Concurrent Hodgkin's disease (mixed cellularity type) and T-cell chronic lymphocytic leukemia/prolymphocytic leukemia.
We describe a patient with leukopenic T-cell chronic lymphocytic leukemia/prolymphocytic leukemia (T-CLL/PLL), according to the Revised European-American Classification of Lymphoid Neoplasms. This patient simultaneously developed classic Hodgkin's disease (HD), a combination previously unreported. The leukemic cells were small and mature, did not have cytoplasmic granulation, and appeared similar to B-cell chronic lymphocytic leukemia. Immunophenotyping of the bone marrow-infiltrating cells revealed a postthymic suppressor/cytotoxic phenotype of CD2+, CD3+, CD4, CD5+, CD8+, CD25-, TCR-alpha beta. A lymph node biopsy showed the histological features of HD (mixed cellularity) with infiltrating CD8+ lymphocytes, and immunohistochemical examination revealed the following phenotype of Reed-Sternberg cells: LeuM1/CD15+, BerH2/CD30+, L26/PanB-, UCHL-1/CD45RO-, cyCD3-, CD4, CD8-, CD20-, CD79a-, EMA-, EBER-1+, LMP-1+. Southern blot analysis of the bone marrow and lymph node revealed the same rearrangement of bands of T-cell-receptor genes. Although the HD was treated with chemotherapy that resulted in complete remission, the T-PLL/CLL took an indolent course. This case may suggest the existence of a subtype of T-CLL/PLL with leukopenia and an indolent clinical course. Both diseases were believed to be independent and not a transformation of one to the other.
Miyata
A
A
Department of Internal Medicine, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers, Hiroshima, Japan. myatak@mint.ocn.ne.jp
Kojima
K
K
Yoshino
T
T
Fujii
S
S
Shinagawa
K
K
Ichimura
K
K
D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D001853:Bone Marrow / Q000737:chemistry / Q000473:pathology; D015321:Gene Rearrangement; D006689:Hodgkin Disease / Q000150:complications* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D015463:Leukemia, Prolymphocytic / Q000150:complications; D015461:Leukemia, Prolymphocytic, T-Cell / Q000150:complications* / Q000473:pathology; D017254:Leukemic Infiltration / Q000473:pathology; D008198:Lymph Nodes / Q000737:chemistry / Q000473:pathology; D008297:Male; D011948:Receptors, Antigen, T-Cell / Q000235:genetics; D016539:Reed-Sternberg Cells / Q000737:chemistry / Q000473:pathology
D015703:Antigens, CD; D011948:Receptors, Antigen, T-Cell