title: A distinctive composite lymphoma consisting of clonally related mantle cell lymphoma and follicle center cell lymphoma.
abstract: Although follicle center cell lymphoma and mantle cell lymphoma are both B cell non-Hodgkin's lymphomas (NHL), they are regarded as separate entities with distinct clinical, morphological, immunophenotypic and molecular characteristics. To our knowledge, the coexistence of these 2 lymphomas in the same patient has never been reported. We describe a 70-year-old woman with a long-standing history of follicle center cell lymphoma, cytological grade I, who subsequently developed a composite lymphoma consisting of well-demarcated foci of persistent follicle center cell lymphoma surrounded by mantle cell lymphoma. This morphological interpretation was supported by the presence of both bcl-1 and bcl-2 gene rearrangements, which are molecular genetic hallmarks of mantle cell lymphoma and follicle center cell lymphoma, respectively. Polymerase chain reaction (PCR) analysis for rearranged immunoglobulin heavy chain (IgH) genes showed a dominant band identical in size in microdissected tumor cells of the follicle center cell and mantle cell lymphomas. Cloning and sequence analysis of the PCR products revealed a common clone-specific IgH gene rearrangement in these 2 lymphomas. These findings suggest that this composite lymphoma represents the unusual evolution of a malignant B-cell clone that resulted in the development of 2 morphologically distinct but clonally related B-cell NHLs. These findings also show the importance of integrating morphological, immunophenotypic, and molecular data to enhance our understanding of the complex pathogenic interrelationships in lymphomagenesis.
authors.affiliation: Department of Pathology, Weill Medical College of Cornell University, New York, NY, 10021, USA.
authors.forename: P
authors.initials: P
authors.lastname: Tsang
authors.forename: L
authors.initials: L
authors.lastname: Pan
authors.forename: E
authors.initials: E
authors.lastname: Cesarman
authors.forename: J
authors.initials: J
authors.lastname: Tepler
authors.forename: D M
authors.initials: DM
authors.lastname: Knowles
mesh_terms: D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D015139:Blotting, Southern; D005260:Female; D006801:Humans; D016130:Immunophenotyping; D008224:Lymphoma, Follicular / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D008228:Lymphoma, Non-Hodgkin / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000235:genetics; D014178:Translocation, Genetic
chemical_list: D015703:Antigens, CD; D019253:Proto-Oncogene Proteins c-bcl-2