Primary splenic B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma: A case report

Gray zone lymphoma effectively treated with cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab chemotherapy: A case report

BACKGROUND

B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (BCLu-DLBCL/cHL), also referred to as gray zone lymphoma (GZL), is known to share features with cHL and DLBCL. However, GZL is often difficult to diagnose. There is no consensus regarding the optimal therapeutic regimen. Most reported cases of GZL have been in Caucasian and Hispanic individuals, and its incidence is lower in African-American and Asian populations, including the Japanese population.

CASE SUMMARY

A 69-year-old female presented at our hospital with a growing mass on the right side of her neck. An elastic, soft mass measuring 9 cm × 6 cm was palpable in the right cervical region. Laboratory analyses showed pancytopenia, increased serum lactate dehydrogenase levels, and markedly increased levels of soluble interleukin-2 receptor. Enhanced computed tomography (CT) and fluorodeoxyglucose positron emission tomography (PET)/CT revealed multiple lesions throughout her body. She was diagnosed with GZL based on the characteristic pathological findings, the immunophenotype [CD20+, PAX5+, OCT2+/BOB1 (focal+), CD30+, CD15-], and the strong positive expression of neoplastic programmed cell death protein ligand 1 (PD-L1) in her lymphoma cells. The lymphoma was stage IV according to the Lugano classification and high-risk according to the International Prognostic Index for aggressive non-Hodgkin lymphoma. The patient received cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (R-CHOP) chemotherapy because the tumor cells were CD20+. She has remained in complete remission for 3 years.

CONCLUSION

GZL was diagnosed based on histopathology and immunophenotyping with ancillary PD-L1 positivity. R-CHOP chemotherapy was an effective treatment.

Treatment of grey zone lymphoma using the R-CODOX-M/R-IVAC protocol: Two case reports

RATIONALE

We report our experience with 2 patients diagnosed with grey zone lymphoma (GZL). The histopathological characteristics of lymphomatous tissues in these patients ranged between those of diffuse large B-cell lymphoma (DLBCL) and the classical Hodgkin lymphoma.

PATIENT CONCERNS

A 52-year-old female presented to the hospital with a history of lower abdominal pain of metastatic origin for 2 days. She was diagnosed with acute appendicitis and had undergone emergency surgery. A 17-year-old male was admitted to the hospital because of acute left upper abdomen pain.

DIAGNOSES

Both patients are diagnosed of GZL primarily based on histopathology.

INTERVENTIONS

Both patients were treated with R-CODOX-M/R-IVAC regimen for 4 to 6 cycles.

OUTCOMES

The short-term curative effect was complete response; no recurrence was observed as of 32-month follow-up.

LESSONS

R-CODOX-M/IVAC regimen exhibited relatively good curative effect. International Prognostic Index score and lactate dehydrogenase level may correlate with prognosis of these patients.