title: A 3-way collision tumor of the upper respiratory tract: a composite of 2 immunophenotypically distinct mantle cell lymphomas and a plasmacytoma.
abstract: Composite lymphoma (CL) is composed of 2 or more morphologically and immunophenotypically distinct lymphomas in a single anatomical site. Here we report a unique CL of the upper respiratory tract in an elderly male patient. Morphologically, the lymphoma was composed of 2 distinct and well-demarcated areas consisting of monotonous small to medium-sized lymphocytes and sheets of mature-appearing plasma cells. Immunophenotyping by both flow cytometry and immunohistochemistry revealed that the small to medium-sized lymphocytes were composed of 2 distinct subpopulations sharing a CD5(+)/CD19(+)/CD20(+)/CD22(+)/CD23(-)/FMC-7(+)/cyclin D1(+) immunophenotype but with different immunoglobulin (Ig) light and heavy chain expression, consistent with 2 immunophenotypically distinct mantle cell lymphomas (MCLs); the plasma cells were composed of CD38(bright +)/CD138(+)/IgG kappa-restricted plasma cells, consistent with a plasmacytoma. Fluorescence in situ hybridization showed the t(11;14) translocation present in the lymphocyte region but absent in the plasma cell area. Ig heavy chain gene rearrangement studies on manually dissected populations showed 2 distinct patterns for the MCL and plasmacytoma. To our knowledge, this is the first report of a 3-way CL consisting of 2 immunophenotypically distinct MCLs and a plasmacytoma.
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75390-9073, USA. huan-you.wang@utsouthwestern.edu
authors.forename: Huan-You
authors.initials: HY
authors.lastname: Wang
authors.forename: Nitin
authors.initials: N
authors.lastname: Karandikar
authors.forename: Deborah
authors.initials: D
authors.lastname: Payne
authors.forename: Atousa
authors.initials: A
authors.lastname: Maleki
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Schultz
authors.forename: Robert
authors.initials: R
authors.lastname: Collins
authors.forename: Robert W
authors.initials: RW
authors.lastname: McKenna
mesh_terms: D002999:Clone Cells / Q000276:immunology; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D020522:Lymphoma, Mantle-Cell / Q000276:immunology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009303:Nasopharyngeal Neoplasms / Q000276:immunology / Q000473:pathology*; D009378:Neoplasms, Multiple Primary / Q000276:immunology / Q000473:pathology*; D010954:Plasmacytoma / Q000276:immunology / Q000473:pathology*