1
|
Primary Cutaneous B-Cell Lymphoma Co-Existing with Mycosis Fungoides-A Case Report and Overview of the Literature. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122067. [PMID: 36556432 PMCID: PMC9785996 DOI: 10.3390/life12122067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/25/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022]
Abstract
The existence of two sequential lymphomas, one localized and one systemic, either both with B or T lymphocytes, or one with B cells and one with T cells, with the same patient, is a known possibility. The second lymphoma is often induced by immunodepression or by the initial treatment. However, the existence of two cutaneous lymphomas with different cell lines, without systemic involvement, represents an uncommon situation. In this report, we describe the case of a 37-year-old man with an initial diagnosis of PMZBCL that over 10 months also developed a MF patch/plaque on the left leg.
Collapse
|
2
|
Gui W, Wang J, Ma L, Wang Y, Su L. Clinicopathological analysis of composite lymphoma: A two-case report and literature review. Open Med (Wars) 2020; 15:654-658. [PMID: 33336022 PMCID: PMC7712032 DOI: 10.1515/med-2020-0191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 04/02/2020] [Accepted: 05/14/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The objective of this study was to evaluate the clinicopathological features and treatment of composite lymphoma (CL) with cervical lymph node enlargement. Methods In this study, two cases of CL are presented. Biopsies of enlarged cervical lymph nodes by excision revealed two distinct types of lymphomas. The diagnoses were confirmed by routine histopathology, immunohistochemistry, in situ hybridization, polymerase chain reactions and flow cytometry. Case 1 was diagnosed with Hodgkin’s lymphoma and cytotoxic T-cell lymphoma complicated by Epstein–Barr virus infection. Case 2 was diagnosed with diffuse large B-cell lymphoma and angioimmunoblastic T-cell lymphoma. Results Case 1 received one cycle of adriamycin, bleomycin, vincristine and dacarbazine (ABVD regimen) combined with chidamide, followed by one cycle of gemcitabine and dexamethasone (GDP regimen) combined with chidamide, and then oral acyclovir. The patient achieved stable disease, but was lost to follow-up. Case 2 received eight cycles of cyclophosphamide, pirarubicin, vincristine and dexamethasone (CTOP regimen) combined with chidamide, and the patient achieved complete remission. Nine months later, relapse was confirmed. She received chidamide monotherapy for 3 months, which was then terminated. One year later, the patient underwent progressive disease and died. Conclusions CL is a kind of rare disease. Due to the complexity of CL, clinicians should consider both disease components in order to increase the likelihood of effective treatment. This is important.
Collapse
Affiliation(s)
- Wei Gui
- Department of Hematology, Shanxi Tumor Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Jing Wang
- Department of Pathology, Shanxi Tumor Hospital, Taiyuan, Shanxi 030013, People's Republic of China
| | - Li Ma
- Department of Hematology, Shanxi Tumor Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Yanli Wang
- Department of Hematology, Shanxi Tumor Hospital, Taiyuan, Shanxi, People's Republic of China
| | - Liping Su
- Department of Hematology, Shanxi Tumor Hospital, Taiyuan, Shanxi, People's Republic of China
| |
Collapse
|
3
|
The Conundrum of Diagnosing Cutaneous Composite Lymphoma in the Molecular Age. Am J Dermatopathol 2019; 41:757-766. [DOI: 10.1097/dad.0000000000001424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
4
|
Abstract
Composite lymphomas have been defined as 2 distinct subtypes of lymphoma occurring at a single anatomic site. Composite lymphomas limited to the skin are a rare occurrence and pose a unique challenge. Many reported cases within the skin are combined B-cell and T-cell lymphomas, typically mycosis fungoides and a low-grade B-cell lymphoma. These cases are challenging to recognize because lymphoid infiltrates within the skin often include a mixed population of B cells and T cells. In particular, reactive lymphoid proliferations (pseudolymphomas), primary cutaneous low-grade B-cell lymphomas, and primary cutaneous CD4+ T-cell lymphoproliferative disorder may show nearly equal numbers of B cells and T cells. In order to exclude these possibilities, overwhelming evidence in support of each lymphoma is helpful, including abnormal architecture, cytology, and immunophenotype, as well as molecular genetic evidence of clonality.
Collapse
Affiliation(s)
| | | | - Alexandra C. Hristov
- From the Department of Pathology, University of Iowa Health Care, Iowa City (Dr Chen); and the Departments of Pathology (Drs Boyer and Hristov) and Dermatology (Dr Hristov), University of Michigan Medical Center, Ann Arbor
| |
Collapse
|
5
|
Szablewski V, Costes-Martineau V, René C, Croci-Torti A, Joujoux JM. Composite cutaneous lymphoma of diffuse large B-cell lymphoma-leg type and subcutaneous panniculitis-like T-cell lymphoma. J Cutan Pathol 2018; 45:716-720. [PMID: 29851123 DOI: 10.1111/cup.13289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/17/2018] [Accepted: 05/25/2018] [Indexed: 12/16/2022]
Abstract
Composite lymphoma (CL) is a rare disease defined by the occurrence of two distinct lymphomas within a single tissue at the same time. We present the case of an 89-year-old male with a clinical history of immunoglobulin M monoclonal gammopathy of undetermined significance. The patient presented cutaneous eruption of nodules on the right bottom and arm. An excisional biopsy revealed cutaneous infiltration composed of two components. The first one consisted of large B-cells with CD20+/MUM1+/BCL2+ phenotype whereas the second one involved the subcutaneous fat in a panniculitic manner, and was CD3+/CD8+/granzyme B+/TCRβF1+. The final diagnosis was CL of primary cutaneous large B-cell lymphoma-leg type (PCLBCL-leg type) and subcutaneous panniculitis-like T-cell lymphoma (SPTCL). We report and characterize for the first time coexistent PCLBCL-leg type and SPTCL in a patient.
Collapse
Affiliation(s)
| | | | - Céline René
- Département d'Immunologie, CHU Montpellier, Montpellier, France
| | | | | |
Collapse
|
6
|
Tanaka J, Su P, Luedke C, Jug R, Yang LH, Deak K, Rapisardo S, Zhang Y, Delos Angeles M, Xie Y, Wang E. Composite lymphoma of follicular B-cell and peripheral T-cell types with distinct zone distribution in a 75-year-old male patient: a case study. Hum Pathol 2017; 76:110-116. [PMID: 29217426 DOI: 10.1016/j.humpath.2017.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 10/28/2017] [Accepted: 11/17/2017] [Indexed: 12/13/2022]
Abstract
Composite lymphoma of T-/B-cell type is rare, and follicular lymphoma composite with peripheral T-cell lymphoma (PTCL) has not previously been reported. We report such a case with both neoplastic components displaying a unique zone of distribution. A 75-year-old male patient presented with generalized lymphadenopathy. Sections of axillary lymph node demonstrated potentially 2 clonal processes, PTCL with aberrant CD20 expression and follicular lymphoma. Interestingly, the 2 neoplastic components were confined to their respective classic distribution zones, with PTCL occupying the interfollicular areas and follicular lymphoma residing in follicles. Both populations were detected by flow cytometry, but their immunophenotypes were insufficient to define clonality. Nonetheless, biclonality was demonstrated by lymphoid receptor gene rearrangement analyses. Molecular cytogenetics showed IGH/BCL2 fusion in the follicular lymphoma and amplification of IGH gene or trisomy/tetrasomy 14 in the PTCL. The current case underscores the complexity of composite lymphoma and advocates a multimodal approach to establishing the diagnosis.
Collapse
MESH Headings
- Aged
- Antigens, CD20/analysis
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/genetics
- Composite Lymphoma/genetics
- Composite Lymphoma/immunology
- Composite Lymphoma/pathology
- Composite Lymphoma/therapy
- Gene Amplification
- Gene Fusion
- Genes, Immunoglobulin Heavy Chain
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/immunology
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/therapy
- Lymphoma, T-Cell, Peripheral/genetics
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Lymphoma, T-Cell, Peripheral/therapy
- Male
- Proto-Oncogene Proteins c-bcl-2/genetics
- Tetrasomy
- Trisomy
Collapse
Affiliation(s)
- John Tanaka
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Pu Su
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Catherine Luedke
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rachel Jug
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Lian-He Yang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Kristen Deak
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sarah Rapisardo
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yang Zhang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Marc Delos Angeles
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Endi Wang
- Department of Pathology, Duke University School of Medicine, Durham, NC 27710, USA.
| |
Collapse
|
7
|
Raufi A, Jerkins J, Lyou Y, Jeyakumar D. A Patient with Supraclavicular Lymphadenopathy and Anterior Mediastinal Mass Presenting as a Rare Case of Composite Lymphoma: A Case Report and Literature Review. Case Rep Oncol 2016; 9:854-860. [PMID: 28203178 PMCID: PMC5260532 DOI: 10.1159/000453255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 12/17/2022] Open
Abstract
Composite lymphoma (CL) is a rare disease with 2 distinct lymphomas concurrently arising in a single patient with an estimated incidence of 1–4.7% of newly diagnosed lymphomas per year. CL most commonly involves 2 B-cell non-Hodgkin lymphomas (NHL) or a B-cell NHL with a Hodgkin lymphoma. Our case is unique in that it was a bilineage CL with both a T-cell and B-cell NHL, which has only been reported in a few case reports. A 49-year-old woman presented with several months of progressive cough, weight loss, dyspnea, and supraclavicular lymphadenopathy. Computed tomographic imaging done upon admission to the hospital found that she had extensive anterior and middle mediastinal lymphadenopathy as well as bilateral supraclavicular lymphadenopathy. The patient underwent an excisional biopsy on the supraclavicular lymph node and was found to have a composite lymphoma involving both a T-cell and B-cell NHL. Her final pathological diagnosis was peripheral T-cell lymphoma and lymphoplasmacytic lymphoma. The patient was found to have stage IIIB disease. Her HIV, hepatitis panel, and tuberculosis tests were all negative. She then underwent chemotherapy with dose-adjusted EPOCH-R (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). The patient showed a complete response and was then referred to a bone marrow transplant center for an autologous hematopoietic stem cell transplant. CL is a rare disease composed of at least 2 distinct lymphomas concurrently arising in a single patient. Due to the complexity in having to treat multiple types of lymphoma simultaneously CL presents challenges with treatment and assessing prognosis.
Collapse
Affiliation(s)
- Alex Raufi
- Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA
| | - James Jerkins
- Department of Medicine, Division of Hematology and Oncology, University of California Irvine Medical Center, Orange, CA, USA
| | - Yung Lyou
- Department of Medicine, Division of Hematology and Oncology, University of California Irvine Medical Center, Orange, CA, USA
| | - Deepa Jeyakumar
- Department of Medicine, Division of Hematology and Oncology, University of California Irvine Medical Center, Orange, CA, USA
| |
Collapse
|
8
|
Epstein-Barr virus-negative diffuse large B cell lymphoma with aberrant expression of CD3 and other T cell-associated antigens: report of three cases with a review of the literature. Ann Hematol 2016; 95:1671-83. [PMID: 27431583 DOI: 10.1007/s00277-016-2749-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023]
Abstract
Expression of CD3 on a mature B cell neoplasm, such as diffuse large B cell lymphoma (DLBCL), is extremely rare. When it is present, it will cause diagnostic confusion since the classification of lymphoid neoplasms is largely based on immunophenotyping to determine the cell lineage. We report three cases of DLBCL with CD3 and other T cell-associated antigens. A literature search identifies 30 additional cases of DLBCL expressing CD3, with the majority (78.6 %) displaying cytoplasmic expression, while two of our cases demonstrate membranous staining. Additionally, expression of CD3 tends to be partial and weak in both our series and the reported cases. Of the 28 cases reported in the literature that were tested for Epstein Barr Virus (EBV), 16 (57.1 %) are positive, suggesting an important role of EBV in promoting lineage ambiguity/infidelity, whereas, all three cases in our series are negative for the virus. All three cases in our series show homogeneous expression of multiple B cell specific antigens, while the reported cases show variable expression with some having B cell antigens downregulated, particularly in those cases with EBV association or anaplastic morphology. A low threshold for testing EBV status is advocated in DLBCL with phenotypic ambiguity along with panels of immunohistochemical stains and B/T cell receptor gene rearrangement analysis.
Collapse
|
9
|
|
10
|
Whitling NA, Shanesmith RP, Jacob L, McBurney E, Sebastian S, Wang E, Wang AR. Composite lymphoma of mycosis fungoides and cutaneous small B-cell lymphoma in a 73-year-old male patient. Hum Pathol 2013; 44:670-5. [PMID: 23313307 DOI: 10.1016/j.humpath.2012.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/13/2012] [Accepted: 09/19/2012] [Indexed: 11/17/2022]
Abstract
Composite lymphoma of T-cell and B-cell type is uncommon, and the one occurring primarily on skin is extremely rare. Herein, we report a unique case of composite lymphoma of mycosis fungoides and cutaneous small B-cell lymphoma in a 73-year-old male patient. The patient presented with multiple erythematous patches, plaques, and nodules on the upper arms, scalp, and trunk. Four punch biopsies of arm and scalp lesions demonstrated lymphoid infiltrate in superficial to deep dermis with a characteristic zone distribution of T-cell and B-cell components. T cells were distributed in papillary and perifollicular dermis and displayed a larger size with convoluted nuclei, whereas B cells were small sized, assuming nodular infiltrate in mid-deep dermis with coexpression of CD5. Molecular test detected clonal rearrangement of both TCRG and IGH/K genes with identical amplicons for each gene in all 4 biopsies. Clinical staging revealed no extracutaneous lesions. A multidisplinary approach is emphasized to establish a definitive diagnosis.
Collapse
|