title: CD20-negative T-cell-rich B-cell lymphoma as a progression of a nodular lymphocyte-predominant Hodgkin's lymphoma treated with rituximab: a molecular analysis using laser capture microdissection.
abstract: Rituximab is a chimeric anti-CD20 monoclonal antibody. It has shown efficacy in patients with B-cell non-Hodgkin lymphoma and also in CD20-positive Hodgkin lymphoma. Recently, CD20-negative tumors have been described after Rituximab therapy. We report a 34-year-old man with a history of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), treated with different chemotherapy regimens, including anthracyclines and Rituximab. After 4 years in complete remission, he developed a CD20-negative T-cell-rich B-cell lymphoma (TCRBCL) presenting as multiple lung lesions. This case shows the difficulties in the diagnosis of CD20-negative lymphomas when the number of tumor cells is low and when they are found in a predominant T-cell context. Using anti-CD79a as a B-cell marker is mandatory to overcome the difficulties in identifying these tumors. Moreover, this case illustrates the usefulness of laser capture microdissection to obtain purified cell populations for molecular studies in lymphomas with relative paucity of tumor cells, as well as the need to analyze different IgH gene regions to decrease the rate of false-negative results in PCR clonality studies.
authors.affiliation: Hospital del Mar-IMAS-IMIM, Autonomous University of Barcelona, Passeig Maritim 25-29, Barcelona 08003, Spain. lpijuan@imas.imim.es
authors.forename: Lara
authors.initials: L
authors.lastname: Pijuan
authors.forename: Luis
authors.initials: L
authors.lastname: Vicioso
authors.forename: Beatriz
authors.initials: B
authors.lastname: Bellosillo
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Ferrer
authors.forename: Teresa
authors.initials: T
authors.lastname: Baró
authors.forename: Carme
authors.initials: C
authors.lastname: Pedro
authors.forename: Josep
authors.initials: J
authors.lastname: Lloreta-Trull
authors.forename: Assumpta
authors.initials: A
authors.lastname: Munné
authors.forename: Sergi
authors.initials: S
authors.lastname: Serrano
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000378:metabolism*; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006689:Hodgkin Disease / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D007834:Lasers; D008175:Lung Neoplasms / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology*; D008297:Male; D042282:Microdissection; D016609:Neoplasms, Second Primary / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology*; D016133:Polymerase Chain Reaction; D000069283:Rituximab; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000970:Antineoplastic Agents; D000069283:Rituximab