Classical Hodgkin lymphoma concurrently evolving in a patient with marginal zone B-cell lymphoma of the spleen.
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.
Harada
Shuko
S
Department of Pathology and Laboratory Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA.
Kalla
Hari
H
Balasubramanian
Manjula
M
Brodsky
Isadore
I
Gladstone
Douglas
D
Hou
J Steve
JS
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
D015703:Antigens, CD