title: Classical Hodgkin lymphoma concurrently evolving in a patient with marginal zone B-cell lymphoma of the spleen.
abstract: Combination of the splenic marginal zone B-cell lymphoma (SMZL) and classical Hodgkin lymphoma (cHL) is extremely rare. We report a unique case with concurrent SMZL and cHL. The patient was a 63-year-old man who presented with fatigue and anemia, showing a splenomegaly and retroperitoneal lymphadenopathy. A splenectomy revealed monotonous marginal zone lymphocytic infiltrates and numerous large Reed-Sternberg-like cells. Flow cytometry revealed a kappa light-chain-restricted CD5 (-), CD23 (-) B-cell population. DNA polymerase chain reaction analysis confirmed the presence of clonal rearrangement of the immunoglobulin heavy-chain gene. Immunohistochemical studies revealed that the large atypical cells were CD30 (+), CD15 (weakly +), CD20 (-), CD45 (-), Pax5 (weakly +), BOB.1 (-), and Oct2 (-), indicating the coexistence of SMZL with cHL. After the chemotherapy, the patient achieved a clinical/radiologic remission, whereas cHL was detected in liver and bone marrow subsequently. The case indicates that both components of lymphoma can present concurrently as a composite form of lymphoma and both need to be treated adequately.
authors.affiliation: Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
authors.forename: Shuko
authors.initials: S
authors.lastname: Harada
authors.forename: Hari
authors.initials: H
authors.lastname: Kalla
authors.forename: Manjula
authors.initials: M
authors.lastname: Balasubramanian
authors.forename: Isadore
authors.initials: I
authors.lastname: Brodsky
authors.forename: Douglas
authors.initials: D
authors.lastname: Gladstone
authors.forename: J Steve
authors.initials: JS
authors.lastname: Hou
mesh_terms: D015703:Antigens, CD / Q000032:analysis; D001402:B-Lymphocytes / Q000737:chemistry / Q000473:pathology; D003131:Combined Modality Therapy; D015326:Gene Rearrangement, B-Lymphocyte, Heavy Chain / Q000235:genetics; D006689:Hodgkin Disease / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008206:Lymphatic Diseases; D018442:Lymphoma, B-Cell, Marginal Zone / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016609:Neoplasms, Second Primary / Q000473:pathology*; D016539:Reed-Sternberg Cells / Q000473:pathology; D012074:Remission Induction; D013160:Splenic Neoplasms / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D013163:Splenomegaly
chemical_list: D015703:Antigens, CD