Discordant lymphoma consisting of mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes: a case report

Diagnostic Pathology

Zhu Liu²  Jianrong Wang¹  Chunyan Chen¹  Yuanxue Yi¹  Chun Zhang¹ 

[1] Department of Pathology, Chongqing Corps Hospital of Chinese People’s Armed Polices, No. 90 Wei-guo Road, Nan’an, Chongqing, China;Department of Orthopaedics, Chongqing Corps Hospital of Chinese People’s Armed Polices, No. 90 Wei-guo Road, Nan’an, Chongqing, China

关键词: Nodular sclerosis Hodgkin lymphoma;    Supraclavicular lymph nodes;    Large B-cell lymphoma;    Mediastinum;    Discordant lymphoma;   

Others  :  1235693
DOI  :  10.1186/s13000-015-0450-6

 received in 2015-08-29, accepted in 2015-12-17,  发布年份 2015

【 摘 要 】

Background

Discordant lymphoma is defined by the simultaneous presence of two or more distinct types of lymphomas at different anatomic sites. With fewer than 20 studies reporting cases of discordant lymphoma to date, the incidence of this condition is believed to be very low.

Case Presentation

Here, we report a case of discordant lymphoma in a 34-year-old female patient that involved mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes. The patient presented with a mass in the mediastinum and enlargement of the right supraclavicular lymph nodes, but no obvious signs of lymphoma. Histological examination revealed that the encapsulated mediastinal mass contained medium- or large-size tumor cells with lightly stained cytoplasm and round vesicular nuclei as well as a high percentage of mitotic cells; strongly positive immunohistochemical staining for PAX5, CD20, and CD79a also was observed. Examination of biopsied right supraclavicular lymph node tissues revealed separation by collagen fibers, extensive inflammatory cell infiltration, and large-size tumor cells, such as Reed–Sternberg cells. These tissues stained strongly positive for PAX5 and CD30, weakly positive for CD15, and negative for Epstein-Barr viral RNA. We also found monoclonal gene rearrangement in the immunoglobulin heavy chain gene in the mediastinal large B-cell lymphoma, but no monoclonal gene rearrangement in the nodular sclerosis Hodgkin lymphoma. These findings suggested that these two lymphomas were not of a common clonal origin. The patient was treated by surgical excision of the mediastinal mass followed by radio-chemotherapy, and no metastasis or recurrence occurred during a follow-up period of 32 months.

Conclusion

A review of previously reported cases indicated that the clinical manifestations and pathological features of discordant lymphoma are diverse due to variation in the types of lymphomas involved. Physicians must have an awareness of discordant lymphoma to avoid incorrect and missed diagnoses, especially considering that the true incidence may not be as low as previously believed.

【 授权许可】

   
2015 Zhang et al.

【 图 表 】

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【 参考文献 】

• [1]Custer R. Pitfalls in the diagnosis of and leukemia from the pathologist’s point of view. Proceedings from the 2nd Nation Cancer Conference. American Cancer Society, New York; 1954.
• [2]Kim H, Dorfman RF. Morphological studies of 84 untreated patients subjected to laparotomy for the staging of non-Hodgkin's lymphomas. Cancer. 1974; 33:657-74.
• [3]Zhang SH, Xu AM, Zheng JM, He MX. Coexistence of splenic marginal zone lymphoma with hepatocellular carcinoma: a case report. Diagn Pathol. 2007; 2:5. BioMed Central Full Text
• [4]Damotte D, Le Tourneau A, Audouin J, Duval C, Martin-Bastenaire F, Villain O, Delobelle-Deroide A, Diebold J. Discordant malignant lymphoma synchronous or successive high-grade B lymphoma associated with Hodgkin's disease. A clinico pathologic and immunophenotypic study of 4 cases. Pathol Res Pract. 1995; 191:8-15.
• [5]Adu-Poku K, Thomas DW, Khan MK, Holgate CS, Smith ME. Langerhans cell histiocytosis in sequential discordant lymphoma. J Clin Pathol. 2005; 58:104-6.
• [6]Nakamura N, Ohshima K, Abe M, Osamura Y. Demonstration of chimeric DNA of bcl-2 and immunoglobulin heavy chain in follicular lymphoma and subsequent Hodgkin lymphoma from the same patient. J Clin Exp Hematop. 2007; 47(1):9-13.
• [7]Tucci A, Motta M, Ungari M, Ruggeri G, Crippa C, Borlenghi E, Ubiali A, Facchetti F, Rossi G. The development of more than one histologic type of lymphoma in the same patient is frequent and confers a worse prognosis. Haematologica. 2005; 90:348-52.
• [8]Oka K, Nagayama R, Iijima S, Yonekawa N, Hirosawa K, Yatabe Y, Mori N. Epstein-Barr virus-associated lymphoproliferative disorder presenting with classical Hodgkin lymphoma and developing as peripheral T-cell lymphoma 9 years later: a case report of composite lymphoma. Pathol Int. 2011; 61:752-5.
• [9]Guarner J, del Rio C, Hendrix L, Unger ER. Composite Hodgkin's and non-Hodgkin's lymphoma in a patient with acquired immune deficiency syndrome. In-situ demonstration of Epstein-Barr virus. Cancer. 1990; 66:796-800.
• [10]Van den Tweel JG, Lukes RJ, Taylor CR. Pathophysiology of lymphocyte transformation. A study of so-called composite lymphomas. Am J Clin Pathol. 1979; 71:509-20.
• [11]Brown JR, Weng AP, Freedman AS. Hodgkin disease associated with T-cell non-Hodgkin lymphomas: case reports and review of the literature. Am J Clin Pathol. 2004; 121:701-8.
• [12]Park J, Lee JE, Kim M, Lim J, Kim Y, Han K, Park G, Jung YH, Roh SY, Hong YS. Discordant lymphocyte-depleted classical Hodgkin's and peripheral T-cell lymphoma arising in a patient 11 years after diagnosis of multicentric Castleman's disease. Int J Hematol. 2013; 98:114-121.
• [13]Reed D, Middlemas E, Gertsen E, Lamb MR. Discordant B- and T-cell non-Hodgkin's lymphoma: case report and review of literature. Tenn Med. 2013; 106:35-37.
• [14]Yamamoto Y, Yamochi-Onizuka T, Shiozawa E, Kushima M, Nakamaki T, Tomoyasu S, Kaneko K, Mitamura K, Hoshino M, Ishii H, Kusano M, Ota H. Discordant lymphoma: MALT lymphoma of the stomach and follicular lymphoma of the parotid gland. Pathol Int. 2003; 53:557-62.
• [15]Goteri G, Rupoli S, Stramazzotti D, Discepoli G, Scortechini AR, Giacchetti A, Morichetti D, Tassetti A, Pulini S, Mulattieri S, Stronati A, Leoni P. Coexistence of two discordant B-cell lymphomas in the skin and lymph node: report of a case with primary cutaneous follicle-center lymphoma and nodal mantle-cell lymphoma. Br J Dermatol. 2007; 157:629-31.
• [16]Prochorec-Sobieszek M, Majewski M, Sikorska A, Centkowski P, Tajer J, Lampka-Wojciechowska E, Rymkiewicz G, Konopka L, Meder J, Warzocha K, Maryniak RK. Transformation in lymphomas--morphological, immunophenotypic and molecular features. Pol J Pathol. 2006; 57:63-70.
• [17]Swerdlow SH, Campo E, Harris NL. WHO classification of tumors of haematopoietic and lymphoid tissues. IARC Press, Lyon; 2008.
• [18]Rosenwald A, Wright G, Leroy K, Yu X, Gaulard P, Gascoyne RD, Chan WC, Zhao T et al.. Molecular diagnosis of primary mediastinal B cell lymphoma identifies a clinically favorable subgroup of diffuse large B cell lymphoma related to Hodgkin lymphoma. J Exp Med. 2003; 6:851-62.
• [19]Hao Y, Chapuy B, Monti S, Sun HH, Rodig SJ, Shipp MA. Selective JAK2 inhibition specifically decreases Hodgkin lymphoma and mediastinal large B-cell lymphoma growth in vitro and in vivo. Clin Cancer Res. 2014; 10:2674-83.