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We present new, detailed carbon-isotope records for bulk carbonate, total organic carbon (TOC) and phytane from three key sections spanning the Cenomanian--Turonian boundary, interval (Eastbourne, England; Gubbio, Italy; Tarfaya, Morocco), with the purpose of establishing a common chemostratigraphic framework for Oceanic Anoxic Event (OAE) 2. Isotope curves from all localities are characterized by a positive carbon-isotope excursion of c. 4[per thousand] for TOC and phytane and c. 2.5[per thousand] for carbonate, although diagenetic overprinting appears to have obliterated the primary carbonate carbon-isotope signal in at least part of the Tarfaya section. Stratigraphically, peak [[delta].sup.13]C values for all components are followed by intervals of high, near-constant [[delta].sup.13]C in the form of an isotopic plateau. Recognition of an unambiguous return to background [[delta].sup.13]C values above the plateau is, however, contentious in all sections, hence no firm chemostratigraphic marker for the end-point of the positive isotopic excursion can be established. The stratigraphically consistent first appearance of the calcarcous nannofossil Quadrum gartneri at or near the Cenomanian--Turonian boundary as established by ammonite stratigraphy, in conjunction with the end of the [[delta].sup.13]C maximum characteristic of the isotopic plateau, provides a potentially powerful tool for delimiting the stratigraphic extent and duration of OAE 2. This Oceanic Anoxic Event is demonstrated to be largely, if not wholly, confined to the latest part of the Cenomanian stage. Keywords: Oceanic Anoxic Event 2, Eastbourne, England, Gubbio, Italy, Tarfaya, Morocco, [sup.13]C.

During the Late Cenomanian-Early Turonian (C/T) Oceanic Anoxic Event (OAE2), organic-rich strata was deposited in rift shelf basins and slopes across North Africa and in deep-sea basins of the adjacent oceans. Based on a review of published and unpublished information, this paper documents the distribution and organic-richness of C/T strata across the whole region within a palaeogeographic framework and systematically analyses the conditions and processes, which controlled their deposition. Previously, the C/T in North Africa has been most intensively studied in southern Morocco (Tarfaya) and Tunisia. Only little data is availabe for other parts of North Africa, namely Algeria, Libya and Egypt, because distribution of C/T Corg strata there becomes more patchy. A general decrease in peak organic richness and black shale thickness occurs from west to east, partly as a result of upwelling along the Moroccan Atlantic coast and the absence of upwelling in the eastern Mediterranean area. Furthermore, in the confined central Atlantic, the oxygen minimum zone (OMZ) in many places reached down to the deep-sea floor (3-4 km), while the lower limit of the OMZ along the North African Tethys was much shallower and underlain by oxic water masses. As documented by high resolution biostratigraphic and chemostratigraphic data, C/T black shale deposition in most areas outside the upwelling zone are restricted to a strong, eustatic, latest Cenomanian transgressive phase. Triggered by this sea-level rise, the OMZ impinged onto the North African continental shelf and the margins of intrashelf basins, which mostly formed during the Early Cretaceous as halfgrabens. Important units containing C/T organic-rich strata in the region are the Atlantic Tarfaya black shales (Morocco, Western Sahara), black shales and phtanites in the Moroccan and Algerian Atlas, the Bahloul Fm. in the SE Constantine Basin and in northern and central Tunisia, the Etel Fm. in the Sirte Basin, the Al Hilal Fm. in Cyrenaica (Libya), the Abu Roash Fm. in the Abu Gharadig and Fayium basins (Western Desert, Egypt), the Daliyya Fm. along the NE Sinai-Palestine-Isreal coast and the Shueib Fm. in west central Jordan. Keywords: Cenomanian-Turonian; anoxia; black shale; North Africa; petroleum source rock

(1) Background: This study aimed to examine the difference in efficacy and toxicity of involved-field (IFRT) and involved-site radiotherapy (ISRT) fields in infradiaphragmal aggressive non-Hodgkin lymphoma patients. (2) Methods: In total, 140 patients with infradiaphragmal lymphoma treated between 2003 and 2020 were retrospectively evaluated. There were 69 patients (49%) treated with IFRT, and 71 (51%) patients treated with ISRT. The median dose in the IFRT group was 36 Gy, (range 4-50.4 Gy), and in the ISRT group, it was 30 Gy (range 4-48 Gy). (3) Results: The median follow-up in the IFRT group was 133 months (95% CI 109-158), and in the ISRT group, it was 48 months (95% CI 39-57). In the IFRT group, locoregional control was 67%, and in the ISRT group, 73%. The 2- and 5-year overall survival (OS) in the IFRT and ISRT groups were 79% and 69% vs. 80% and 70%, respectively ( p = 0.711). The 2- and 5-year event-free survival (EFS) in the IFRT and ISRT groups were 73% and 68% vs. 77% and 70%, respectively ( p = 0.575). Acute side effects occurred in 43 (31%) patients, which is more frequent in the IFRT group, 34 (39%) patients, than in the ISRT group, 9 (13%) patients, p > 0.01. Late toxicities occurred more often in the IFRT group of patients, (10/53) 19%, than in the ISRT group of patients, (2/37) 5%, ( p = 0.026). (4) Conclusions: By reducing the radiotherapy volume and the doses in the treatment of infradiaphragmatic fields, treatment with significantly fewer acute and long-term side effects is possible. At the same time, efficiency and local disease control are not compromised.

Purpose: Data on efficacy and toxicity of infradiaphragmal radiotherapy fields in lymphoma patients are scarce. We therefore performed this retrospective study to analyse our experience with radiotherapy exclusively to infradiaphragmal fields., Materials and Methods: we retrospectively evaluated 101 patients treated between 2003 and 2014. Median dose was 36 Gy, range 4 to 54 Gy. Medium dose per fraction was 2 Gy, range 1.5 to 7 Gy., Results: After a median follow-up of 66 months (range 1-211 months), we observed lymphoma recurrence in 38 patients (38%), five in the RT field and 33 out-of-field. Recurrences were significantly more frequent in the salvage group (17 out-of-field and 4 in-field in 31 patients) than in adjuvant group (16 out-of-field and 1 in-field in 70 patients; p < 0.001). The 2-, 5- and 10-year event-free survival (EFS) rates were 62%, 56% and 54%. The 2-, 5- and 10-year overall survival (OS) rates for the entire group of patients are 73%, 60% and 54%, respectively. Acute side effects occurred in 43 (43%) patients, most frequent gastrointestinal in 26 (26%) patients. Late side effects occurred in 12 (12%) of all patients, 6 of 23 (26%) followed up for more than 10 years. Six patients developed secondary cancers, four gastrointestinal disturbances, two diabetes mellitus and three renal failure., Conclusion: Radiotherapy is an effective and safe treatment option for patients with infradiaphragmatic lymphoma providing excellent local disease control with minimal late toxicity. Infradiaphragmatic lymphoma localization should not be regarded as a contraindication for use of radiotherapy. However, patients should be monitored for a secondary malignancy., (© 2023. Italian Society of Medical Radiology.)

Introduction Multiple myeloma (MM) treatment has evolved substantially in recent years. Solid data on the impact of treatment strategies on patient outcomes beyond clinical trials are scarce, especially in budget‑restricted environments with limited access to new treatments. Objectives This study investigated treatment practices, patterns, and outcomes in real‑world clinical practice in Bulgaria, Croatia, Czech Republic, Poland, Romania, and Slovakia. Patients and methods This was a noninterventional, observational chart review comprising a cross‑sectional and a retrospective longitudinal phase observing adult patients with symptomatic MM at all stages of therapy. Results The study revealed structural differences in clinical practice compared with a similarly designed study previously conducted in 7 Western European countries. Stem cell transplantation was performed in less than half of newly diagnosed eligible patients. The most frequently used first‑line regimens were bortezomib based, with frequent bortezomib retreatment after the first relapse. Lenalidomide‑based regimens were predominant in the third and subsequent lines of therapy. Depth of response decreased with each treatment line, with half of patients achieving at least very good partial response (≥VGPR) in the first line, while only one‑fourth achieved ≥VGPR in the third or subsequent lines. Time to progression was longer in patients with better response levels. Conclusions Inadequate access to advanced antimyeloma regimens and-in some countries-stem cell transplantation highlights the challenges of MM treatment in the region. Information on real‑world patient management and its outcomes can provide valuable input for decision makers to effectively allocate limited resources.

ALK positive anaplastic large cell lymphoma is a T-cell lymphoma usually occurring in children and young adults. It frequently involves lymph nodes and extranodal sites and is associated with favorable prognosis. A 20-year old man was admitted for painful mass in the left axilla with overlying skin redness. Clinical presentation and US findings were highly suspicious for sarcoma. Definitive diagnosis was established cytolologically and using ancillary technologies from cytological samples. Fine needle aspiration cytology of tumor mass (lymph node conglomerate and surrounding tissue) show predominance of large, pleomorphic, atypical cells with large nuclei and vacuolised cytoplasm. Atypical cells immunocytochemically were positive for LCA, CD30, CD3, EMA, and ALK; negative for CD15 and CD56. NPM-ALK transcript was detected by reverse transcriptase-polymerase chain reaction (RT-PCT). Molecular analysis of TCRß and TCRγ genes demonstrated clonal TCR genes rearrangement. Complex karyotype with multiple numerical and structural changes was found on conventional cytogenetics. These findings excluded sarcoma and corroborated the diagnosis of ALK positive ALCL. Cutaneous involvement in ALCL can clinically mimic sarcoma, especially in cases with localized disease without B symptoms. In those cases, immunostaining, PCR, and conventional cytogenetics are helpful to exclude sarcoma. Diagn. Cytopathol. 2017;45:51-54. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Primary plasma cell leukemia (PCL) is a rare and aggressive variant of plasma cell (PC) myeloma characterized by high levels of circulating PCs. Clinical presentation is like other acute leukemia, with extramedullary infiltration of various tissues and organs being a frequent complication. The disease has a fulminant course and poor prognosis. Morphology of PCs in PCL includes a spectrum of maturity, with most cases having lymphoplasmacytoid or plasmablastic morphology. Presentation as more primitive cells that do not resemble PCs is even rarer and requires additional morphological and immunophenotypic studies. We present a case of 79-year-old woman who presented with severe pancytopenia and lobar pneumonia. Laboratory and clinical evaluation revealed primary, nonsecretory PCL with atypical, immature blast morphology, extramedullary renal involvement, and plasmablasts in urine. Despite therapeutic efforts the patient succumbed to the disease. Detection of PCs in the urine indicates extramedullary spread of disease, especially without accompanying hematuria, and may contribute to impairment of renal function, what is already a frequent complication in these patients., (© 2014 Wiley Periodicals, Inc.)

Febrile cholestatic liver disease is an extremely unusual presentation of Hodgkin lymphoma (HL). The liver biopsy of a 40-year-old man with febrile episodes and cholestatic laboratory pattern disclosed an uncommon subtype of HL, a nodular lymphocyte-predominant HL (NLPHL). Liver involvement in the early stage of the usually indolent NLPHL's clinical course suggests an aggressiveness and unfavorable outcome. Emphasizing a liver biopsy early in the diagnostic algorithm enables accurate diagnosis and appropriate treatment. Although rare, HL should be considered in the differential diagnosis of cholestasis.