Downgraded non-Hodgkin's lymphoma in the neck occurring as a secondary malignancy.
While the histologic progression from low-grade non-Hodgkin's lymphoma (NHL) to intermediate- or high-grade NHL has been well documented, a rare phenomenon called downgrading in which the histologic conversion of a low-grade NHL occurs after treatment for intermediate- or high-grade NHL has recently been recognized. We report the clinical, immunologic, and genetic features of a patient with a diffuse NHL (intermediate grade) who initially achieved complete remission by both chemotherapy and radiation therapy and then presented with a follicular NHL (low grade) 14 years later. The immunohistochemical study of the lymphoma cells showed B lymphocytes in biopsied lymph nodes at both the initial and the second diagnosis. However, a polymerase chain reaction (PCR) analysis for the immunoglobulin gene rearrangement indicated that the clone of the initial intermediate-grade NHL showed monoclonal cell population, and was distinct from that of the second downgraded form. Given the PCR results and the clinical features, we suggest that a follicular NHL can occur as a secondary malignancy following combined therapy for a diffuse NHL.
Department of Otolaryngology, Yamaguchi University, School of Medicine, Yamaguchi, Japan. yoichi-o@po.cc.yamaguchi-u.ac.jp
Y
Y
Ogata
M
M
Setoguchi
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T
Tahara
M
M
Takahashi
D017809:Fatal Outcome; D005260:Female; D015321:Gene Rearrangement; D005803:Genes, Immunoglobulin; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008228:Lymphoma, Non-Hodgkin / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D016133:Polymerase Chain Reaction / Q000379:methods