Composite B-cell and T-cell lymphoma arising 24 years after nodular lymphocyte predominant Hodgkin's disease.
Twenty-four years after apparently successful treatment for nodular lymphocyte predominant Hodgkin's disease (nLPHD), a 41-year old male developed "B" symptoms and extensive adenopathy. A right axillary lymph node biopsy showed two distinct regions including (1) histiocyte-rich B-cell lymphoma and (2) diffuse small T-cell lymphoma. A clonal rearrangement of the gene for the T-cell receptor beta chain confirmed the presence of a T-cell neoplasm, and this was further confirmed by selective polymerase chain reaction (PCR) on this morphologic zone. PCR on the morphologic B-cell lymphoma confirmed the presence of an immunoglobulin gene rearrangement. These two regions were separated by a less-defined zone containing a mixture of small CD57 positive T lymphocytes, small B lymphocytes, and rare lymphocytic and histiocytic (L&H) cells, highly suggestive of recurrent LPHD. The development of composite B-cell and T-cell lymphoma in this patient raises the speculation that nLPHD may be a neoplasm of lymphoid cells, which can differentiate in both B- and T-cell directions, with the "L&H" cells constituting their B-cell progeny.
Hancock
J C
JC
Department of Pathology and Laboratory Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Wells
A
A
Halling
K C
KC
Tilashalski
K
K
Conner
M G
MG
Johns
C
C
Listinsky
C M
CM
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D005434:Flow Cytometry; D019084:Fluorescent Antibody Technique, Indirect; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain / Q000235:genetics; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor / Q000235:genetics; D006689:Hodgkin Disease / Q000235:genetics / Q000473:pathology*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000235:genetics / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D016393:Lymphoma, B-Cell / Q000235:genetics / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000235:genetics / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000235:genetics / Q000473:pathology*; D008297:Male; D016133:Polymerase Chain Reaction; D016539:Reed-Sternberg Cells / Q000473:pathology