examination. Thrombocytopenic patients were enrolled in a training set and a receiving operating characteristics (ROC) curve was plotted to obtain the cut-off value of MPV. A validation set of patients was recruited to validate the cut-off value. The training set included 240 patients. Half with with underproductive (n=120) and half with over-destructive thrombocytopenia (n=120). The best cut-off value of MPV was 8.8 fL. The validation set included 119 patients in total, again in 2 groups, those with underproductive (n=84) and those with overdestructive thrombocytopenia (n=35). The sensitivity, specificity, PPV and NPV when MPV ≥8.8 fL indicating over-destructive thrombocytopenia were 77%, 89%, 89% and 77%, respectively. MPV is useful for differentiating the cause of thrombocytopenia. The value of MPV ≥8.8 fL has acceptable sensitivity and specificity for diagnosis of over-destructive thrombocytopenia.

Background:The prognosis and management of primary thrombocytosis (PT) and secondary thrombocytosis (ST) are different. This study aims to evaluate the role of platelet function tests by light transmission platelet aggregometry (LTA), plasma von Willebrand factor antigen (vWF:Ag), ristocetin cofactor activity (vWF:RCo) and inflammatory markers [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)] for the differentiation between PT and ST. Methods:This prospective study was carried out in patients with platelet counts greater than 450 x 109/L. Primary outcomes were the sensitivity and specificity of platelet function tests by LTA for the differentiation of PT and ST. Secondary outcomes were sensitivity and specificity of ESR, CRP, vWF:Ag, and vWF:RCo for the differentiation of PT and ST. Results:Fifty-two patients were enrolled onto the study of which 26 (50%) had PT. The sensitivity and specificity of epinephrine, collagen, and arachidonic acid (AA) induced abnormal LTA for the differentiation of PT from ST were sensitivity of 50%, 38.5%, 26.9% and specificity of 88.5%, 100%, 100% respectively. The sensitivity and specificity of abnormal ESR, CRP, and either abnormal ESR or CRP in the differentiation of ST from PT were sensitivity of 88.5%, 80.8%, 100% and specificity of 65.4%, 61.5%, 46.2% respectively. The sensitivity and specificity of low vWF:Ag and vWF:RCo in the differentiation of PT from ST were sensitivity of 7.69%, 42.3% and specificity of 100%, 88.5% respectively. Conclusions:Abnormal platelet function determined by LTA with collagen, AA, epinephrine had high specificity ratings enabling the differentiation between PT and ST. vWF:RCo, ESR and CRP levels could be helpful in differentiating between PT and ST.

Hepatosplenic T-cell lymphoma (HSTCL) is a rare type of lymphoma. Presenting with hepatosplenomegaly, fever, cytopenia without significant lymphadenopathy, most patients are young men with poor outcomes. Here is the report of two cases of HSTCL from Maharaj Nakorn Chiang-Mai Hospital, Thailand. Both patients were middle-aged men presented with prolonged fever, hepatosplenomegaly and cytopenia. Abnormal lymphoid cells, not demonstrated by flow cytometry, were microscopically revealed in the patients’ bone marrow. The diagnosis of HSTCL was based on the histopathologic section obtained from splenectomy and liver biopsy. Both patients received cyclophosphamide, doxorubicin, vincristine, prednisolone (CHOP) regimen initially while one of them was salvaged with etoposide, methylprednisolone, cytarabine, cisplatin (ESHAP) and methotrexate, high-dose cytarabine, methylprednisolone (cycle B of hyperCVAD) regimen. They responded poorly to chemotherapy and succumbed to severe sepsis. The presented cases confirmed that HSTCL is very difficult to diagnose and current treatment modalities appear to be ineffective

Background There was still a lack of consensus regarding optimal antithrombotic strategies in Antiphospholipid syndrome (APS) with arterial thrombosis. Purpose This Systematic review and Network meta-analysis (NMA) were conducted to evaluate the relative efficacy and safety of secondary thromboprophylaxis strategies in this setting. Methods We searched OVID MEDLINE, Web of Science and the Cochrane Controlled Register of Trials (CENTRAL) from inception to the March 1, 2022 without language restriction. Eligible studies were: i) included APS with arterial thrombosis; ii) treated with any of antiplatelet, warfarin, direct oral anticoagulants (DOACs) or a combination of those treatments, and iii) reported recurrent thrombotic events. Case reports or small studies which included less than 5 patients in each arm were excluded. Two investigators independently abstracted data and assessed risk of bias of included studies. A frequentist random-effects network meta-analysis was performed. All results were analyzed using the netmeta package in R, version 3.6.2. Results The database search resulted in 4076 results. After screening, 3998 studies were excluded. A total of 78 studies were included in full-text reviews. Finally, there were 12 studies (6 randomized and 6 non-randomized studies) included in this network meta-analysis, comprising 681 participants. Dual antiplatelet therapy (DAPT) and combined antiplatelet with warfarin were associated with lower risk of recurrent thrombosis with odds ratio (OR) 0.16 (95% CI 0.03 to 0.90) and 0.25 (95% CI 0.08 to 0.78) respectively comparing to single antiplatelet therapy (SAPT). DOACs and moderate-intensity warfarin were associated with higher recurrent arterial thrombosis with OR 12.59 (95% CI 2.03 to 78.19) and 5.25 (95% CI 1.17 to 23.48) respectively. There was no significant different major bleeding risk among antithrombotic regimens. The certainty of the evidences was very-low for all outcomes. Conclusion This network meta-analysis shows that a combination of antiplatelet with warfarin and DAPT were relatively effective antithrombotic strategies secondary prevention of recurrent thrombosis in arterial-thrombotic APS as compared to SAPT. However, there was still limited quality of evidence. Funding Acknowledgement Type of funding sources: None.