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Gu J, Qian J, Cao X. Composite diffuse large B-cell lymphoma and peripheral T-cell lymphoma: a case report with two-year follow-up and literature review. Front Oncol 2024; 14:1272209. [PMID: 38529384 PMCID: PMC10961394 DOI: 10.3389/fonc.2024.1272209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Composite lymphoma is an uncommon type of lymphoid malignancy, and those consisting of concurrent diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) in the same organ are rare. Here, we report a case of a 75-year-old male patient admitted to our emergency department with intestinal obstruction presenting with abdominal pain and vomiting. He underwent partial resection of the small intestine under general anesthesia, and subsequent histopathology confirmed the mass to be composite DLBCL and PTCL-NOS. The patient received chemotherapy with a rituximab-based regimen and achieved complete remission (CR). However, the recurrent disease presented with obstruction again ten months after treatment. He refused a second surgery, but salvage treatment was not effective. The patient survived for 20 months after diagnosis. In addition, we did a literature review to understand the clinical features, pathology, treatment, and prognosis of this type of composite lymphoma.
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Affiliation(s)
| | | | - Xin Cao
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, China
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2
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Gao HX, Duan YL, Zhou CJ, Zhang NN, Jin L, Yang J, Huang S, Zhang M, Zhang YH. [Other iatrogenic immunodeficiency associated lymphoproliferative diseases in children with lymphoma: a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2023; 44:1045-1048. [PMID: 38503532 PMCID: PMC10834865 DOI: 10.3760/cma.j.issn.0253-2727.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Indexed: 03/21/2024]
Affiliation(s)
- H X Gao
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Y L Duan
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - C J Zhou
- Department of Pathology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - N N Zhang
- Department of Imaging, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - L Jin
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - J Yang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - S Huang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - M Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
| | - Y H Zhang
- Medical Oncology Department, Pediatric Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing Key Laboratory of Pediatric Hematology Oncology, National Key Clinical Discipline of Pediatric Oncology, Key Laboratory of Major Diseases in Children, Ministry of Education, Beijing 100045, China
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3
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Hariharan N, Kabadi A, Don M, Odish M, Heyman B. Composite Angioimmunoblastic T-Cell Lymphoma and Diffuse Large B-Cell Lymphoma Presenting with Distributive Shock. Hematol Rep 2023; 15:627-633. [PMID: 37987320 PMCID: PMC10660698 DOI: 10.3390/hematolrep15040064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/12/2023] [Accepted: 11/06/2023] [Indexed: 11/22/2023] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) and angioimmunoblastic T-cell lymphoma (AITL) are two subtypes of non-Hodgkin lymphoma (NHL). The simultaneous occurrence of DLBCL and AITL in a composite lymphoma is very rare, and there are no established treatment regimens. We present the case of an 85-year-old male admitted to the intensive care unit with distributive shock, lymphocytosis, and lymphadenopathy, who was subsequently diagnosed with composite AITL and DLBCL, and treated with brentuximab vedotin (BV) and rituximab. To our knowledge, this is the first case of composite lymphoma presenting with distributive shock and treated with BV and rituximab, with successful resolution of shock.
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Affiliation(s)
- Nisha Hariharan
- Department of Medicine, Division of Hematology/Oncology, University of California, La Jolla, CA 92093, USA;
| | - Alisha Kabadi
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California, La Jolla, CA 92093, USA
| | - Michelle Don
- Department of Pathology, University of California, La Jolla, CA 92093, USA
| | - Mazen Odish
- Department of Medicine, Division of Pulmonary, Critical Care, Sleep Medicine, and Physiology, University of California, La Jolla, CA 92093, USA
| | - Benjamin Heyman
- Department of Medicine, Division of Regenerative Medicine, University of California, La Jolla, CA 92093, USA
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4
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Gu L, Xin G, Qu Y, Wang K, Jiang K, Xing S, Huang A. Case report: Anterior mediastinal mass in a patient with pleural effusion and dyspnea. Front Surg 2023; 10:1088642. [PMID: 37206341 PMCID: PMC10189153 DOI: 10.3389/fsurg.2023.1088642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/04/2023] [Indexed: 05/21/2023] Open
Abstract
Background Compound lymphoma is an uncommon type of lymphoid malignancy, and those consisting of concurrent B- and T-cell tumors are relatively rare. Case Summary A 41-year-old man was presented with a 1-month history of progressively worsening cough, chest tightness, and dyspnea after exercise, which could be relieved following rest. Contrast-enhanced computed tomography scan demonstrated a 7.4 × 4.9 cm2 heterogeneous mass in the anterior mediastinum, where a large area of cystic liquid existed, and multiple enlarged lymph nodes in the mediastinum. Since the biopsy failed to yield an exact diagnosis and there was no sign of metastasis, the tumor was surgically resectioned. Surgical findings included obscure boundaries and consistent tumor stiffness with pericardial and pleural invasion. Further pathological examination combined with immunophenotype and gene rearrangement test found the mass composite of angioimmunoblastic T-cell lymphoma (AITL) and B-cell lymphoma. The patient recovered well after R0 resection and received chemotherapy with four cycles of CHOP combined with chidamide 2 weeks after surgery. The patient has had a complete response for over 60 months. Conclusion In conclusion, we reported a composite lymphoma of AITL combined with B-cell lymphomas. Our experience provides the first successful attempt to treat this rare disease with combined surgery and chemotherapy.
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Affiliation(s)
- Lin Gu
- Department of Thoracic Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Guangdong, China
| | - Gaojie Xin
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yue Qu
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Wang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Jiang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijie Xing
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Ai Huang Shijie Xing
| | - Ai Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Correspondence: Ai Huang Shijie Xing
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5
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Lin W, Chen X, Cai Z, Zheng H, Huang H, Yang H, Hu J, Zheng J, Asakawa T. Insights from a patient with chronic lymphocytic leukemia complicating ALK + anaplastic large cell lymphoma. Intractable Rare Dis Res 2022; 11:196-201. [PMID: 36457588 PMCID: PMC9709618 DOI: 10.5582/irdr.2022.01086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Chronic lymphocytic leukemia (CLL) that transforms into a more aggressive lymphoma has been termed Richter syndrome (RS). CLL with T-cell neoplasia is rarely reported; those with ALK+ anaplastic large cell lymphoma (ALCL) are also exceedingly rarely reported. A 63-year-old woman from the south of China presented with generalized lymphadenectasis and fever; she already had a prior diagnosis of CLL 9 years ago. As per her current diagnosis, it was CLL with ALK+ ALCL. The two-lymph node and bone marrow biopsies presented two types of cellular groups: i) left cervical lymph node biopsy suggested CLL (Ki67: 10%), along with bone marrow biopsy exhibited enhancement of the small lymphocytes (30%) with scant cytoplasm, round or irregular cell nuclei, and massive amounts of chromatin. Large cells (< 1%) that expressed CD30 and ALK were visible; The results of immunohistochemistry were as follows: CD20 (weak positive); PAX5 (positive); CD23 and CD5 (weak positive); and CD3, CD10, and CyclinD1 (negative); ii) left supraclavicular lymph node biopsy suggested ALK+ ALCL (Ki67: 70%). The final diagnosis was CLL with ALCL. The mechanisms of this condition are not fully understood, which might be associated with chronic stimulation of T cells by CLL cells along with immune dysfunction.
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Affiliation(s)
- Wuqiang Lin
- Department of Hematology, the First Hospital of Putian City, Putian, Fujian, China
| | - Xiuli Chen
- Department of Hematology, the First Hospital of Putian City, Putian, Fujian, China
| | - Zhenjie Cai
- Department of Hematology, the First Hospital of Putian City, Putian, Fujian, China
| | - Heyong Zheng
- Department of Hematology, the First Hospital of Putian City, Putian, Fujian, China
| | - Hanxing Huang
- Department of Pathology, the First Hospital of Putian City, Putian, Fujian, China
| | - Huanxing Yang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jianda Hu
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Jing Zheng
- Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Address correspondence to:Jing Zheng, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou 350001, Fujian, China.
| | - Tetsuya Asakawa
- Institute of Neurology, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong. China
- Address correspondence to:Jing Zheng, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Xinquan Road 29, Fuzhou 350001, Fujian, China.
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6
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Nicolae A, Bouilly J, Lara D, Fataccioli V, Lemonnier F, Drieux F, Parrens M, Robe C, Poullot E, Bisig B, Bossard C, Letourneau A, Missiaglia E, Bonnet C, Szablewski V, Traverse-Glehen A, Delfau-Larue MH, de Leval L, Gaulard P. Nodal cytotoxic peripheral T-cell lymphoma occurs frequently in the clinical setting of immunodysregulation and is associated with recurrent epigenetic alterations. Mod Pathol 2022; 35:1126-1136. [PMID: 35301414 DOI: 10.1038/s41379-022-01022-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/26/2022] [Indexed: 12/18/2022]
Abstract
Nodal peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) with cytotoxic phenotype is overall rare, with most reports coming from Asia. Given its elusive pathobiology, we undertook a clinicopathological and molecular study of 54 Western patients diagnosed with PTCL, NOS expressing cytotoxic molecules, within a lymph node. More commonly males (M/F-2,6/1) with median age of 60 years were affected. Besides lymphadenopathy, 87% of patients had ≥1 involved extranodal site. High-stage disease (III-IV), International Prognostic Index >2, B symptoms, LDH level, and cytopenia(s) were observed in 92, 63, 67, 78, and 66% of cases, respectively. Ten patients had a history of B-cell malignancies, one each of myeloid neoplasm, breast or prostate cancer, and 4 others had underlying immune disorders. Most patients (70%) died, mostly of disease, with a median overall survival of 12.7 months. Immunophenotypically, the neoplastic lymphocytes were T-cell receptor (TCR) αβ + (47%), TCR-silent (44%) or TCRγδ+ (10%), commonly CD8 + (45%) or CD4-CD8- (32%). All except one had an activated cytotoxic profile, and 95% were subclassified into PTCL-TBX21 subtype based on CXCR3, TBX21, and GATA3 expression pattern. Seven patients (13%) disclosed EBER + tumor cells. Targeted DNA deep-sequencing (33 cases) and multiplex ligation-dependent reverse transcription-polymerase chain reaction assay (43 cases) identified frequent mutations in epigenetic modifiers (73%), including TET2 (61%) and DNMT3A (39%), recurrent alterations affecting the TCR (36%) and JAK/STAT (24%) signaling pathways and TP53 mutations (18%). Fusion transcripts involving VAV1 were identified in 6/43 patients (14%). Patients with nodal cytotoxic PTCL, NOS have an aggressive behavior and frequently present in a background of impaired immunity, although the association with Epstein-Barr virus is rare. The recurrent alterations in genes involved in DNA methylation together with genes related to cytokine or TCR signaling, suggest that co-operation of epigenetic modulation with cell-signaling pathways plays a critical role in the pathogeny of these lymphomas.
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Affiliation(s)
- Alina Nicolae
- Department of Pathology, Hautepierre, University Hospital Strasbourg, Strasbourg, France.,INSERM, IRFAC / UMR-S1113, ITI InnoVec, FHU ARRIMAGE, FMTS, University of Strasbourg, Strasbourg, France.,INSERM U955, Université Paris-Est, Créteil, France
| | - Justine Bouilly
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Diane Lara
- INSERM U955, Université Paris-Est, Créteil, France.,Service d'Hématologie, Centre Hospitalier Robert Boulin, Libourne, France
| | - Virginie Fataccioli
- INSERM U955, Université Paris-Est, Créteil, France.,Département de Pathologie, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - François Lemonnier
- INSERM U955, Université Paris-Est, Créteil, France.,Unité Hémopathies lymphoïdes, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - Fanny Drieux
- INSERM U1245, Centre Henri Becquerel, Rouen, France.,Service d'Anatomie et Cytologie Pathologiques, Centre Henri Becquerel, Rouen, France
| | - Marie Parrens
- Département de Pathologie, Hôpital Haut -Lévêque, Université de Bordeaux, INSERM, BaRITOn, U1053, F-33000, Bordeaux, France
| | - Cyrielle Robe
- INSERM U955, Université Paris-Est, Créteil, France.,Département de Pathologie, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - Elsa Poullot
- INSERM U955, Université Paris-Est, Créteil, France.,Département de Pathologie, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - Bettina Bisig
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Céline Bossard
- Service d'Anatomie et Cytologie Pathologiques, CHU de Nantes, Nantes, France
| | - Audrey Letourneau
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Edoardo Missiaglia
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | | | | | - Marie-Hélène Delfau-Larue
- INSERM U955, Université Paris-Est, Créteil, France.,Département d'Hématologie et Immunologie Biologique, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France
| | - Laurence de Leval
- Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital (CHUV) and Lausanne University, Lausanne, Switzerland
| | - Philippe Gaulard
- INSERM U955, Université Paris-Est, Créteil, France. .,Département de Pathologie, Groupe Hospitalier Henri Mondor, AP-HP, Créteil, France.
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7
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Angioimmunoblastic T-Cell Lymphoma and Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Novel Form of Composite Lymphoma Potentially Mimicking Richter Syndrome. Am J Surg Pathol 2021; 45:773-786. [PMID: 33739791 DOI: 10.1097/pas.0000000000001646] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is an indolent small B-cell neoplasm that may transform into a clinically aggressive disease, namely Richter syndrome, usually as diffuse large B-cell lymphoma. Besides, CLL/SLL encompasses an increased risk of developing other secondary cancers, including a variety of T-cell lymphomas, often of the anaplastic large-cell type or with a cytotoxic phenotype. Here, we report a small series of patients with composite lymphomas consisting of CLL/SLL and angioimmunoblastic T-cell lymphoma (AITL), a hitherto unrecognized association. The 3 patients (1 male/2 females, 68 to 83 y) presented with high-grade-type symptoms. One patient was clinically suspicious for Richter syndrome, in the others CLL/SLL and AITL were concomitant de novo diagnoses. CLL/SLL and AITL were admixed in the same lymph nodes (3/3 cases) and in the bone marrow (1/2 cases). In all cases, the AITL comprised prominent clear cells with a strong T follicular helper immunophenotype and similar mutations consisting of TET2 or DNMT3A alterations, IDH2 R172K/M, and RHOA G17V. The 3 patients received chemotherapy. One died of early AITL relapse. The other 2 remained in complete remission of AITL, 1 died with recurrent CLL, and 1 of acute myeloid leukemia. These observations expand the spectrum of T-cell lymphoma entities that occur in association with CLL/SLL, adding AITL to the rare variants of aggressive neoplasms manifesting as Richter syndrome. Given that disturbances of T-cell homeostasis in CLL/SLL affect not only cytotoxic but also helper T-cell subsets, these may contribute to the emergence of neoplasms of T follicular helper derivation.
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8
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Geladari E, Dimopoulou G, Margellou E, Paraskevas A, Kafetzis G, Rontogianni D, Vadiaka M. Coexistence of Hodgkin and Non-Hodgkin Lymphoma; Composite Lymphoma [CL] in a Patient Presenting with Waxing and Waning Lymphadenopathy. Cardiovasc Hematol Disord Drug Targets 2021; 20:160-163. [PMID: 31633478 DOI: 10.2174/1871529x19666191014111118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 08/30/2019] [Accepted: 09/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND The coexistence of two or more types of lymphoma within the same organ at the same time of diagnosis is defined as composite lymphoma, a rare disease that has recently been identified in the literature. Pointedly, the concurrence may be Hodgkin lymphoma with a Non-Hodgkin lymphoma [NHL], either B or T cells, or two different entities of NHLs. Furthermore, this condition has been described concurrently or sequentially. In order for the diagnosis to be established, two or more distinct clones should be proven by morphological and laboratory tests. CASE PRESENTATION Herein, we cite a seventy-three-year old female patient with low-grade fever, waxing and waning cervical lymphadenopathy, whose biopsy of an axillary lymph node demonstrated the rare coexistence of Hodgkin and NHL, known as composite lymphoma. CONCLUSION Composite lymphomas pose a particular diagnostic challenge, and currently, there are no agreed standards for treatment.
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Affiliation(s)
- Eleni Geladari
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
| | - Georgia Dimopoulou
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
| | - Evangelia Margellou
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
| | | | - Georgios Kafetzis
- 4th Surgical Department, Evaggelismos General Hospital, Athens, Greece
| | | | - Maria Vadiaka
- 1st Internal Medicine Department, Evaggelismos General Hospital, Athens, Greece
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9
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Liu YA, Finn AJ, Subtil A. Primary cutaneous lymphomas in patients with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL): A series of 12 cases. J Cutan Pathol 2021; 48:617-624. [PMID: 33415780 DOI: 10.1111/cup.13956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/03/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is associated with an increased risk of a second malignancy. METHODS We conducted a retrospective clinicopathologic review of 12 patients with CLL/SLL who developed a second lymphoma in the skin. Demographic data, clinical information, and histopathology from 31 biopsies were recorded. Cases of secondary cutaneous involvement by CLL/SLL (leukemia cutis) and non-primary cutaneous lymphomas were excluded. RESULTS A wide variety of primary cutaneous lymphomas was identified, including classic mycosis fungoides (3), cutaneous marginal zone lymphoma (2), primary cutaneous peripheral T-cell lymphoma unspecified (2), folliculotropic mycosis fungoides (1), Sézary syndrome (1), cutaneous gamma-delta T-cell lymphoma (1), cutaneous CD8+ aggressive epidermotropic cytotoxic T-cell lymphoma (1), and cutaneous anaplastic large cell lymphoma (1). A male predominance was observed, and the average age was 74.1 years. In all patients, CLL/SLL predated the development of the second lymphoma, which was aggressive in the majority of cases (58%). Aggressive cytotoxic T-cell lymphomas, generally rare neoplasms, were relatively common (30%). CONCLUSIONS CLL/SLL patients may develop a second lymphoma in the skin, which may be aggressive. Atypical cutaneous lymphoid infiltrates in this patient population should not be assumed to represent secondary CLL/SLL involvement and require thorough immunohistochemical analysis.
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Affiliation(s)
- Yi Ariel Liu
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander J Finn
- Department of Laboratory Medicine, Island Health, Victoria, British Columbia, Canada.,Department of Laboratory Medicine and Pathology, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Van Der Nest BM, Leslie C, Joske D, Radeski D, White R, Cheah CY. Peripheral T-Cell Lymphoma Arising in Patients With Chronic Lymphocytic Leukemia. Am J Clin Pathol 2019; 152:818-827. [PMID: 31433844 DOI: 10.1093/ajcp/aqz109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To describe three further cases of anaplastic large cell lymphoma (ALCL) occurring in patients with preexisting chronic lymphocytic leukemia (CLL). We also reviewed the literature of previously published cases. METHODS We discuss the clinical features, histopathology, and outcomes for three patients with ALCL and CLL from Perth, Australia. The cases were also included in a literature review of existing cases and comparisons were made with our cohort. RESULTS The three patients included two men (aged 77 and 74 years) and one woman (aged 66 years). All had a history of untreated CLL with diagnosis established 4 to 16 years before. They had lymphadenopathy and/or cutaneous/soft tissue lesions that proved to be ALCL, ALK+ (one case) or ALCL, ALK- (two cases). CONCLUSIONS Further research is required in this area to establish prognostic and management recommendations. Increasing numbers of cases are being described. Positron emission tomography with computed tomography was not useful in our cohort for diagnosing progression.
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Affiliation(s)
| | - Connull Leslie
- Department of Anatomical Pathology, Pathwest Laboratory Medicine, Perth, Australia
| | - David Joske
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley
| | - Dejan Radeski
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley
| | - Rohen White
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Chan Yoon Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Pathwest Laboratory Medicine WA, Nedlands, Australia
- Medical School, University of Western Australia, Crawley
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11
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Kawai H, Matsushita H, Kawakami S, Furuya D, Shiraiwa-Hara S, Ichiki A, Hara R, Aoyama Y, Ogiya D, Suzuki R, Machida S, Onizuka M, Shirasugi Y, Ogawa Y, Kawada H, Nakamura N, Ando K. A Case of Composite Lymphoma with Extranodal NK/T-cell Lymphoma, Nasal-type and Diffuse Large B-cell Lymphoma. J Clin Exp Hematop 2019; 59:34-39. [PMID: 30918142 PMCID: PMC6528137 DOI: 10.3960/jslrt.18038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Composite lymphoma (CL) is defined as the occurrence of two distinct types of lymphoma within the same patient. Most cases of CL involve Hodgkin and non-Hodgkin lymphomas or two distinct types of B-cell lymphomas; true CL is a composite B-cell and T-cell lymphoma, and is rare. We herein report a case involving concurrent extranodal NK/T-cell lymphoma, nasal-type and diffuse large B-cell lymphoma, which has not been previously reported. As the mechanisms and treatments of composite B-cell and T-cell lymphomas are unclear, further studies are required to improve the prognosis.
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12
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Caballero A, Novelli S, Mozos A, Muret PG, Sierra J, Briones J. Silent T-cell receptor cutaneous T-cell lymphoma associated to a clonal plasma cell proliferation. Hematol Rep 2019; 11:7841. [PMID: 30915203 PMCID: PMC6397994 DOI: 10.4081/hr.2019.7841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/07/2018] [Indexed: 02/01/2023] Open
Abstract
Within T-cell lymphomas (TCL) there are 2 entities expressing gamma-delta TCR: hepatosplenic gamma-delta T-cell lymphoma (HSGDTL) and the primary cutaneous gamma-delta T-cell lymphoma (PCGDTL). PCGDTL is a rare form of Tcell lymphoma with specific tropism for skin that have a dismal prognosis. Although even rarer, there have been reports of TCL with loss of expression of the TCR, which have been termed peripheral TCL TCR-silent type. We report the case of a cutaneous TCR-silent type lymphoma associated to a clonal plasma cell proliferation with an ominous outcome that led to a lot of discussion in its classification. Due to the aggressiveness of the disease and the scant evidence about therapy in this strange entity the outcome was fatal. We report a unique case of a TCR-silent cutaneous TCL with an exceptional histopathology, prolonged clinical evolution and a subsequent plasma cell clonal expansion.
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Affiliation(s)
| | | | | | - Pilar Garcia Muret
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Peripheral T-Cell Lymphoma of the Submandibular Salivary Gland as an Unusual Manifestation of Richter's Syndrome: A Case Report and Literature Review. Case Rep Hematol 2018; 2017:1262368. [PMID: 29410924 PMCID: PMC5733220 DOI: 10.1155/2017/1262368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/22/2017] [Indexed: 12/22/2022] Open
Abstract
Richter's syndrome is the development of high-grade non-Hodgkin lymphoma (NHL) or Hodgkin lymphoma in patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). In most patients with Richter's syndrome, the high-grade NHL is diffuse large B-cell lymphoma. Only a small minority of CLL/SLL patients develop T-cell malignancies. Herein, we describe a 40-year-old male patient presenting with peripheral T-cell lymphoma not otherwise specified (PTCL-NOS) in the submandibular salivary gland, two years after the diagnosis of CLL/SLL. The PTCL-NOS consisted of small lymphocytes, which complicated diagnosis. Immunohistochemical, cytological, and molecular studies allowed the correct diagnosis of composite lymphoma (SLL/PTCL-NOS) of the submandibular salivary gland. The PTCL-NOS had a cytotoxic phenotype and aberrant expression of CD79a. There was no evidence to suggest that the PTCL-NOS of the submandibular salivary gland developed from an intimately associated submandibular lymph node or by PTCL-NOS dissemination. A review of the literature and presented case suppose that the PTCLs developed following CLL/SLL have the cytotoxic phenotype and can clinically mimic typical Richter's syndrome.
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Nijland ML, Koens L, Pals ST, Berge IJMT, Bemelman FJ, Kersten MJ. Clinicopathological characteristics of T-cell non-Hodgkin lymphoma arising in patients with immunodeficiencies: a single-center case series of 25 patients and a review of the literature. Haematologica 2017; 103:486-496. [PMID: 29269521 PMCID: PMC5830383 DOI: 10.3324/haematol.2017.169987] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 12/13/2017] [Indexed: 12/19/2022] Open
Abstract
Although it is known that B-cell lymphomas occur more frequently in immunocompromised patients, thus far such an association has not been clearly established for T-cell lymphomas. Of the 251 patients who were diagnosed with a T-cell non-Hodgkin lymphoma in our center between 1999 and 2014, at least 25 were identified in immunocompromised patients. Herein, we retrospectively analyzed the clinical and pathological characteristics of these 25 cases. In addition, we searched the literature and present an overview of 605 previously published cases. The actual number of patients with B-cell chronic lymphocytic leukemia and patients on immunosuppressive drugs for inflammatory bowel disease or rheumatoid arthritis in the total cohort of 251 patients diagnosed with T-cell non-Hodgkin lymphoma was much higher than the number of patients expected to have these diseases in this cohort, based on their prevalence in the general population. This, together with the large number of additional cases found in the literature, suggest that the risk of developing T-cell non-Hodgkin lymphoma is increased in immunocompromised patients. Compared to T-cell non-Hodgkin lymphoma in the general population, these lymphomas are more often located extranodally, present at a younger age and appear to have a poor outcome. The observations made in the study herein should raise awareness of the possible development of T-cell non-Hodgkin lymphoma in immunodeficient patients, and challenge the prolonged use of immunosuppressive drugs in patients who are in clinical remission of their autoimmune disease.
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Affiliation(s)
- Marieke L Nijland
- Renal Transplant Unit, Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands
| | - Steven T Pals
- Department of Pathology and Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Academic Medical Center, Amsterdam, the Netherlands
| | - Ineke J M Ten Berge
- Renal Transplant Unit, Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands
| | - Frederike J Bemelman
- Renal Transplant Unit, Department of Nephrology, Academic Medical Center, Amsterdam, the Netherlands
| | - Marie José Kersten
- Department of Hematology and Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Academic Medical Center, Amsterdam, the Netherlands
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15
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Mature lymphoid malignancies: origin, stem cells, and chronicity. Blood Adv 2017; 1:2444-2455. [PMID: 29296894 DOI: 10.1182/bloodadvances.2017008854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 10/10/2017] [Indexed: 12/15/2022] Open
Abstract
The chronic behavior of mature lymphoid malignancies, with relapses occurring years apart in many patients, has until recently been unexplained. Patterns of relapse also differ vastly between disease entities, with some being highly curable by chemotherapy whereas others are destined to reemerge after treatment. Lately, the use of next-generation sequencing techniques has revealed essential information on the clonal evolution of lymphoid malignancies. Also, experimental xenograft transplantation point to the possible existence of an ancestral (stem) cell. Such a malignant lymphoid stem cell population could potentially evade current therapies and be the cause of chronicity and death in lymphoma patients; however, the evidence is divergent across disease entities and between studies. In this review we present an overview of genetic studies, case reports, and experimental evidence of the source of mature lymphoid malignancy and discuss the perspectives.
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Conversy B, Freulon AL, Graille M. Focal uterine T-cell lymphoma in an ovariectomized cat. J Am Vet Med Assoc 2017; 251:1059-1063. [DOI: 10.2460/javma.251.9.1059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Adem J, Eray M, Eeva J, Nuutinen U, Pelkonen J. Advantages of targeting B cell receptor complex to treat B-cell derived autoimmune diseases and lymphomas. Mol Immunol 2017. [PMID: 28644972 DOI: 10.1016/j.molimm.2017.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Antibodies produced by B-cells provide protection from infectious agents. However, impaired cell death signaling pathways in B-cells can lead to cancer, immunodeficiency or autoimmune diseases. B-cell signaling molecules such as CD20, CD19, Btk, and BAFF-R are targeted by therapeutic drugs and used to treat B-cell derived lymphomas or autoimmune diseases. Nevertheless, B-cells could develop resistance to these therapeutic drugs or the therapeutic drugs may have off-target effects. For instance, repeated rituximab (anti-CD20 antibody) treatment may lead to the loss of its target cell surface molecule, CD20. In addition, in B-cell malignancies, loss of CD19 expression has been observed. Another target molecule, Btk is expressed not only in B-cells but also in mast cells, macrophages, and dendritic cells. Thus, targeting Btk could negatively regulate the functions of innate immunity. The expression of BAFF-R is thought to be restricted to B-cells but it is also expressed on T-cells. Targeting BAFF-R, therefore, may lead to depletion of T-cells in addition to B-cells. B cell receptor (BCR) expression and signaling, however, are critically important for development, differentiation and survival of B-cells. Moreover, BCR is exclusively expressed on B-cells, which makes it an excellent target to avoid off-target effects.
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Affiliation(s)
- Jemal Adem
- Department of Clinical Microbiology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70210 Kuopio, Finland.
| | - Mine Eray
- Department of Pathology (HUSLAB), Helsinki University Hospital, Helsinki, Finland
| | - Jonna Eeva
- Department of Hematology, Tampere University Hospital, Tampere, Finland
| | - Ulla Nuutinen
- Department of Clinical Microbiology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70210, Kuopio, Finland
| | - Jukka Pelkonen
- Department of Clinical Microbiology, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1C, 70210, Kuopio, Finland; Eastern Finland Laboratory Centre (IS LAB), Kuopio, Finland; Cancer Center of University of Eastern, Finland
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18
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Molecular genetic data favoring a sequential clonal transformation of a large B cell lymphoma into an anaplastic large T cell lymphoma, ALK-negative. J Hematop 2015. [DOI: 10.1007/s12308-015-0245-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Composite ALK-negative anaplastic large cell lymphoma and small lymphocytic lymphoma involving the right inguinal lymph node. Pathol Res Pract 2014; 210:127-9. [DOI: 10.1016/j.prp.2013.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/13/2013] [Accepted: 09/18/2013] [Indexed: 11/20/2022]
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20
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Porwit A. Immunophenotyping of selected hematologic disorders - focus on lymphoproliferative disorders with more than one malignant cell population. Int J Lab Hematol 2013; 35:275-82. [DOI: 10.1111/ijlh.12080] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
- A. Porwit
- Department of Pathobiology and Laboratory Medicine; University of Toronto; University Health Network; Toronto ON Canada
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Alomari A, Hui P, Xu M. Composite peripheral T-cell lymphoma not otherwise specified, and B-cell small lymphocytic lymphoma presenting with hemophagocytic lymphohistiocytosis. Int J Surg Pathol 2012; 21:303-8. [PMID: 23129836 DOI: 10.1177/1066896912464047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We report a case of a 68-year-old female patient who developed hemophagocytic lymphohistiocytosis (HLH) secondary to peripheral T-cell lymphoma (PTCL) not otherwise specified (NOS) that developed in the setting of treatment-resistant B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL). The patient's B-cell lymphoma had a good initial response to chemotherapy for 4 years, after which it became less responsive and was thought to have undergone transition to a higher-grade lymphoma. Different regimens of chemoradiotherapy were then tried with modest response until the patient presented 3 years later with signs and symptoms of HLH. The patient died 1 month later, and an autopsy was performed. Significant para-aortic lymphadenopathy and splenomegaly were found. Microscopic, immunohistochemical and molecular evaluations confirmed the presence of composite B-cell and T-cell lymphoma in the para-aortic enlarged lymph nodes. Bone marrow examination showed hemophagocytosis, and the liver demonstrated infiltration by activated macrophages with hepatocellular necrosis. This report highlights the importance of searching for a possible underlying T-cell lymphoma in light of HLH. Different theories have been proposed to explain the rare occurrence of concurrent B- and T-cell lymphomas, but the development of HLH in this patient highlights the importance of immune dysregulation as a proposed mechanism to explain some cases of composite lymphomas. A review of the literature and discussion of the relative merits of these hypotheses are presented in the context of this case.
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Suefuji N, Niino D, Arakawa F, Karube K, Kimura Y, Kiyasu J, Takeuchi M, Miyoshi H, Yoshida M, Ichikawa A, Sugita Y, Ohshima K. Clinicopathological analysis of a composite lymphoma containing both T- and B-cell lymphomas. Pathol Int 2012; 62:690-8. [DOI: 10.1111/j.1440-1827.2012.02858.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Boiocchi L, Witter RE, He B, Subramaniyam S, Mathew S, Nie K, Cerutti A, Coleman M, Knowles DM, Orazi A, Tam W. Composite chronic lymphocytic leukemia/small lymphocytic lymphoma and follicular lymphoma are biclonal lymphomas: a report of two cases. Am J Clin Pathol 2012; 137:647-59. [PMID: 22431543 DOI: 10.1309/ajcphxo5ugw2oela] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Composite lymphomas (CLs) consisting of 2 indolent B-cell lymphomas are rare. We present 2 CL cases composed of chronic lymphocytic leukemia (CLL) and follicular lymphoma (FL), each with unique clinicopathologic features. In the first case, the FL was negative for IGH-BCL2 and harbored a novel IGH-associated translocation; in the second case, the CL manifested in the skin. The individual components in both CLs were derived from different B-cell clones. This is the first complete characterization, including molecular analysis, of CLs composed of leukemic CLL and FL and the first report of a cutaneous CL derived from 2 low-grade B cell lymphomas. Our results provide additional supporting evidence that CLs of indolent B-cell lymphomas are biclonal and suggest that they are pathogenetically different from CLs composed of a low-grade B-cell lymphoma and an aggressive B-cell lymphoma or Hodgkin lymphoma, which are usually clonally related.
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Roullet MR, Martinez D, Ma L, Fowler MH, McPhail ED, Judkins A, Arber DA, Bagg A. Coexisting follicular and mantle cell lymphoma with each having an in situ component: A novel, curious, and complex consultation case of coincidental, composite, colonizing lymphoma. Am J Clin Pathol 2010; 133:584-91. [PMID: 20231612 DOI: 10.1309/ajcp5rt4mrsdgksx] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
A diagnosis of composite lymphoma is typically prompted by the observation of morphologic discordance. We present a case of a spleen revealing histologic features of follicular lymphoma, without any indication of a second lymphoma. Immunohistochemical stains supported this diagnosis and showed the follicular lymphoma to be BCL2-. However, these studies revealed 2 additional unexpected findings: cyclin D1+ mantle zone cells surrounding neoplastic and reactive follicles (indicative of in situ mantle cell lymphoma) and BCL2-bright, histologically nonneoplastic follicles (indicative of in situ follicular lymphoma). ImmunoFISH and microdissection and polymerase chain reaction analysis documented the clonal nature of the cyclin D1+ mantle zones and illustrated clonal independence from the follicular lymphoma. This case illustrates an uncommon and unusual composite follicular and mantle cell lymphoma, with the follicular lymphoma accompanied by an in situ component, whereas the only manifestation of the mantle cell lymphoma was in situ.
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Du Z, Chen J, Zhou X, Zhang T, Chen B, Tang F. Composite lymphoma with relapse of enteropathy-type T-cell lymphoma. Leuk Lymphoma 2009; 50:749-56. [DOI: 10.1080/10428190902795519] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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26
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Composite Lymphoma: EBV-positive Classic Hodgkin Lymphoma and Peripheral T-cell Lymphoma. Appl Immunohistochem Mol Morphol 2009; 17:72-6. [DOI: 10.1097/pai.0b013e31817c551f] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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