A Patient with Supraclavicular Lymphadenopathy and Anterior Mediastinal Mass Presenting as a Rare Case of Composite Lymphoma: A Case Report and Literature Review

Clinicopathological analysis of composite lymphoma: A two-case report and literature review

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.

Composite Lymphoma Comprising Extranodal NK/T-Cell Lymphoma and Diffuse Large B-Cell Lymphoma

We report a rare case of composite lymphoma comprising extranodal NK/T-cell lymphoma, nasal type, (ENKL) and diffuse large B-cell lymphoma (DLBCL) in a 70-year-old man complaining of fatigue. Computed tomography showed multiple consolidations in both lungs, and ENKL was diagnosed from transbronchial lung biopsy. Positron emission tomography also detected abnormal uptake in the stomach, and DLBCL was diagnosed from subsequent gastroscopy. Two courses of chemotherapy including rituximab achieved reduction in DLBCL, but ENKL proved resistant to this treatment and progressed. Concomitant ENKL and DLBCL have not been previously described among reports of composite lymphomas.