Composite lymphoma of T-cell rich, histiocyte-rich diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma: a case report

Abstract Background Composite lymphoma is a rare entity where two or more distinct subtypes of lymphoma coexist within a single organ or tissue. Case presentation We report a new case of a 67-year-old Caucasian male patient, who presented with fatigue, weakness, weight loss, and polyuria. He also had epigastric and left lumbar pain, enlarged spleen, and enlarged left axillary lymph node on examination, with no relevant medical or familial history. A biopsy from the node showed an appearance of T-cell rich, histiocyte-rich diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma. The patient was initially treated with adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine chemotherapy regimen, then switched to rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone regimen. During the therapy, some regression was noticed, especially in the size of the splenic enlargement; however, the patient died 2 months after completing the regimen. Conclusion Composite lymphomas should continue to be studied. Also, treatment is still debatable in type, efficacy, and outcomes.

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

Case Reports in Hematology ◽

10.1155/2018/1583925 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Shin Nagai ◽

Junji Hiraga ◽

Noriyuki Suzuki ◽

Naruko Suzuki ◽

Yusuke Takagi ◽

...

Keyword(s):

T Cell ◽

B Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

T Cell Lymphoma ◽

Composite Lymphoma ◽

Large B Cell Lymphoma ◽

Positron Emission ◽

Nk T Cell ◽

Large B Cell

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.

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Nodular Lymphocyte Predominant Hodgkin Lymphoma: A Rare Case with Fan Pattern E

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.234 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S107-S107

Author(s):

E Ozluk ◽

E Wei

Keyword(s):

T Cells ◽

Lymph Node ◽

T Cell ◽

B Cell ◽

Hodgkin Lymphoma ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Atypical Cells ◽

Large B Cell

Abstract Introduction/Objective Growth patterns of nodular lymphocyte predominant Hogdkin lymphoma (NLPHL) has been further described by Fan et all. Pattern E is T cell/histiocyte rich large B-cell lymphoma-like and is quite rare. The treatment usually may follow large B cell lymphoma protocol instead of Hodgkin lymphoma regimen. Methods Here we report a patient with NLPHL pattern E. Patient was a 25 years-old African American man who initially presented with generalized lymphadenopathy. Results Biopsy of the axillary lymph node revealed effaced lymph node architecture by a malignant neoplasm in a diffuse and vaguely nodular pattern. In the background of a diffuse infiltrate, there were small to medium sized lymphocytes, numerous atypical large cells with irregular, basophilic nucleoli, and variable cytoplasm. The large cells focally sheeted out. Many histiocytes were also seen in the background. The large atypical cells were positive for CD20, BOB-1, OCT2, BCL-2 (focally), BCL-6, PAX5, and MUM-1, and IgD, whereas negative for BCL-1, CD10, CD15, CD30. CD2, CD3, CD4, CD5, CD7, CD8 highlighted numerous T cells with mild cytological atypia, forming rosettes around the large atypical cells. T cells were negative for ALK-1, CD1a, TdT with increased Ki-67 proliferation index around 35%. Although the surrounding T cells appear atypical in morphology, flow cytometric analysis showed predominantly reactive T-cells with no loss of T-cell associated antigens. PCR analysis showed a producible peak in a single IgH reaction. However, the fragment size of the peak observed did not meet the criteria. T-cell gene rearrangement by TCR gamma and TCR beta PCR was negative for monoclonal T-cells. BCL-1, BCL-2, and BCL-6 FISH panel were negative for gene rearrangements. Based on these findings the diagnosis was made at stage IV. Patient started treatment with R-CHOP therapy with subsequent relapse. Patient has been placed on RICE chemotherapy with partial response. Conclusion NLPHL Pattern E type should be differentiated from classical Hodgkin lymphoma, diffuse large B-cell lymphoma and peripheral T cell lymphoma because the treatment greatly differs from those with higher stage and tendency for recurrence. It is the pathologist role to lead the clinician and render a correct histopathologic diagnosis.

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Meningeal Relapse of Nodular Lymphocyte Predominant Hodgkin Lymphoma Transformed to T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: A Case Report

Frontiers in Oncology ◽

10.3389/fonc.2020.01745 ◽

2020 ◽

Vol 10 ◽

Author(s):

Paolo Salvioni Chiabotti ◽

Bettina Bisig ◽

Anne Cairoli ◽

Steven D. Hajdu ◽

Pierre-Yves Lovey ◽

...

Keyword(s):

Case Report ◽

T Cell ◽

B Cell ◽

Hodgkin Lymphoma ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Morphologic, immunphenotypic and clinical discriminators between T-cell/histiocyterich large B-cell lymphoma and lymphocyte-predominant Hodgkin lymphoma

Hematology/Oncology and Stem Cell Therapy ◽

10.1016/s1658-3876(08)50056-2 ◽

2008 ◽

Vol 1 (1) ◽

pp. 22-27 ◽

Cited By ~ 5

Author(s):

Walid A. Mourad ◽

Sheikha Al Thani ◽

Abdelghani Tbakhi ◽

Mohamed Al Omari ◽

Yasser Khafaga ◽

...

Keyword(s):

T Cell ◽

B Cell ◽

Hodgkin Lymphoma ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Does Functional Imaging Distinguish Nodular Lymphocyte-Predominant Hodgkin Lymphoma From T-Cell/Histiocyte-Rich Large B-Cell Lymphoma?

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2013.03.004 ◽

2013 ◽

Vol 13 (4) ◽

pp. 392-397 ◽

Cited By ~ 8

Author(s):

Nicholas A. Barber ◽

Fausto R. Loberiza ◽

Anamarija M. Perry ◽

Martin Bast ◽

Karen P. Holdeman ◽

...

Keyword(s):

T Cell ◽

B Cell ◽

Hodgkin Lymphoma ◽

Functional Imaging ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Nodular lymphocyte-predominant Hodgkin lymphoma and T cell histiocyte-rich large B cell lymphoma: diagnosis in two monozygotic twins

Histopathology ◽

10.1111/j.1365-2559.2010.03585.x ◽

2010 ◽

Vol 57 (1) ◽

pp. 159-162

Author(s):

Isabel Cano ◽

María Lozano ◽

Álvaro Rodríguez ◽

Alberto Mate ◽

Magdalena Adrados ◽

...

Keyword(s):

T Cell ◽

B Cell ◽

Hodgkin Lymphoma ◽

Cell Lymphoma ◽

Monozygotic Twins ◽

B Cell Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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A composite lymphoma combining a Hodgkin lymphoma and a marginal zone lymphoma transformed into a diffuse large B‐cell lymphoma

Clinical Case Reports ◽

10.1002/ccr3.1841 ◽

2018 ◽

Vol 6 (12) ◽

pp. 2341-2346 ◽

Cited By ~ 1

Author(s):

Claire Auditeau ◽

Olivier Lambotte ◽

Joffrey Feriel ◽

Thierry Lazure ◽

Ali Turhan ◽

...

Keyword(s):

B Cell ◽

Hodgkin Lymphoma ◽

Marginal Zone ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Marginal Zone Lymphoma ◽

Composite Lymphoma ◽

Large B Cell Lymphoma ◽

Large B Cell

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Pitfalls in the Diagnosis of Nodular Lymphocyte Predominant Hodgkin Lymphoma: Variant Patterns, Borderlines and Mimics

Cancers ◽

10.3390/cancers13123021 ◽

2021 ◽

Vol 13 (12) ◽

pp. 3021

Author(s):

Sheren Younes ◽

Rebecca B. Rojansky ◽

Joshua R. Menke ◽

Dita Gratzinger ◽

Yasodha Natkunam

Keyword(s):

T Cell ◽

B Cell ◽

Hodgkin Lymphoma ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Growth Patterns ◽

Biological Behavior ◽

Large Tumor ◽

Large B Cell Lymphoma ◽

Large B Cell

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) represents approximately 5% of Hodgkin lymphoma and typically affects children and young adults. Although the overall prognosis is favorable, variant growth patterns in NLPHL correlate with disease recurrence and progression to T-cell/histiocyte-rich large B-cell lymphoma or frank diffuse large B-cell lymphoma (DLBCL). The diagnostic boundary between NLPHL and DLBCL can be difficult to discern, especially in the presence of variant histologies. Both diagnoses are established using morphology and immunophenotype and share similarities, including the infrequent large tumor B-cells and the lymphocyte and histiocyte-rich microenvironment. NLPHL also shows overlap with other lymphomas, particularly, classic Hodgkin lymphoma and T-cell lymphomas. Similarly, there is overlap with non-neoplastic conditions, such as the progressive transformation of germinal centers. Given the significant clinical differences among these entities, it is imperative that NLPHL and its variants are carefully separated from other lymphomas and their mimics. In this article, the characteristic features of NLPHL and its diagnostic boundaries and pitfalls are discussed. The current understanding of genetic features and immune microenvironment will be addressed, such that a framework to better understand biological behavior and customize patient care is provided.

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