Nadir Bir Şilöz Asit Nedeni: Foliküler Lenfoma
Özet
İki aydır devam eden abdominal şişlik şikayeti olan 65 yaşındaki kadın hastanın fizik muayenesinde masif asit ve alt ekstremitelerde ödem saptandı. Laboratuvar incelemelerinde böbrek fonksiyonlarında bozulma ve trombositoz dikkat çekerken, karaciğer fonksiyon testleri normal bulundu. Asit sıvısının süt görünümünde olması ve trigliserit düzeyinin 623 mg/dL olması şilöz asit ile uyumlu değerlendirildi. Enfeksiyöz nedenler dışlanmış, hastada gelişen böbrek yetmezliği ve hiperkalemi nedeniyle periton diyalizi başlandı. Görüntüleme yöntemlerinde mezenterik bölgede kitleler ve yaygın lenfadenopatiler saptandı. Eksizyonel lenf nodu biyopsisi sonucunda immünohistokimyasal bulgular eşliğinde derece 3A foliküler lenfoma tanısı konuldu. Prognostik değerlendirmede Folliküler Lenfoma Uluslararası Prognostik İndeksi (FLIPI) skoru 4 olarak hesaplanıp ve yüksek riskli hastalık olarak sınıflandırıldı. PET-BT bulgularına göre evre IV hastalık saptanan olgumuza R-CHOP (rituksimab, siklofosfamid, doksorubisin, vinkristin, prednizon) kemoterapi rejimi başlandı.
Referanslar
Tlili Y, Hadrich Z, Hafsi M et al. Refractory chylous ascites revealing follicular lymphoma: A case report. Int J Surg Case Rep. 2024 Mar;116:109414. doi: 10.1016/j.ijscr.2024.109414. Epub 2024 Feb 23. PMID: 38430893; PMCID: PMC10943983.
Lizaola B, Bonder A, Trivedi HD et al. Review article: the diagnostic approach and current management of chylous ascites. Aliment Pharmacol Ther. 2017 Nov;46(9):816-824. doi: 10.1111/apt.14284. Epub 2017 Sep 11. PMID: 28892178.
Swerdlow SH, Campo E, Harris NL et al. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th ed. IARC: Lyon, France, 2017.
Campo E, Jaffe ES, Cook JR. et al. The International Consensus Classification of Mature Lymphoid Neoplasms: A report from the Clinical Advisory Committee. Blood 2022, 140, 1229–1253.
Alaggio R, Amador C, Anagnostopoulos I et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia 2022, 36, 1720–1748.
Bastos-Oreiro M, Muntañola A, Panizo C et al. RELINF: Prospective epidemiological registry of lymphoid neoplasms in Spain. A project from the GELTAMO group. Ann. Hematol. 2020, 99, 799–808.
Batlevi CL, Sha F, Alperovich A et al. Follicular lymphoma in the modern era: Survival, treatment outcomes, and identification of high-risk subgroups. Blood Cancer J. 2020, 10, 74.
Horsman DE, Gascoyne RD, Coupland RW et al. Comparison of cytogenetic analysis, southern analysis, and polymerase chain reaction for the detection of t(14; 18) in follicular lymphoma. Am. J. Clin. Pathol. 1995, 103, 472–478.
Ott G, Katzenberger T, Lohr A et al. Cytomorphologic, immunohistochemical, and cytogenetic profiles of follicular lymphoma: 2 types of follicular lymphoma grade 3. Blood 2002, 99, 3806–3812.
Peñalver FJ, Magnano L, Álvarez SA et al. Guidelines for Diagnosis, Treatment, and Follow-Up of Patients with Follicular Lymphoma-Spanish Lymphoma Group (GELTAMO) 2025. Cancers 2026, 18, 395.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): B-Cell Lymphomas. Version 1.2026. Published 2026. Accessed March 17, 2026.
Imber BS, Chau, KW, Lee J et al. Excellent response to very-low-dose radiation (4 Gy) for indolent B-cell lymphomas: Is 4 Gy suitable for curable patients? Blood Adv. 2021, 5, 4185–4197.
MacManus M, Fisher R, Roos D et al. Randomized Trial of Systemic Therapy After Involved-Field Radiotherapy in Patients with Early-Stage Follicular Lymphoma: TROG 99.03. J. Clin. Oncol. 2018, 36, 2918–2925.
Rodier C, Kanagaratnam L, Morland D et al. Risk Factors of Progression in Low-tumor Burden Follicular Lymphoma Initially Managed byWatch and Wait in the Era of PET and Rituximab. Hemasphere 2023, 7, e861.
Northend M, Wilson W, Ediriwickrema K et al. Early rituximab monotherapy versus watchful waiting for advanced stage, asymptomatic, low tumour burden follicular lymphoma: Long-term results of a randomised, phase 3 trial. Lancet Haematol. 2025, 12, e335–e345.
Kim TM, Taszner M, Novelli S et al. Safety and efficacy of odronextamab in patients with relapsed or refractory follicular lymphoma. Ann. Oncol. 2024, 35, 1039–1047. Erratum in Ann. Oncol. 2025, 36, 352.
Budde LE, Sehn LH, Matasar M et al. Safety and efficacy of mosunetuzumab, a bispecific antibody, in patients with relapsed or refractory follicular lymphoma: A single-arm, multicentre, phase 2 study. Lancet Oncol. 2022, 23, 1055–1065.
Linton KM, Vitolo U, Jurczak W et al. Epcoritamab monotherapy in patients with relapsed or refractory follicular lymphoma (EPCORE NHL-1): A phase 2 cohort of a single-arm, multicentre study. Lancet Haematol. 2024, 11, e593–e605
Neelapu SS, Chavez JC, Sehgal AR et al. Three-year follow-up analysis of axicabtagene ciloleucel in relapsed/refractory indolent non-Hodgkin lymphoma (ZUMA-5). Blood 2024, 143, 496–506.
Sehn LH, Luminari S, Scholz CW et al. Tafasitamab Plus Lenalidomide and Rituximab for Relapsed or Refractory Follicular Lymphoma: Results from a Phase 3 Study (inMIND). Blood 2024, 144, LBA-1.
Batlevi C, Salles G, Park S et al. Tazemetostat in Combination with Lenalidomide and Rituximab in Patients with Relapsed/Refractory Follicular Lymphoma: Phase 1b Results of Symphony-1. Blood 2022, 140, 2296–2298
Leonard JP, Trneny M, Offner F et al. Five-year results and overall survival update from the phase 3 randomized study AUGMENT: Lenalidomide plus rituximab (R-2) vs rituximab plus placebo in patients with relapsed/refractory indolent Non-Hodgkin lymphoma. Blood 2022, 140, 561–563.
Casulo C, Friedberg JW, Ahn KW et al. Autologous Transplantation in Follicular Lymphoma with Early Therapy Failure: A National LymphoCare Study and Center for International Blood and Marrow Transplant Research Analysis. Biol. Blood Marrow Transplant. 2018, 24, 1163–1171
Jiménez-Ubieto A, Grande C, Caballero D et al. Autologous Stem Cell Transplantation for Follicular Lymphoma: Favorable Long-Term Survival Irrespective of Pretransplantation Rituximab Exposure. Biol Blood Marrow Transplant. 2017, 23, 1631–1640.
Jiménez-Ubieto A, Grande C, Caballero D et al. Autologous stem cell transplantation may be curative for patients with follicular lymphoma with early therapy failure who reach complete response after rescue treatment. Hematol. Oncol. 2018, 36, 765–772.
Hill BT, Nastoupil L, Winter AM et al. Maintenance rituximab or observation after frontline treatment with bendamustine-rituximab for follicular lymphoma. Br. J. Haematol. 2019, 184, 524–535.
Bastos-Oreiro M, Gutierrez A, Cabero A et al. Comparing R-Bendamustine vs. R-CHOP Plus Maintenance Therapy as First-Line Systemic Treatment in Follicular Lymphoma: A Multicenter Retrospective GELTAMO Study. Cancers 2024, 16, 1285.
Iacoboni G, Navarro V, Martín-López AÁ et al. Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients with Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy. J. Clin. Oncol. 2024, 42, 205–217.
Morschhauser F, Le Gouill S, Feugier P et al. Obinutuzumab combined with lenalidomide for relapsed or refractory follicular B-cell lymphoma (GALEN): A multicentre, single-arm, phase 2 study. Lancet Haematol. 2019, 6, e429–e437.
Luminari S, Biasoli I, Versari A et al. The prognostic role of post-induction FDG-PET in patients with follicular lymphoma: A subset analysis from the FOLL05 trial of the Fondazione Italiana Linfomi (FIL). Ann. Oncol. 2014, 25, 442–447.
Jiménez-Ubieto A, Poz, M, Martin-Muñoz A et al. Real-life disease monitoring in follicular lymphoma patients using liquid biopsy ultra-deep sequencing and PET/CT. Leukemia 2023, 37, 659–669.
Claudel A, Cottereau AS, Bachy E et al. Combined PET and ctDNA response as a predictor of POD24 for follicular lymphoma after first-line induction treatment. Blood 2025, 146, 913–925
Luminari S, Manni M, Galimberti S et al. Response-Adapted Postinduction Strategy in Patients with Advanced-Stage Follicular Lymphoma: The FOLL12 Study. J. Clin. Oncol. 2022, 40, 729–739
