Clinical analysis of lymphoma with malignant solid tumor simultaneously: a retrospective case series

Clinical analysis of lymphoma with malignant solid tumor simultaneously: a retrospective case series | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical analysis of lymphoma with malignant solid tumor simultaneously: a retrospective case series Ning Zhu, Yuan Gao, Yu Pan, Liling Song, Yan Yang, Ying Yin, Yunjun Wang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5977195/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Apr, 2025 Read the published version in Diagnostic Pathology → Version 1 posted 6 You are reading this latest preprint version Abstract This study aimed to investigate the clinical features and potential pathogenesis of lymphoma complicated with malignant solid tumors. Clinical data from 35 patients treated at Yantai Yuhuangding Hospital between January 2018 and March 2023 were retrospectively analyzed. Among 1726 lymphoma patients, 35 (2.03%) were found to have solid tumors, including 22 males and 13 females, with a median age of 62 years (range: 49–83 years). The lymphoma subtypes included 14 cases of diffuse large B-cell lymphoma (DLBCL), 8 cases of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL), 7 cases of marginal zone lymphoma (MZL), 3 cases of peripheral T-cell lymphoma (PTCL), 2 cases of follicular lymphoma (FL), and 1 case of Waldenström macroglobulinemia (WM). The solid tumors included 9 cases of papillary thyroid carcinoma (PTC), 8 cases of colorectal cancer (CRC), 7 cases of lung cancer (LC), 5 cases of gastric cancer (GC), 2 cases of prostate cancer (PCa), and 1 case each of breast cancer (BC), clear cell renal cell carcinoma (ccRCC), pharyngeal squamous cell carcinoma (PSCC), and bladder cancer (BLCA). Lymphoma with solid tumors is rare, often affecting elderly males. Non-Hodgkin’s lymphoma, especially DLBCL, was the most common subtype, and PTC was the most frequent solid tumor. Clinicians should focus on these cases to improve diagnosis and treatment. Lymphoma Neoplasms Multiple primary malignancies Diagnosis Clinical features Figures Figure 1 Introduction Lymphoma complicated by malignant solid tumors is classified as multiple primary malignancies (MPMs) [ 1 ]. Currently, the diagnostic criteria for MPMs proposed by Warren et al. are widely accepted [ 2 ]. The International Classification of Diseases, 11th Revision continues to support and adopt the definition of MPMs, providing a detailed classification of various tumor types in its oncology section, including a clear definition and categorization of MPMs. Specifically, each tumor must be independently confirmed as malignant, exhibit distinct histological types, and exclude metastatic or recurrent tumors [ 3 ]. Based on the interval between the diagnosis of the first and second primary tumors, MPMs can be classified into synchronous and metachronous types. Synchronous carcinoma (SC) are defined as those with a diagnostic interval of six months or less, whereas metachronous carcinoma have a diagnostic interval of more than six months [ 2 ]. In recent years, the application of techniques such as immunohistochemistry (IHC), molecular detection, endoscopy, and positron emission tomography/computed tomography (PET/CT) has gradually improved the detection rate of MPMs. However, SC account for only 0.37–2.79% of patients with malignant tumors, with a low incidence [ 4 – 10 ]. Lymphoma is one of the most common malignant tumors in China. Its pathological types are complex and heterogeneous, and treatment strategies vary accordingly [ 11 ]. Lymphoma complicated by malignant solid tumors is rare, although some cases have been reported previously [ 12 – 14 ]. In a study involving 92 patients with non-Hodgkin’s lymphoma (NHL), the incidence of synchronous tumors was only 0.8% [ 6 ]. Currently, the pathogenesis, incidence, clinical characteristics, and treatment of lymphoma complicated by malignant solid tumors remain unclear. To enhance understanding of such cases, we collected 35 cases of lymphoma complicated by malignant solid tumors, summarized their clinical features, and explored potential pathogenesis. These findings aim to provide valuable insights for clinical diagnosis and treatment strategies. Materials and Methods Patients and diagnostic criteria We conducted a retrospective analysis of lymphoma cases presented to Yantai Yuhuangding Hospital from January 2018 to March 2023, and screened for patients with malignant solid tumors. Specimens were obtained through surgical resection or needle biopsy to ensure accurate pathological diagnoses, which included routine morphological examination and IHC staining. Each case was independently diagnosed by two pathologists and subsequently reviewed and confirmed by two senior specialists with subspecialty expertise in hematopathology at the associate chief physician level or higher. The diagnosis and classification of lymphoma were based on the 2017 WHO classification of lymphoid neoplasms, while those of solid tumors adhered to the WHO classification of tumors. In all cases, both tumors were confirmed to be primary malignancies, occurring either simultaneously or within an interval of less than six months. This study was approved by the Medical Ethics Committee of Yantai Yuhuangding Hospital Affiliated with Qingdao University, and the requirement for patient informed consent was waived. Follow-up Detailed follow-up data were obtained from telephone interviews, and causes of death were extracted from clinical records or obtained from patients' families. As of March 8, 2023, the follow-up time ranged from 0 to 68 months. Follow-up time was defined as the time from the patient's initial diagnosis to the final follow-up date or the date of death. Results Patient characteristics A total of 1726 cases of lymphoma were diagnosed between January 2018 and March 2023, of which 35 cases were also complicated with malignant solid tumors, with an incidence of approximately 2.03%. Among the 35 patients, there were 22 males and 13 females, with the median age of 67 (49–83) years. Lymphoma pathological subtypes All 35 cases of lymphoma complicated by malignant solid tumors were NHL, of which 32 cases (91.43%) were B-cell NHL and 3 cases (8.57%) were T-cell NHL. The lymphoma cases comprised 14 cases of diffuse large B-cell lymphoma (DLBCL, 40.00%), 8 cases of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL, 22.86%), 7 cases of marginal zone lymphoma (MZL, 20.00%), 3 cases of peripheral T-cell lymphoma (PTCL, 8.57%), 2 cases of follicular lymphoma (FL, 5.71%), and 1 case of Waldenström macroglobulinemia (WM, 2.86%) (Fig. 1 A). Solid tumors subtypes There were 9 cases of papillary thyroid carcinoma (PTC, 25.71%), 8 cases of colorectal cancer (CRC, 22.86%), 7 cases of lung cancer (LC, 20.00%), 5 cases of gastric cancer (GC, 14.29%), 2 cases of prostate cancer (PCa, 5.71%), 1 case of breast cancer (BC, 2.86%), 1 case of clear cell renal cell carcinoma (ccRCC, 2.86%), 1 case of pharyngeal squamous cell carcinoma (PSCC, 2.86%), and 1 case of bladder cancer (BLCA, 2.86%) (Fig. 1 B). Treatment and Prognosis Of the 34 patients receiving treatment, 8 cases received treatment for lymphoma only, 8 cases received treatment for solid tumors only, and 18 cases received treatment for both types of tumors. The treatment modalities for lymphoma included chemotherapy in 18 cases, radiotherapy in 1 case, a combination of chemotherapy and radiotherapy in 1 case, chemotherapy with autologous stem cell transplantation in 1 case, chemotherapy combined with targeted therapy in 2 cases, surgery in 3 cases, no treatment in 8 cases, and 1 case lost to follow-up. The treatment modalities for solid tumors included surgery in 17 cases, surgery combined with chemotherapy in 1 case, surgery combined with radiotherapy and chemotherapy in 2 cases, chemotherapy in 1 case, surgery combined with targeted therapy in 1 case, targeted therapy in 1 case, endocrine therapy in 3 cases, no treatment in 8 cases, and 1 case lost to follow-up. Among the 35 SC patients, 24 survived, 6 died, and 5 were lost to follow-up. The follow-up period ranged from 0 to 68 months, with a median follow-up time of 18 months (Table 1 ). Table 1 Clinical data of 35 patients with lymphoma complicated with primary solid tumor. No. Sex/ age Lymphoma Solid tumor 1st Tumor Survival Status Follow-up (month) Subtypes site Treatment Subtypes site Treatment 1 M/49 MALT Parotid gland RT Papillary carcinoma Thyroid Surgery Lymphoma Survival 38 2 M/69 SLL/CLL Lymph node No treatment Clear cell carcinoma Kidney Surgery and Axitinib Lymphoma Survival 34 3 F/59 DLBCL Sinuses RCDOP, RCHOP, RTX, MTX, and autoHSCT Papillary carcinoma Thyroid Levothyroxine sodium Lymphoma Survival 33 4 M/76 DLBCL Abdominal cavity No treatment Adenocarcinoma rectum No treatment Solid tumor Death 3 5 F/66 DLBCL Pelvic cavity RCHOP and RCDOP Papillary carcinoma Thyroid NA Lymphoma NA NA 6 F/55 DLBCL Lymph node RCHOP, RCDOP and RGDP Papillary carcinoma Thyroid Surgery Solid tumor NA NA 7 M/74 DLBCL Small intestine Refusal of treatment Adenocarcinoma Stomach Surgery Lymphoma Death 6 8 F/81 DLBCL Pharynx RminiCHOP and RminiCDOP Papillary carcinoma Thyroid No treatment Lymphoma Survival 28 9 F/70 MALT Breast Mammotome excision Invasive ductal carcinoma Breast Surgery, EPI, CTX, DTX and RT Lymphoma Survival 27 10 M/80 PTCL Skin miniCVP and miniCHOP Adenocarcinoma Prostate Endocrine therapy Lymphoma Survival 27 11 M/70 MZL Lymph node RCDOP, CVP and Obrutinib Adenocarcinoma Prostate Endocrine therapy Lymphoma Survival 27 12 M/62 SLL/CLL Appendix Surgery and Ibrutinib Adenocarcinoma Lung Surgery Solid tumor Survival 26 13 F/72 FL tonsil RCHOP Adenocarcinoma Lung Surgery Lymphoma Survival 24 14 M/74 SLL/CLL Abdominal cavity No treatment Adenocarcinoma Colon Surgery Solid tumor Survival 23 15 F/67 DLBCL Stomach RCDOP Papillary carcinoma Thyroid No treatment Lymphoma Survival 19 16 F/83 DLBCL Stomach R-miniCDOP, R2-GemOx and BR Adenocarcinoma Rectum No treatment Lymphoma Death 6 17 M/57 FL Lymph node RCHOP Squamous cell carcinoma Lung Microwave ablation Lymphoma Survival 17 18 F/55 SLL/CLL Lymph node Ibrutinib and RTX Micropapillary carcinoma Thyroid Surgery Lymphoma Survival 68 19 M/68 PTCL Small intestine CHOP Papillary urothelial carcinoma Bladder Transurethral resection of bladder tumors Solid tumor NA NA 20 M/75 DLBCL Lymph node R2-GemOx Adenocarcinoma Colon No treatment Solid tumor Death 1 21 F/55 MALT Stomach RT and RCVP Papillary carcinoma Thyroid Surgery Lymphoma Survival 56 22 M/65 DLBCL Stomach miniCHOP and RCHOP Adenocarcinoma appendix Surgery Solid tumor Death 6 23 M/80 SLL/CLL Lymph node No treatment Adenocarcinoma Stomach Surgery Lymphoma NA NA 24 M/72 SLL/CLL Lymph node No treatment Adenocarcinoma Lung Cisplatin and Pemetrexed Lymphoma Death 20 25 M/68 MZL Lymph node No treatment Adenocarcinoma Stomach Surgery and SOX Lymphoma Survival 41 26 M/62 MZL Lymph node NA Squamous cell carcinoma Pharynx Surgery, RT and chemotherapy Lymphoma NA NA 27 M/71 DLBCL Ileocecal RCHOP Adenocarcinoma Colon No treatment Lymphoma Survival 16 28 M/59 DLBCL Lymph node RCHOP and PD1 + RICE Adenocarcinoma Stomach Surgery Lymphoma Survival 15 29 M/62 DLBCL Tonsil RCDOP Adenocarcinoma Stomach Surgery Solid tumor Survival 14 30 M/79 SLL/CLL Rectum Surgery Adenocarcinoma Rectum Surgery lymphoma Survival 14 31 F/66 SLL/CLL Lymph node No treatment Adenocarcinoma Lung Targeted therapy Solid tumor Survival 7 32 M/59 PTCL Lymph node Chemotherapy NA Lung Surgery lymphoma Survival 10 33 M/65 WM bone marrow Obrutinib Adenocarcinoma Colon Surgery Solid tumor Survival 7 34 F/67 MZBL Lymph node BR Papillary carcinoma Thyroid No treatment Lymphoma Survival 1 35 F /65 DLBCL Lymph node RCHOP Adenocarcinoma Lung No treatment lymphoma Survival 0 Abbreviation: MALT: marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; SLL/CLL: small lymphocytic lymphoma/chronic lymphocytic leukemia; DLBCL: diffuse large B-cell lymphoma; PTCL: peripheral T-cell lymphoma; MZL: marginal zone lymphoma; FL: follicular lymphoma; WM: Waldenström macroglobulinemia; RT: Radiotherapy; RCDOP: rituximab + cyclophosphamide + vincristine + liposomal doxorubicin + prednisone; RCHOP: rituximab + cyclophosphamide + vincristine + doxorubicin + prednisone; auto-HSCT: autologous hematopoietic stem cell transplantation; R2-GemOx: rituximab + lenalidomide + gemcitabine + oxaliplatin; BR: rituximab + bendamustine; RCVP: rituximab + cyclophosphamide + vindesine + dexamethasone; RGDP: rituximab + gemcitabine + cisplatin + dexamethasone; SOX: oxaliplatin + tegafur; MTX: methotrexate; RTX: rituximab;CTX: cyclophosphamide; DTX: docetaxel; EPI: epirubicin; RICE༚rituximab + ifosfamide + carboplatin + etoposide; NA, not available. Discussion The occurrence of SC is relatively rare. The reported incidence of SC ranges from 0.37–2.79%, which may be attributed to differences in the duration of retrospective analyses, sample sizes, and the inclusion of autopsy series or analyses of specific tumors associated with SC in certain studies [ 4 – 10 ]. We collected clinical and pathological data from 1,726 lymphoma patients and found that 35 patients had SC, with an incidence rate of 2.02%, which is within the range of the incidence rate reported above. During follow-up, six patients died, five of whom had DLBCL combined with gastrointestinal adenocarcinoma, and four of them died within six months. These findings suggest that patients with DLBCL combined with adenocarcinoma have a higher risk of death and worse prognosis. Furthermore, all CRC-related deaths occurred in elderly patients, who had poor chemotherapy tolerance and a higher risk of severe infections and multiple organ failure. Among the 35 SC cases in our study, DLBCL was the most common lymphoma type, consistent with previous findings in non-MPM NHL patients [ 15 , 16 ]. Although the digestive system was the most commonly affected site by solid tumors, the most common SC was DLBCL combined with PTC. This aligns with the findings of Jiang et al. [ 6 ], but differs from a systematic review of 308 SC cases, which identified MALT lymphoma with gastrointestinal tumors as the most frequent combination, with the discrepancy possibly related to the smaller sample size in our study [ 17 ]. The pathogenesis of lymphoma combined with PTC remains unclear. Recent studies have shown that BRAFV600E mutation can induce immunosuppression. BRAFV600E reactivates the developmental factor TBX3, which subsequently upregulates CXCR2 ligands in a TLR2-NFκB-dependent manner, facilitating the recruitment of myeloid-derived suppressor cells (MDSCs) into the tumor microenvironment. By increasing the infiltration of MDSCs, BRAFV600E promotes the progression of thyroid cancer [ 18 , 19 ]. Karrethet al. found that the BRAF pseudogene (BRAFP1) is frequently overexpressed in DLBCL, potentially acting as an oncogene by enhancing BRAF activity and activating the MAPK signaling pathway, thus accelerating the development and progression of DLBCL [ 20 ]. Furthermore, the BRAFV600E mutation has also been identified in hairy cell leukemia, DLBCL, MZL, CLL/SLL, and multiple myeloma [ 21 – 25 ]. Therefore, BRAF mutations may serve as a key driver in the coexistence of lymphoma and PTC. The etiology of synchronous lymphoma combined with carcinoma remains unclear. However, long-term smoking and alcohol consumption have been recognized as major pathogenic factors for MPMs in the respiratory and digestive systems [ 26 – 28 ]. Among the cases we collected, three patients with LC, one with PSCC, and one with PCa had a history of smoking for more than 30 years. Additionally, four patients with GC or CRC had a history of alcohol consumption for more than 20 years. Talamini et al. found that smoking is a significant risk factor for NHL, with heavy smokers having approximately twice the risk compared to non-smokers [ 29 ]. A pooled analysis conducted by the International Lymphoma Epidemiology Consortium, involving 15,486 participants from nine case-control studies, revealed a modest increase in risk across all NHL subtypes [ 30 ]. Furthermore, long-term exposure to radiation, industrial pollution, and other environmental factors also contribute to the development of MPMs [ 8 , 31 – 34 ]. Conventional imaging (CI) techniques, including ultrasound, computed tomography, magnetic resonance imaging, and nuclear imaging, have limitations in detecting SC due to their localized imaging approach. In contrast, PET/CT offers more advantages in diagnosing SC compared to CI [ 35 , 36 ]. For elderly men, we suggested that PET/CT and gastrointestinal endoscopy should be used as key methods for diagnosing colorectal tumors and confirming lymphoma. In our study cohort, a 79-year-old male patient had a rectal biopsy revealing adenocarcinoma. Post-surgical pathological examination showed moderately differentiated adenocarcinoma, and SLL/CLL was present within the full-thickness intestinal wall. A collision tumor refers to the coexistence of two independent primary malignancies occurring at the same anatomical site or organ, which come into contact or infiltrate each other to form a single mass. Among lymphomas involved in collision with solid tumors, DLBCL is the most commonly observed type [ 17 ]. The pathogenesis of collision tumors remains unclear, although several hypotheses have been proposed. The most widely accepted theory is neoplastic heterogeneity, which posits that collision tumors originate from two distinct clones of neoplastic cells that develop independently and coexist within the same anatomical site. This phenomenon may be facilitated by impaired immune surveillance associated with lymphoma, thereby creating a permissive microenvironment for the development of a secondary malignancy [ 37 – 39 ]. Another possible mechanism is the interaction theory, which suggests that one tumor induces changes in the epidermis or stroma through paracrine effects, with the altered microenvironment promoting the formation of a second tumor [ 40 ]. Currently, there is no unified treatment principle for lymphoma combined with malignant solid tumors. Our retrospective analysis included a 75-year-old male patient diagnosed with DLBCL and colon adenocarcinoma passed away less than a month after diagnosis. During rituximab treatment for DLBCL, the patient developed diarrhea, abdominal pain, liver and kidney failure, and an IL-6 level exceeding 5000 ng/ml, suggesting cytokine release syndrome (CRS) induced by rituximab. Rituximab-induced CRS has been reported, and we found that underlying conditions such as heart disease, diabetes, and advanced age increase the risk of fatal CRS [ 41 , 42 ]. This can be achieved by reducing the injection dose, administering rituximab after CHOP chemotherapy, or using premedication to reduce adverse reactions [ 15 , 43 ]. We analyzed whether the sequence of treatment for both types of tumors had an impact on prognosis in SC patients and found no statistically significant difference. This may be attributed to the small sample size of patients receiving treatment for both tumors simultaneously (n = 18). Furthermore, we observed no significant difference in prognosis between lymphoma patients with or without a background of solid tumors. These findings may be attributed to factors such as the patients' overall health status, the heterogeneity and staging of both lymphoma and solid tumors, and the limited sample size, as well as the significant differences in gene mutations, tumor cell proliferation and metastasis abilities, tumor microenvironment, and therapeutic responses, which largely determine tumor progression, prognosis, and sensitivity to treatment [ 44 – 46 ]. Therefore, we recommend that treatment plans for SC be individualized to improve patients' quality of life. Conclusion This study highlights the rare occurrence of synchronous lymphoma combined with malignant solid tumors and provides clinical insights into its presentation, treatment challenges, and prognosis. Our findings indicate that DLBCL is commonly associated with solid tumors, with PTC being the most frequent concomitant malignancy. Despite the complexity of managing these cases, we observed no significant difference in prognosis between lymphoma patients with concomitant solid tumors and those with lymphoma alone. This may be attributed to the heterogeneity of both lymphoma and solid tumors, differences in patients' overall health status, and the limited sample size. As the pathogenesis and optimal treatment strategies remain unclear, we recommend an individualized treatment plan based on the type and stage of both lymphoma and solid tumors, as well as the patient's overall condition, with the aim of improving outcomes. In the future, we plan to further validate the effectiveness of treatment strategies through larger sample sizes and multi-center collaborations, providing more clinical evidence for the development of individualized treatment plans. Declarations Acknowledgements The authors are grateful for Shandong Natural Science Foundation and Yantai Science and Technology Plan for their support of this project. Conflict of interest The authors declare that they have no conflict of interest. Funding This study was supported by the fund of Shandong Natural Science Foundation [NO.ZR2022MH297], and Yantai Science and Technology Plan [NO.2021MSGY043]. Ethics approval The study was exempted from review by the Institutional Review Board at the Yantai Yuhuangding Hospital. Author contributions Guohua Yu designed and conceived the study. Yuan Gao and Ning Zhu drafted the manuscript. Ning Zhu and Yunjun Wang critically revised the manuscript. Yuan Gao, Yu Pan and Shishou Wu performed literature research. Yan Yang, Ying Yin and Liyan Zhang drafted tables and create images. All authors read and approved the final manuscript. Availability of data and materials All relevant data and materials are available for public access and can be provided upon reasonable request. Patient consent for publication The authors confirm that written informed consent for publication was obtained from the patients involved in this study. The patients provided consent for the use of their medical information, including images and other relevant data. References Moertel CG. Multiple primary malignant neoplasms: historical perspectives. Cancer. 1977;40(4 Suppl):1786–92. Warren S, Gates O. Multiple primary malignant tumors: a survey of the literature and a statistical study. Am J Cancer. 1932;16(1358 – 414. Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250–81. Etiz D, Metcalfe E, Akcay M. Multiple primary malignant neoplasms: A 10-year experience at a single institution from Turkey. J Cancer Res Ther. 2017;13(1):16–20. Powell S, Tarchand G, Rector T, Klein M. Synchronous and metachronous malignancies: analysis of the Minneapolis Veterans Affairs (VA) tumor registry. Cancer Causes Control. 2013;24(8):1565–73. Jiang Y, Miao Z, Wang J, Chen J, Lv Y, Xing D, et al. Clinical characteristics and prognosis associated with multiple primary malignant tumors in non-Hodgkin lymphoma patients. Tumori. 2019;105(6):474–82. Si L, Feng Y, Wang Y, Zhong J, Sun Z, Li X, et al. Clinical and pathological characteristics of multiple primary malignant neoplasms cases. Int J Clin Pract. 2021;75(11):e14663. Zhai C, Cai Y, Lou F, Liu Z, Xie J, Zhou X, et al. Multiple Primary Malignant Tumors - A Clinical Analysis of 15,321 Patients with Malignancies at a Single Center in China. J Cancer. 2018;9(16):2795–801. Lv M, Zhang X, Shen Y, Wang F, Yang J, Wang B, et al. Clinical analysis and prognosis of synchronous and metachronous multiple primary malignant tumors. Med (Baltim). 2017;96(17):e6799. Irimie A, Achimas-Cadariu P, Burz C, Puscas E. Multiple primary malignancies–epidemiological analysis at a single tertiary institution. J Gastrointestin Liver Dis. 2010;19(1):69–73. Liu W, Qi J, Liu J, Song Y, Wang L, Zhou M, et al. Mortality Rate of Lymphoma in China, 2013–2020. Front Oncol. 2022;12:902643. Dayer N, Fasquelle F, Salati E, Dietrich G. Multiple primary malignancies: synchronous lymphoma, pancreatic neuroendocrine tumour and colorectal cancer. BMJ Case Rep. 2021;14(6):e241938. Li J, Zhou C, Liu W, Sun X, Meng X. Synchronous diffuse large B-cell lymphoma of the stomach and small cell lung carcinoma: A case report. Med (Baltim). 2017;96(50):e8873. Meng J, Pan H, Li X, Liu T, Liu Z, Li Q, et al. Diagnosis and Treatment of Synchronous Lymphoma and Digestive System Carcinoma: Report of Four Cases and Literature Review. Front Oncol. 2019;9:1367. Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia. 2022;36(7):1720–48. Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, et al. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood. 2022;140(11):1229–53. Parra-Medina R, Rocha F, Castañeda-González JP, Moreno-Lucero P, Veloza L, Romero-Rojas AE. Synchronous or collision solid neoplasms and lymphomas: A systematic review of 308 case reports. Med (Baltim). 2022;101(28):e28988. Santhanam P, Khthir R, Solnes LB, Ladenson PW, THE RELATIONSHIP OF BRAF(V600E) MUTATION STATUS TO FDG PET/CT AVIDITY IN THYROID CANCER. A REVIEW AND META-ANALYSIS. Endocr Pract. 2018;24(1):21–6. Zhang P, Guan H, Yuan S, Cheng H, Zheng J, Zhang Z, et al. Targeting myeloid derived suppressor cells reverts immune suppression and sensitizes BRAF-mutant papillary thyroid cancer to MAPK inhibitors. Nat Commun. 2022;13(1):1588. Karreth FA, Reschke M, Ruocco A, Ng C, Chapuy B, Léopold V, et al. The BRAF pseudogene functions as a competitive endogenous RNA and induces lymphoma in vivo. Cell. 2015;161(2):319–32. Maitre E, Cornet E, Troussard X. Hairy cell leukemia: 2020 update on diagnosis, risk stratification, and treatment. Am J Hematol. 2019;94(12):1413–22. Jebaraj BM, Kienle D, Bühler A, Winkler D, Döhner H, Stilgenbauer S, et al. BRAF mutations in chronic lymphocytic leukemia. Leuk Lymphoma. 2013;54(6):1177–82. Wang XY, Li M, Zhao YX, Wang LF, Li DJ, Xu ZG, et al. [Clinicopathological features and BRAF V600E and MYD88 L265P mutation status of nodal marginal zone lymphoma]. Zhonghua Bing Li Xue Za Zhi. 2022;51(4):301–6. Andrulis M, Lehners N, Capper D, Penzel R, Heining C, Huellein J, et al. Targeting the BRAF V600E mutation in multiple myeloma. Cancer Discov. 2013;3(8):862–9. Lohr JG, Stojanov P, Lawrence MS, Auclair D, Chapuy B, Sougnez C, et al. Discovery and prioritization of somatic mutations in diffuse large B-cell lymphoma (DLBCL) by whole-exome sequencing. Proc Natl Acad Sci U S A. 2012;109(10):3879–84. Bresadola L, Weber D, Ritzel C, Löwer M, Bukur V, Akilli-Öztürk Ö et al. Comprehensive Genomic and Transcriptomic Analysis of Three Synchronous Primary Tumours and a Recurrence from a Head and Neck Cancer Patient. Int J Mol Sci. 2021;22(14). Fujita S, Masago K, Takeshita J, Togashi Y, Hata A, Kaji R, et al. Multiple primary malignancies in patients with non-small cell lung cancer. Intern Med. 2015;54(3):325–31. Liu H, Zhang Q, Zhang S, Zhang Y, Song R, Li P, et al. Clinical features and risk of multiple primary malignancies after endoscopic treatment in patients with early esophageal squamous cell carcinoma: a retrospective cohort study. J Gastrointest Oncol. 2024;15(4):1386–98. Talamini R, Polesel J, Montella M, Maso LD, Crispo A, Spina M, et al. Smoking and non-Hodgkin lymphoma: case-control study in Italy. Int J Cancer. 2005;115(4):606–10. Morton LM, Hartge P, Holford TR, Holly EA, Chiu BC, Vineis P, et al. Cigarette smoking and risk of non-Hodgkin lymphoma: a pooled analysis from the International Lymphoma Epidemiology Consortium (interlymph). Cancer Epidemiol Biomarkers Prev. 2005;14(4):925–33. Farshadpour F, Hordijk GJ, Koole R, Slootweg PJ. Head and neck squamous cell carcinoma in non-smoking and non-drinking patients with multiple tumors: etiologic significance of p53 and Ki-67 in non-tumorous epithelium. J Oral Pathol Med. 2008;37(9):549–54. Hsu CH, Huang CL, Hsu YH, Iqbal U, Nguyen PA, Jian WS. Co-occurrence of second primary malignancy in patients with thyroid cancer. QJM. 2014;107(8):643–8. Sakellakis M, Peroukides S, Iconomou G, Boumpoucheropoulos S, Kalofonos H. Multiple primary malignancies: a report of two cases. Chin J Cancer Res. 2014;26(2):215–8. Vogt A, Schmid S, Heinimann K, Frick H, Herrmann C, Cerny T, et al. Multiple primary tumours: challenges and approaches, a review. ESMO Open. 2017;2(2):e000172. Luo ZH, Qi WL, Jin AF, Liao FX, Liu Q, Zeng QY. The role of (18)F-FDG PET/CT in patients with synchronous multiple primary malignant neoplasms occurring at the same time. Front Oncol. 2022;12:1068055. Sun L, Wan Y, Lin Q, Sun YH, Zhao L, Luo ZM, et al. Multiple primary malignant tumors of upper gastrointestinal tract: a novel role of 18F-FDG PET/CT. World J Gastroenterol. 2010;16(31):3964–9. Satter EK, Metcalf J, Lountzis N, Elston DM. Tumors composed of malignant epithelial and melanocytic populations: a case series and review of the literature. J Cutan Pathol. 2009;36(2):211–9. Boyd AS, Rapini RP. Cutaneous collision tumors. An analysis of 69 cases and review of the literature. Am J Dermatopathol. 1994;16(3):253–7. Cornejo KM, Deng AC. Malignant melanoma within squamous cell carcinoma and basal cell carcinoma: is it a combined or collision tumor?--a case report and review of the literature. Am J Dermatopathol. 2013;35(2):226–34. Hopster D, Smith PA, Nash JR, Elders K, Poston GJ. Synchronous multiple lymphomatous polyposis and adenocarcinomata in the large bowel. Postgrad Med J. 1995;71(837):443. Seifert G, Reindl T, Lobitz S, Seeger K, Henze G. Fatal course after administration of rituximab in a boy with relapsed all: a case report and review of literature. Haematologica. 2006;91(6 Suppl):Ecr23. Tournamille JF, Rigal-Huguet F, Pathak A, Montastruc JL, Lapeyre-Mestre M. [Cardiac effects of cytokines produced after rituximab infusion]. Bull Cancer. 2005;92(9):769–71. Makino K, Nakata J, Kawachi S, Hayashi T, Nakajima A, Yokoyama M. Treatment strategy for reducing the risk of rituximab-induced cytokine release syndrome in patients with intravascular large B-cell lymphoma: a case report and review of the literature. J Med Case Rep. 2013;7:280. Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet. 2017;390(10091):298–310. Rauth S, Malafa M, Ponnusamy MP, Batra SK. Emerging Trends in Gastrointestinal Cancer Targeted Therapies: Harnessing Tumor Microenvironment, Immune Factors, and Metabolomics Insights. Gastroenterology. 2024;167(5):867–84. Tarhini AA, Eads JR, Moore KN, Tatard-Leitman V, Wright J, Forde PM et al. Neoadjuvant immunotherapy of locoregionally advanced solid tumors. J Immunother Cancer. 2022;10(8). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Apr, 2025 Read the published version in Diagnostic Pathology → Version 1 posted Editorial decision: Accepted 17 Apr, 2025 Reviews received at journal 17 Apr, 2025 Reviewers agreed at journal 16 Apr, 2025 Reviewers invited by journal 16 Apr, 2025 Submission checks completed at journal 16 Apr, 2025 First submitted to journal 15 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5977195","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":443998726,"identity":"0186528b-1343-41b5-9ee2-840f70b85a98","order_by":0,"name":"Ning Zhu","email":"","orcid":"","institution":"Binzhou Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ning","middleName":"","lastName":"Zhu","suffix":""},{"id":443998729,"identity":"1ed3e1a7-a84d-41c5-aa61-cf32e1fc5b72","order_by":1,"name":"Yuan Gao","email":"","orcid":"","institution":"Shandong Second Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yuan","middleName":"","lastName":"Gao","suffix":""},{"id":443998730,"identity":"8ddae35a-526c-402e-bfd9-916e79a7b514","order_by":2,"name":"Yu Pan","email":"","orcid":"","institution":"Shandong Second Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Pan","suffix":""},{"id":443998731,"identity":"56479181-7175-4f4a-85e1-38bcfee72522","order_by":3,"name":"Liling Song","email":"","orcid":"","institution":"Yantai Yuhuangding Hospital Affiliated Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Liling","middleName":"","lastName":"Song","suffix":""},{"id":443998732,"identity":"e64b6200-90b0-425e-988e-6339891e9064","order_by":4,"name":"Yan Yang","email":"","orcid":"","institution":"Yantai Yuhuangding Hospital Affiliated Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Yang","suffix":""},{"id":443998733,"identity":"483ca491-951a-4fa1-a5d5-fc461566f1f0","order_by":5,"name":"Ying Yin","email":"","orcid":"","institution":"Yantai Yuhuangding Hospital Affiliated Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Yin","suffix":""},{"id":443998734,"identity":"b452575d-8db1-40f1-b173-206974ec87ea","order_by":6,"name":"Yunjun Wang","email":"","orcid":"","institution":"Yantai Yuhuangding Hospital Affiliated Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Yunjun","middleName":"","lastName":"Wang","suffix":""},{"id":443998735,"identity":"ec0d4e30-74b0-4852-aa1e-dcb78d036c06","order_by":7,"name":"Liyan Zhang","email":"","orcid":"","institution":"Yantai Yuhuangding Hospital Affiliated Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Liyan","middleName":"","lastName":"Zhang","suffix":""},{"id":443998736,"identity":"33b107a3-c58d-435c-88ab-fbf6c73ec151","order_by":8,"name":"Shishou Wu","email":"","orcid":"","institution":"Yantai Yuhuangding Hospital Affiliated Qingdao University","correspondingAuthor":false,"prefix":"","firstName":"Shishou","middleName":"","lastName":"Wu","suffix":""},{"id":443998737,"identity":"412ef764-7f2b-48ca-a0c8-e6c186c5fd39","order_by":9,"name":"Guohua Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYHACNjDJz8BgAKSYSdAi2UCyFoMDxGqRj0g+9pin5nDi5uPJ2yQYKqwTG9jPHsCrxfBGWroxz7HDidvOPCuTYDiTntjAk5eAX8uMHDNpHjaglhs5ZhKMbYcTGyR4DIjQ8g/osBkgLf+I0CIvAdTCCzR8gwRISwMRWgx4nqVJzu1LN55x5lmxRcKxdOM2nhwCtrQnH5N4881atr89eeONDzVABvsZArYcAFPNQJwARtBowmdLA5iqg2gZBaNgFIyCUYANAAC/zER6ZomCOAAAAABJRU5ErkJggg==","orcid":"","institution":"Binzhou Medical University","correspondingAuthor":true,"prefix":"","firstName":"Guohua","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2025-02-07 02:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5977195/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5977195/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13000-025-01653-y","type":"published","date":"2025-04-26T15:57:39+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":81004078,"identity":"162c433a-aa90-4614-89f7-79b5a244b225","added_by":"auto","created_at":"2025-04-21 06:43:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1207887,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of lymphoma and solid tumor subtypes among 35 cases. (A) Lymphoma subtypes. (B) Solid tumor subtypes.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5977195/v1/cdc35a04385c28b62ef0ba81.png"},{"id":81569875,"identity":"5bbd19e8-cff1-42eb-a6a9-aa79e25eec34","added_by":"auto","created_at":"2025-04-28 16:12:14","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2096273,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5977195/v1/5c0ffbe5-cdd8-4995-8dd9-648e7f541a48.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical analysis of lymphoma with malignant solid tumor simultaneously: a retrospective case series","fulltext":[{"header":"Introduction","content":" \u003cp\u003eLymphoma complicated by malignant solid tumors is classified as multiple primary malignancies (MPMs) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Currently, the diagnostic criteria for MPMs proposed by Warren et al. are widely accepted [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The International Classification of Diseases, 11th Revision continues to support and adopt the definition of MPMs, providing a detailed classification of various tumor types in its oncology section, including a clear definition and categorization of MPMs. Specifically, each tumor must be independently confirmed as malignant, exhibit distinct histological types, and exclude metastatic or recurrent tumors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Based on the interval between the diagnosis of the first and second primary tumors, MPMs can be classified into synchronous and metachronous types. Synchronous carcinoma (SC) are defined as those with a diagnostic interval of six months or less, whereas metachronous carcinoma have a diagnostic interval of more than six months [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, the application of techniques such as immunohistochemistry (IHC), molecular detection, endoscopy, and positron emission tomography/computed tomography (PET/CT) has gradually improved the detection rate of MPMs. However, SC account for only 0.37\u0026ndash;2.79% of patients with malignant tumors, with a low incidence [\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLymphoma is one of the most common malignant tumors in China. Its pathological types are complex and heterogeneous, and treatment strategies vary accordingly [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Lymphoma complicated by malignant solid tumors is rare, although some cases have been reported previously [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In a study involving 92 patients with non-Hodgkin\u0026rsquo;s lymphoma (NHL), the incidence of synchronous tumors was only 0.8% [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Currently, the pathogenesis, incidence, clinical characteristics, and treatment of lymphoma complicated by malignant solid tumors remain unclear. To enhance understanding of such cases, we collected 35 cases of lymphoma complicated by malignant solid tumors, summarized their clinical features, and explored potential pathogenesis. These findings aim to provide valuable insights for clinical diagnosis and treatment strategies.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatients and diagnostic criteria\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective analysis of lymphoma cases presented to Yantai Yuhuangding Hospital from January 2018 to March 2023, and screened for patients with malignant solid tumors. Specimens were obtained through surgical resection or needle biopsy to ensure accurate pathological diagnoses, which included routine morphological examination and IHC staining. Each case was independently diagnosed by two pathologists and subsequently reviewed and confirmed by two senior specialists with subspecialty expertise in hematopathology at the associate chief physician level or higher. The diagnosis and classification of lymphoma were based on the 2017 WHO classification of lymphoid neoplasms, while those of solid tumors adhered to the WHO classification of tumors. In all cases, both tumors were confirmed to be primary malignancies, occurring either simultaneously or within an interval of less than six months. This study was approved by the Medical Ethics Committee of Yantai Yuhuangding Hospital Affiliated with Qingdao University, and the requirement for patient informed consent was waived.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eFollow-up\u003c/h3\u003e\n\u003cp\u003eDetailed follow-up data were obtained from telephone interviews, and causes of death were extracted from clinical records or obtained from patients' families. As of March 8, 2023, the follow-up time ranged from 0 to 68 months. Follow-up time was defined as the time from the patient's initial diagnosis to the final follow-up date or the date of death.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eA total of 1726 cases of lymphoma were diagnosed between January 2018 and March 2023, of which 35 cases were also complicated with malignant solid tumors, with an incidence of approximately 2.03%. Among the 35 patients, there were 22 males and 13 females, with the median age of 67 (49\u0026ndash;83) years.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLymphoma pathological subtypes\u003c/h3\u003e\n\u003cp\u003eAll 35 cases of lymphoma complicated by malignant solid tumors were NHL, of which 32 cases (91.43%) were B-cell NHL and 3 cases (8.57%) were T-cell NHL. The lymphoma cases comprised 14 cases of diffuse large B-cell lymphoma (DLBCL, 40.00%), 8 cases of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL, 22.86%), 7 cases of marginal zone lymphoma (MZL, 20.00%), 3 cases of peripheral T-cell lymphoma (PTCL, 8.57%), 2 cases of follicular lymphoma (FL, 5.71%), and 1 case of Waldenstr\u0026ouml;m macroglobulinemia (WM, 2.86%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSolid tumors subtypes\u003c/h2\u003e \u003cp\u003eThere were 9 cases of papillary thyroid carcinoma (PTC, 25.71%), 8 cases of colorectal cancer (CRC, 22.86%), 7 cases of lung cancer (LC, 20.00%), 5 cases of gastric cancer (GC, 14.29%), 2 cases of prostate cancer (PCa, 5.71%), 1 case of breast cancer (BC, 2.86%), 1 case of clear cell renal cell carcinoma (ccRCC, 2.86%), 1 case of pharyngeal squamous cell carcinoma (PSCC, 2.86%), and 1 case of bladder cancer (BLCA, 2.86%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eB).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTreatment and Prognosis\u003c/h3\u003e\n\u003cp\u003eOf the 34 patients receiving treatment, 8 cases received treatment for lymphoma only, 8 cases received treatment for solid tumors only, and 18 cases received treatment for both types of tumors. The treatment modalities for lymphoma included chemotherapy in 18 cases, radiotherapy in 1 case, a combination of chemotherapy and radiotherapy in 1 case, chemotherapy with autologous stem cell transplantation in 1 case, chemotherapy combined with targeted therapy in 2 cases, surgery in 3 cases, no treatment in 8 cases, and 1 case lost to follow-up. The treatment modalities for solid tumors included surgery in 17 cases, surgery combined with chemotherapy in 1 case, surgery combined with radiotherapy and chemotherapy in 2 cases, chemotherapy in 1 case, surgery combined with targeted therapy in 1 case, targeted therapy in 1 case, endocrine therapy in 3 cases, no treatment in 8 cases, and 1 case lost to follow-up. Among the 35 SC patients, 24 survived, 6 died, and 5 were lost to follow-up. The follow-up period ranged from 0 to 68 months, with a median follow-up time of 18 months (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical data of 35 patients with lymphoma complicated with primary solid tumor.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eNo.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex/\u003c/p\u003e \u003cp\u003eage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1st Tumor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSurvival Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFollow-up (month)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSubtypes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003esite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSubtypes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003esite\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTreatment\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParotid gland\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eClear cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKidney\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery and Axitinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSinuses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCDOP, RCHOP, RTX, MTX, and autoHSCT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLevothyroxine sodium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbdominal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003erectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePelvic cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP and RCDOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP, RCDOP and RGDP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmall intestine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRefusal of treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePharynx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRminiCHOP and RminiCDOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMammotome excision\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eInvasive ductal carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBreast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery, EPI, CTX, DTX and RT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePTCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSkin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eminiCVP and miniCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProstate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEndocrine therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMZL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCDOP, CVP and Obrutinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eProstate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eEndocrine therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAppendix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurgery and Ibrutinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003etonsil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAbdominal cavity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCDOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eR-miniCDOP, R2-GemOx and BR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMicrowave ablation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIbrutinib and RTX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eMicropapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePTCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSmall intestine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary urothelial carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eBladder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTransurethral resection of bladder tumors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eR2-GemOx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRT and RCVP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eminiCHOP and RCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eappendix\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eCisplatin and Pemetrexed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMZL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery and SOX\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMZL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSquamous cell carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003ePharynx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery, RT and chemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIleocecal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP and PD1\u0026thinsp;+\u0026thinsp;RICE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTonsil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCDOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eStomach\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eRectum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003elymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSLL/CLL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTargeted therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePTCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003elymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM/65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ebone marrow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObrutinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eColon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eSolid tumor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF/67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMZBL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ePapillary carcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eThyroid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF /65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDLBCL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eLymph node\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRCHOP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAdenocarcinoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNo treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003elymphoma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eSurvival\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"12\"\u003eAbbreviation: MALT: marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue; SLL/CLL: small lymphocytic lymphoma/chronic lymphocytic leukemia; DLBCL: diffuse large B-cell lymphoma; PTCL: peripheral T-cell lymphoma; MZL: marginal zone lymphoma; FL: follicular lymphoma; WM: Waldenstr\u0026ouml;m macroglobulinemia; RT: Radiotherapy; RCDOP: rituximab\u0026thinsp;+\u0026thinsp;cyclophosphamide\u0026thinsp;+\u0026thinsp;vincristine\u0026thinsp;+\u0026thinsp;liposomal doxorubicin\u0026thinsp;+\u0026thinsp;prednisone; RCHOP: rituximab\u0026thinsp;+\u0026thinsp;cyclophosphamide\u0026thinsp;+\u0026thinsp;vincristine\u0026thinsp;+\u0026thinsp;doxorubicin\u0026thinsp;+\u0026thinsp;prednisone; auto-HSCT: autologous hematopoietic stem cell transplantation; R2-GemOx: rituximab\u0026thinsp;+\u0026thinsp;lenalidomide\u0026thinsp;+\u0026thinsp;gemcitabine\u0026thinsp;+\u0026thinsp;oxaliplatin; BR: rituximab\u0026thinsp;+\u0026thinsp;bendamustine; RCVP: rituximab\u0026thinsp;+\u0026thinsp;cyclophosphamide\u0026thinsp;+\u0026thinsp;vindesine\u0026thinsp;+\u0026thinsp;dexamethasone; RGDP: rituximab\u0026thinsp;+\u0026thinsp;gemcitabine\u0026thinsp;+\u0026thinsp;cisplatin\u0026thinsp;+\u0026thinsp;dexamethasone; SOX: oxaliplatin\u0026thinsp;+\u0026thinsp;tegafur; MTX: methotrexate; RTX: rituximab;CTX: cyclophosphamide; DTX: docetaxel; EPI: epirubicin; RICE༚rituximab\u0026thinsp;+\u0026thinsp;ifosfamide\u0026thinsp;+\u0026thinsp;carboplatin\u0026thinsp;+\u0026thinsp;etoposide; NA, not available.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe occurrence of SC is relatively rare. The reported incidence of SC ranges from 0.37\u0026ndash;2.79%, which may be attributed to differences in the duration of retrospective analyses, sample sizes, and the inclusion of autopsy series or analyses of specific tumors associated with SC in certain studies [\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. We collected clinical and pathological data from 1,726 lymphoma patients and found that 35 patients had SC, with an incidence rate of 2.02%, which is within the range of the incidence rate reported above. During follow-up, six patients died, five of whom had DLBCL combined with gastrointestinal adenocarcinoma, and four of them died within six months. These findings suggest that patients with DLBCL combined with adenocarcinoma have a higher risk of death and worse prognosis. Furthermore, all CRC-related deaths occurred in elderly patients, who had poor chemotherapy tolerance and a higher risk of severe infections and multiple organ failure.\u003c/p\u003e \u003cp\u003eAmong the 35 SC cases in our study, DLBCL was the most common lymphoma type, consistent with previous findings in non-MPM NHL patients [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Although the digestive system was the most commonly affected site by solid tumors, the most common SC was DLBCL combined with PTC. This aligns with the findings of Jiang et al. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], but differs from a systematic review of 308 SC cases, which identified MALT lymphoma with gastrointestinal tumors as the most frequent combination, with the discrepancy possibly related to the smaller sample size in our study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The pathogenesis of lymphoma combined with PTC remains unclear. Recent studies have shown that BRAFV600E mutation can induce immunosuppression. BRAFV600E reactivates the developmental factor TBX3, which subsequently upregulates CXCR2 ligands in a TLR2-NFκB-dependent manner, facilitating the recruitment of myeloid-derived suppressor cells (MDSCs) into the tumor microenvironment. By increasing the infiltration of MDSCs, BRAFV600E promotes the progression of thyroid cancer [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Karrethet al. found that the BRAF pseudogene (BRAFP1) is frequently overexpressed in DLBCL, potentially acting as an oncogene by enhancing BRAF activity and activating the MAPK signaling pathway, thus accelerating the development and progression of DLBCL [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Furthermore, the BRAFV600E mutation has also been identified in hairy cell leukemia, DLBCL, MZL, CLL/SLL, and multiple myeloma [\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, BRAF mutations may serve as a key driver in the coexistence of lymphoma and PTC.\u003c/p\u003e \u003cp\u003eThe etiology of synchronous lymphoma combined with carcinoma remains unclear. However, long-term smoking and alcohol consumption have been recognized as major pathogenic factors for MPMs in the respiratory and digestive systems [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Among the cases we collected, three patients with LC, one with PSCC, and one with PCa had a history of smoking for more than 30 years. Additionally, four patients with GC or CRC had a history of alcohol consumption for more than 20 years. Talamini et al. found that smoking is a significant risk factor for NHL, with heavy smokers having approximately twice the risk compared to non-smokers [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A pooled analysis conducted by the International Lymphoma Epidemiology Consortium, involving 15,486 participants from nine case-control studies, revealed a modest increase in risk across all NHL subtypes [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, long-term exposure to radiation, industrial pollution, and other environmental factors also contribute to the development of MPMs [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eConventional imaging (CI) techniques, including ultrasound, computed tomography, magnetic resonance imaging, and nuclear imaging, have limitations in detecting SC due to their localized imaging approach. In contrast, PET/CT offers more advantages in diagnosing SC compared to CI [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. For elderly men, we suggested that PET/CT and gastrointestinal endoscopy should be used as key methods for diagnosing colorectal tumors and confirming lymphoma. In our study cohort, a 79-year-old male patient had a rectal biopsy revealing adenocarcinoma. Post-surgical pathological examination showed moderately differentiated adenocarcinoma, and SLL/CLL was present within the full-thickness intestinal wall. A collision tumor refers to the coexistence of two independent primary malignancies occurring at the same anatomical site or organ, which come into contact or infiltrate each other to form a single mass. Among lymphomas involved in collision with solid tumors, DLBCL is the most commonly observed type [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The pathogenesis of collision tumors remains unclear, although several hypotheses have been proposed. The most widely accepted theory is neoplastic heterogeneity, which posits that collision tumors originate from two distinct clones of neoplastic cells that develop independently and coexist within the same anatomical site. This phenomenon may be facilitated by impaired immune surveillance associated with lymphoma, thereby creating a permissive microenvironment for the development of a secondary malignancy [\u003cspan additionalcitationids=\"CR38\" citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Another possible mechanism is the interaction theory, which suggests that one tumor induces changes in the epidermis or stroma through paracrine effects, with the altered microenvironment promoting the formation of a second tumor [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, there is no unified treatment principle for lymphoma combined with malignant solid tumors. Our retrospective analysis included a 75-year-old male patient diagnosed with DLBCL and colon adenocarcinoma passed away less than a month after diagnosis. During rituximab treatment for DLBCL, the patient developed diarrhea, abdominal pain, liver and kidney failure, and an IL-6 level exceeding 5000 ng/ml, suggesting cytokine release syndrome (CRS) induced by rituximab. Rituximab-induced CRS has been reported, and we found that underlying conditions such as heart disease, diabetes, and advanced age increase the risk of fatal CRS [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This can be achieved by reducing the injection dose, administering rituximab after CHOP chemotherapy, or using premedication to reduce adverse reactions [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. We analyzed whether the sequence of treatment for both types of tumors had an impact on prognosis in SC patients and found no statistically significant difference. This may be attributed to the small sample size of patients receiving treatment for both tumors simultaneously (n\u0026thinsp;=\u0026thinsp;18). Furthermore, we observed no significant difference in prognosis between lymphoma patients with or without a background of solid tumors. These findings may be attributed to factors such as the patients' overall health status, the heterogeneity and staging of both lymphoma and solid tumors, and the limited sample size, as well as the significant differences in gene mutations, tumor cell proliferation and metastasis abilities, tumor microenvironment, and therapeutic responses, which largely determine tumor progression, prognosis, and sensitivity to treatment [\u003cspan additionalcitationids=\"CR45\" citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Therefore, we recommend that treatment plans for SC be individualized to improve patients' quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights the rare occurrence of synchronous lymphoma combined with malignant solid tumors and provides clinical insights into its presentation, treatment challenges, and prognosis. Our findings indicate that DLBCL is commonly associated with solid tumors, with PTC being the most frequent concomitant malignancy. Despite the complexity of managing these cases, we observed no significant difference in prognosis between lymphoma patients with concomitant solid tumors and those with lymphoma alone. This may be attributed to the heterogeneity of both lymphoma and solid tumors, differences in patients' overall health status, and the limited sample size. As the pathogenesis and optimal treatment strategies remain unclear, we recommend an individualized treatment plan based on the type and stage of both lymphoma and solid tumors, as well as the patient's overall condition, with the aim of improving outcomes. In the future, we plan to further validate the effectiveness of treatment strategies through larger sample sizes and multi-center collaborations, providing more clinical evidence for the development of individualized treatment plans.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful for Shandong Natural Science Foundation and Yantai Science and Technology Plan for their support of this project.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the fund of Shandong Natural Science Foundation [NO.ZR2022MH297], and Yantai Science and Technology Plan [NO.2021MSGY043].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was exempted from review by the Institutional Review Board at the Yantai Yuhuangding Hospital.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGuohua Yu designed and conceived the study. Yuan Gao and Ning Zhu drafted the manuscript. Ning Zhu and Yunjun Wang critically revised the manuscript. Yuan Gao, Yu Pan and Shishou Wu performed literature research. Yan Yang, Ying Yin and Liyan Zhang drafted tables and create images. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant data and materials are available for public access and can be provided upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that written informed consent for publication was obtained from the patients involved in this study. The patients provided consent for the use of their medical information, including images and other relevant data.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMoertel CG. Multiple primary malignant neoplasms: historical perspectives. Cancer. 1977;40(4 Suppl):1786\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarren S, Gates O. Multiple primary malignant tumors: a survey of the literature and a statistical study. Am J Cancer. 1932;16(1358\u0026thinsp;\u0026ndash;\u0026thinsp;414.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018;68(4):250\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEtiz D, Metcalfe E, Akcay M. Multiple primary malignant neoplasms: A 10-year experience at a single institution from Turkey. J Cancer Res Ther. 2017;13(1):16\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowell S, Tarchand G, Rector T, Klein M. Synchronous and metachronous malignancies: analysis of the Minneapolis Veterans Affairs (VA) tumor registry. Cancer Causes Control. 2013;24(8):1565\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang Y, Miao Z, Wang J, Chen J, Lv Y, Xing D, et al. Clinical characteristics and prognosis associated with multiple primary malignant tumors in non-Hodgkin lymphoma patients. Tumori. 2019;105(6):474\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSi L, Feng Y, Wang Y, Zhong J, Sun Z, Li X, et al. Clinical and pathological characteristics of multiple primary malignant neoplasms cases. Int J Clin Pract. 2021;75(11):e14663.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhai C, Cai Y, Lou F, Liu Z, Xie J, Zhou X, et al. Multiple Primary Malignant Tumors - A Clinical Analysis of 15,321 Patients with Malignancies at a Single Center in China. J Cancer. 2018;9(16):2795\u0026ndash;801.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLv M, Zhang X, Shen Y, Wang F, Yang J, Wang B, et al. Clinical analysis and prognosis of synchronous and metachronous multiple primary malignant tumors. Med (Baltim). 2017;96(17):e6799.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIrimie A, Achimas-Cadariu P, Burz C, Puscas E. Multiple primary malignancies\u0026ndash;epidemiological analysis at a single tertiary institution. J Gastrointestin Liver Dis. 2010;19(1):69\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu W, Qi J, Liu J, Song Y, Wang L, Zhou M, et al. Mortality Rate of Lymphoma in China, 2013\u0026ndash;2020. Front Oncol. 2022;12:902643.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDayer N, Fasquelle F, Salati E, Dietrich G. Multiple primary malignancies: synchronous lymphoma, pancreatic neuroendocrine tumour and colorectal cancer. BMJ Case Rep. 2021;14(6):e241938.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi J, Zhou C, Liu W, Sun X, Meng X. Synchronous diffuse large B-cell lymphoma of the stomach and small cell lung carcinoma: A case report. Med (Baltim). 2017;96(50):e8873.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeng J, Pan H, Li X, Liu T, Liu Z, Li Q, et al. Diagnosis and Treatment of Synchronous Lymphoma and Digestive System Carcinoma: Report of Four Cases and Literature Review. Front Oncol. 2019;9:1367.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms. Leukemia. 2022;36(7):1720\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCampo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC, et al. The International Consensus Classification of Mature Lymphoid Neoplasms: a report from the Clinical Advisory Committee. Blood. 2022;140(11):1229\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParra-Medina R, Rocha F, Casta\u0026ntilde;eda-Gonz\u0026aacute;lez JP, Moreno-Lucero P, Veloza L, Romero-Rojas AE. Synchronous or collision solid neoplasms and lymphomas: A systematic review of 308 case reports. Med (Baltim). 2022;101(28):e28988.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSanthanam P, Khthir R, Solnes LB, Ladenson PW, THE RELATIONSHIP OF BRAF(V600E) MUTATION STATUS TO FDG PET/CT AVIDITY IN THYROID CANCER. A REVIEW AND META-ANALYSIS. Endocr Pract. 2018;24(1):21\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang P, Guan H, Yuan S, Cheng H, Zheng J, Zhang Z, et al. Targeting myeloid derived suppressor cells reverts immune suppression and sensitizes BRAF-mutant papillary thyroid cancer to MAPK inhibitors. Nat Commun. 2022;13(1):1588.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarreth FA, Reschke M, Ruocco A, Ng C, Chapuy B, L\u0026eacute;opold V, et al. The BRAF pseudogene functions as a competitive endogenous RNA and induces lymphoma in vivo. Cell. 2015;161(2):319\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaitre E, Cornet E, Troussard X. Hairy cell leukemia: 2020 update on diagnosis, risk stratification, and treatment. Am J Hematol. 2019;94(12):1413\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJebaraj BM, Kienle D, B\u0026uuml;hler A, Winkler D, D\u0026ouml;hner H, Stilgenbauer S, et al. BRAF mutations in chronic lymphocytic leukemia. Leuk Lymphoma. 2013;54(6):1177\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang XY, Li M, Zhao YX, Wang LF, Li DJ, Xu ZG, et al. [Clinicopathological features and BRAF V600E and MYD88 L265P mutation status of nodal marginal zone lymphoma]. Zhonghua Bing Li Xue Za Zhi. 2022;51(4):301\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndrulis M, Lehners N, Capper D, Penzel R, Heining C, Huellein J, et al. Targeting the BRAF V600E mutation in multiple myeloma. Cancer Discov. 2013;3(8):862\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLohr JG, Stojanov P, Lawrence MS, Auclair D, Chapuy B, Sougnez C, et al. Discovery and prioritization of somatic mutations in diffuse large B-cell lymphoma (DLBCL) by whole-exome sequencing. Proc Natl Acad Sci U S A. 2012;109(10):3879\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBresadola L, Weber D, Ritzel C, L\u0026ouml;wer M, Bukur V, Akilli-\u0026Ouml;zt\u0026uuml;rk \u0026Ouml; et al. Comprehensive Genomic and Transcriptomic Analysis of Three Synchronous Primary Tumours and a Recurrence from a Head and Neck Cancer Patient. Int J Mol Sci. 2021;22(14).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFujita S, Masago K, Takeshita J, Togashi Y, Hata A, Kaji R, et al. Multiple primary malignancies in patients with non-small cell lung cancer. Intern Med. 2015;54(3):325\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu H, Zhang Q, Zhang S, Zhang Y, Song R, Li P, et al. Clinical features and risk of multiple primary malignancies after endoscopic treatment in patients with early esophageal squamous cell carcinoma: a retrospective cohort study. J Gastrointest Oncol. 2024;15(4):1386\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTalamini R, Polesel J, Montella M, Maso LD, Crispo A, Spina M, et al. Smoking and non-Hodgkin lymphoma: case-control study in Italy. Int J Cancer. 2005;115(4):606\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorton LM, Hartge P, Holford TR, Holly EA, Chiu BC, Vineis P, et al. Cigarette smoking and risk of non-Hodgkin lymphoma: a pooled analysis from the International Lymphoma Epidemiology Consortium (interlymph). Cancer Epidemiol Biomarkers Prev. 2005;14(4):925\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFarshadpour F, Hordijk GJ, Koole R, Slootweg PJ. Head and neck squamous cell carcinoma in non-smoking and non-drinking patients with multiple tumors: etiologic significance of p53 and Ki-67 in non-tumorous epithelium. J Oral Pathol Med. 2008;37(9):549\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsu CH, Huang CL, Hsu YH, Iqbal U, Nguyen PA, Jian WS. Co-occurrence of second primary malignancy in patients with thyroid cancer. QJM. 2014;107(8):643\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakellakis M, Peroukides S, Iconomou G, Boumpoucheropoulos S, Kalofonos H. Multiple primary malignancies: a report of two cases. Chin J Cancer Res. 2014;26(2):215\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVogt A, Schmid S, Heinimann K, Frick H, Herrmann C, Cerny T, et al. Multiple primary tumours: challenges and approaches, a review. ESMO Open. 2017;2(2):e000172.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo ZH, Qi WL, Jin AF, Liao FX, Liu Q, Zeng QY. The role of (18)F-FDG PET/CT in patients with synchronous multiple primary malignant neoplasms occurring at the same time. Front Oncol. 2022;12:1068055.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSun L, Wan Y, Lin Q, Sun YH, Zhao L, Luo ZM, et al. Multiple primary malignant tumors of upper gastrointestinal tract: a novel role of 18F-FDG PET/CT. World J Gastroenterol. 2010;16(31):3964\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSatter EK, Metcalf J, Lountzis N, Elston DM. Tumors composed of malignant epithelial and melanocytic populations: a case series and review of the literature. J Cutan Pathol. 2009;36(2):211\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoyd AS, Rapini RP. Cutaneous collision tumors. An analysis of 69 cases and review of the literature. Am J Dermatopathol. 1994;16(3):253\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornejo KM, Deng AC. Malignant melanoma within squamous cell carcinoma and basal cell carcinoma: is it a combined or collision tumor?--a case report and review of the literature. Am J Dermatopathol. 2013;35(2):226\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHopster D, Smith PA, Nash JR, Elders K, Poston GJ. Synchronous multiple lymphomatous polyposis and adenocarcinomata in the large bowel. Postgrad Med J. 1995;71(837):443.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeifert G, Reindl T, Lobitz S, Seeger K, Henze G. Fatal course after administration of rituximab in a boy with relapsed all: a case report and review of literature. Haematologica. 2006;91(6 Suppl):Ecr23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTournamille JF, Rigal-Huguet F, Pathak A, Montastruc JL, Lapeyre-Mestre M. [Cardiac effects of cytokines produced after rituximab infusion]. Bull Cancer. 2005;92(9):769\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakino K, Nakata J, Kawachi S, Hayashi T, Nakajima A, Yokoyama M. Treatment strategy for reducing the risk of rituximab-induced cytokine release syndrome in patients with intravascular large B-cell lymphoma: a case report and review of the literature. J Med Case Rep. 2013;7:280.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eArmitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. Lancet. 2017;390(10091):298\u0026ndash;310.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRauth S, Malafa M, Ponnusamy MP, Batra SK. Emerging Trends in Gastrointestinal Cancer Targeted Therapies: Harnessing Tumor Microenvironment, Immune Factors, and Metabolomics Insights. Gastroenterology. 2024;167(5):867\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTarhini AA, Eads JR, Moore KN, Tatard-Leitman V, Wright J, Forde PM et al. Neoadjuvant immunotherapy of locoregionally advanced solid tumors. J Immunother Cancer. 2022;10(8).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"diagnostic-pathology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dpat","sideBox":"Learn more about [Diagnostic Pathology](http://diagnosticpathology.biomedcentral.com)","snPcode":"13000","submissionUrl":"https://submission.nature.com/new-submission/13000/3","title":"Diagnostic Pathology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lymphoma, Neoplasms, Multiple primary malignancies, Diagnosis, Clinical features","lastPublishedDoi":"10.21203/rs.3.rs-5977195/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5977195/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThis study aimed to investigate the clinical features and potential pathogenesis of lymphoma complicated with malignant solid tumors. Clinical data from 35 patients treated at Yantai Yuhuangding Hospital between January 2018 and March 2023 were retrospectively analyzed. Among 1726 lymphoma patients, 35 (2.03%) were found to have solid tumors, including 22 males and 13 females, with a median age of 62 years (range: 49\u0026ndash;83 years). The lymphoma subtypes included 14 cases of diffuse large B-cell lymphoma (DLBCL), 8 cases of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL), 7 cases of marginal zone lymphoma (MZL), 3 cases of peripheral T-cell lymphoma (PTCL), 2 cases of follicular lymphoma (FL), and 1 case of Waldenstr\u0026ouml;m macroglobulinemia (WM). The solid tumors included 9 cases of papillary thyroid carcinoma (PTC), 8 cases of colorectal cancer (CRC), 7 cases of lung cancer (LC), 5 cases of gastric cancer (GC), 2 cases of prostate cancer (PCa), and 1 case each of breast cancer (BC), clear cell renal cell carcinoma (ccRCC), pharyngeal squamous cell carcinoma (PSCC), and bladder cancer (BLCA). Lymphoma with solid tumors is rare, often affecting elderly males. Non-Hodgkin\u0026rsquo;s lymphoma, especially DLBCL, was the most common subtype, and PTC was the most frequent solid tumor. Clinicians should focus on these cases to improve diagnosis and treatment.\u003c/p\u003e","manuscriptTitle":"Clinical analysis of lymphoma with malignant solid tumor simultaneously: a retrospective case series","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 06:35:18","doi":"10.21203/rs.3.rs-5977195/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Accepted","date":"2025-04-17T14:36:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-17T08:03:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120756728195899715799370434843125805806","date":"2025-04-17T03:52:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-16T18:05:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-16T09:58:26+00:00","index":"","fulltext":""},{"type":"submitted","content":"Diagnostic Pathology","date":"2025-04-15T15:48:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"diagnostic-pathology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"dpat","sideBox":"Learn more about [Diagnostic Pathology](http://diagnosticpathology.biomedcentral.com)","snPcode":"13000","submissionUrl":"https://submission.nature.com/new-submission/13000/3","title":"Diagnostic Pathology","twitterHandle":"@OncoBioMed","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea9d38f4-ccda-4ac9-81ea-ac7963a83e26","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-04-28T16:05:45+00:00","versionOfRecord":{"articleIdentity":"rs-5977195","link":"https://doi.org/10.1186/s13000-025-01653-y","journal":{"identity":"diagnostic-pathology","isVorOnly":false,"title":"Diagnostic Pathology"},"publishedOn":"2025-04-26 15:57:39","publishedOnDateReadable":"April 26th, 2025"},"versionCreatedAt":"2025-04-21 06:35:18","video":"","vorDoi":"10.1186/s13000-025-01653-y","vorDoiUrl":"https://doi.org/10.1186/s13000-025-01653-y","workflowStages":[]},"version":"v1","identity":"rs-5977195","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5977195","identity":"rs-5977195","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}