title: From brain to testis: immune escape and clonal selection in a B cell lymphoma with selective outgrowth in two immune sanctuaries [correction of sanctuariesy].
abstract: We describe a patient with a primary diffuse large B-cell lymphoma of the central nervous system who developed a localized testicular relapse after 8 years. Both tumours lacked HLA-DR expression, the relapse additionally lost HLA class I expression. Immunoglobulin heavy chain gene rearrangements were identical in both lymphomas with extensive and ongoing somatic hypermutations resulting in extensive idiotype modulation. We hypothesize that these immune sanctuaries initially provided a safe haven for the tumour cells. When the environment becomes more permissive for an anti-tumour response, the continuous idiotype modulation and progressive loss of HLA expression on the tumour cells facilitates further immune escape.
authors.affiliation: Dept. of Pathology and Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. m.booman@path.umcg.nl
authors.forename: Marije
authors.initials: M
authors.lastname: Booman
authors.forename: Jenny
authors.initials: J
authors.lastname: Douwes
authors.forename: Marie-Cecile
authors.initials: MC
authors.lastname: Legdeur
authors.forename: Joop
authors.initials: J
authors.lastname: van Baarlen
authors.forename: Ed
authors.initials: E
authors.lastname: Schuuring
authors.forename: Philip
authors.initials: P
authors.lastname: Kluin
mesh_terms: D001483:Base Sequence; D001932:Brain Neoplasms / Q000235:genetics / Q000276:immunology* / Q000556:secondary; D002454:Cell Differentiation / Q000276:immunology*; D002999:Clone Cells; D006801:Humans; D016393:Lymphoma, B-Cell / Q000235:genetics / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D013736:Testicular Neoplasms / Q000235:genetics / Q000276:immunology* / Q000556:secondary; D019139:Tumor Escape / Q000235:genetics / Q000276:immunology*