ABSTRACT
Anaplastic large cell lymphoma and small lymphocytic lymphoma are two lymphoid malignancies with completely distinct morphologies and natural histories. We present a rare case of composite anaplastic large cell lymphoma and small lymphocytic lymphoma in an inguinal lymph node of an otherwise healthy 47-year-old male patient. Immunohistochemical and molecular studies identified the two populations clearly. Their separation is imperative as anaplastic large cell lymphoma can be an aggressive neoplasm and easily overlooked in cases of small lymphocytic lymphoma with a small population of anaplastic large cell lymphoma cells.
Subject(s)
Biomarkers, Tumor/metabolism , Composite Lymphoma/pathology , Leukemia, Lymphocytic, Chronic, B-Cell/pathology , Lymph Nodes/pathology , Lymphoma, Large-Cell, Anaplastic/pathology , Anaplastic Lymphoma Kinase , Composite Lymphoma/diagnostic imaging , Composite Lymphoma/metabolism , DNA, Neoplasm/genetics , Diagnosis, Differential , Groin , Humans , Immunohistochemistry , Leukemia, Lymphocytic, Chronic, B-Cell/diagnostic imaging , Leukemia, Lymphocytic, Chronic, B-Cell/metabolism , Lymphoma, Large-Cell, Anaplastic/diagnostic imaging , Lymphoma, Large-Cell, Anaplastic/metabolism , Male , Middle Aged , Radiography , Receptor Protein-Tyrosine Kinases/geneticsABSTRACT
A 68-year-old man was admitted to our hospital because of left back pain and systemic lymphadenopathy with hypercalcemia. Serum anti-HTLV-1 antibody was positive. Left cervical lymph node (LN) biopsy revealed proliferation of medium-sized to large CD4-positive atypical cells with modest infiltration of CD20 and Epstein-Barr virus (EBV)-encoded RNA dual-positive atypical large cells. Monoclonal integration of HTLV-1 proviral DNA, plus clonal rearrangement of the T-cell receptor chain gene and the immunoglobulin heavy chain gene, were detected in the same LN specimen. Composite lymphoma consisting of adult T-cell leukemia/lymphoma (ATL) and EBV positive diffuse large B-cell lymphoma (DLBCL) was diagnosed. He was successfully treated with aggressive chemotherapy including rituximab and attained remission. However, eight months later, he developed right shoulder pain due to multiple bone invasions with bilateral cervical lymphadenopathy. Biopsies of a bone lesion and cervical LN revealed recurrence of ATL alone. The patient died despite salvage chemoradiotherapy. These findings suggest that ATL-related immunodeficiency might induce EBV-associated DLBCL.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Composite Lymphoma/pathology , Leukemia-Lymphoma, Adult T-Cell/pathology , Lymphoma, Large B-Cell, Diffuse/pathology , Aged , Biopsy , Composite Lymphoma/diagnostic imaging , Composite Lymphoma/drug therapy , Fatal Outcome , Herpesvirus 4, Human/isolation & purification , Humans , Leukemia-Lymphoma, Adult T-Cell/diagnostic imaging , Leukemia-Lymphoma, Adult T-Cell/drug therapy , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Lymphoma, Large B-Cell, Diffuse/drug therapy , Male , Radiography , RecurrenceABSTRACT
Primary laryngeal lymphoma occurs very rarely, accounting for far less than 1% of primary malignant laryngeal neoplasms. To the best of our knowledge, primary laryngeal composite lymphoma has not been reported in the literature. Herein, we report the first case of primary laryngeal composite lymphoma composed of diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), in a 43-year-old man. Of special interest is the patient's unique clinical presentation of left subglottic tracheal fistula, esophageal diverticulum, and neck abscess with no discrete mass identified. We describe the clinical and pathological characteristics of this case and review the literature.
