ABSTRACT
Lymphoma is an increasingly recognized complication of tumor necrosis factor (TNF) inhibition for the treatment of autoimmune and inflammatory disease; the majority of these cases are non-Hodgkin lymphomas (NHL). The impact of withdrawing TNF inhibition therapy in cases of lymphoma is not well described. A woman with Crohn's disease (CD) was diagnosed with Hodgkin lymphoma (HL) and subsequently went into remission with standard chemotherapy. Her CD later worsened, requiring initiation of adalimumab, a TNF inhibitor. Ten months later, she was found to have recurrence of HL. When she opted against additional treatment for the lymphoma, the TNF inhibitor was discontinued. Three months later, the measurable sites of disease had completely regressed. It can be concluded that HL is a potential complication of treatment with TNF inhibitors. Withdrawal of immunosuppression may be a consideration for patients treated for lymphoproliferative disorders including HL. Maintenance of an intact immune system may be important for prevention of lymphoma relapse. Further understanding of this complex interaction will help clinicians determine in which patients these agents have a favorable risk-benefit ratio.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Antibodies, Monoclonal/therapeutic use , Crohn Disease/drug therapy , Hodgkin Disease/pathology , Neoplasm Regression, Spontaneous/pathology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adalimumab , Anti-Inflammatory Agents/adverse effects , Antibodies, Monoclonal/adverse effects , Antibodies, Monoclonal, Humanized , Cholecystitis/complications , Cholecystitis/diagnostic imaging , Cholecystitis/surgery , Fatal Outcome , Female , Hematoma/etiology , Hodgkin Disease/chemically induced , Hodgkin Disease/diagnostic imaging , Humans , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Lymphatic Diseases/diagnostic imaging , Lymphatic Diseases/pathology , Middle Aged , Radiography , Retroperitoneal Space , UltrasonographyABSTRACT
The normal counterparts of mantle cell lymphoma (MCL) are naive, quiescent B cells that have not been processed through the germinal center (GC). For this reason, although lymphomas arising from GC or post-GC B cells often exhibit plasmacytic differentiation, MCL rarely presents with plasmacytic features. Seven cases of MCL with a monotypic plasma cell (PC) population were collected from 6 centers and were studied by immunohistochemistry, fluorescence immunophenotyping and interphase cytogenetics as a tool for the investigation of neoplasms analysis, capillary gel electrophoresis, and restriction fragment length polymorphism of immunoglobulin heavy chain analysis of microdissections of each of the MCL and PC populations to assess their clonal relationship. The clinical presentation was rather unusual compared with typical MCL, with 2 cases arising from the extranodal soft tissues of the head. All MCL cases were morphologically and immunohistochemically typical, bearing the t(11;14)(q13;q32). In all cases, the PC population was clonal. In 5 of the 7 cases, the MCL and PC clones showed identical restriction fragments, indicating a common clonal origin of the neoplastic population. The 2 cases with clonal diversity denoted the coexistence of 2 different tumors in a composite lymphoma/PC neoplasm. Our findings suggest that MCL can present with a PC component that is often clonally related to the lymphoma, representing a rare but unique biological variant of this tumor.
