title: Composite lymphoma: EBV-positive classic Hodgkin lymphoma and peripheral T-cell lymphoma: a case report.
abstract: Composite lymphomas are rare and defined as hematopoietic neoplasms with more than 1 malignant lymphomatous clone showing different phenotypic features. Of all possible combinations between non-Hodgkin lymphomas, B cell or T cell, and Hodgkin lymphoma, the least frequent are the ones combining T-cell non-Hodgkin lymphoma and classic Hodgkin lymphoma. We report a case of a 55-year-old woman with cervical and mediastinal lymphadenopathy, fever, weight loss, and night sweats. A cervical lymph node biopsy revealed a composite lymphoma with classic Hodgkin lymphoma and peripheral T-cell lymphoma components. The bone marrow was not involved. The patient refused treatment and died of disease progression 2 months after diagnosis. The biopsied lymph node showed 2 distinct populations, one composed of large cells including typical Reed-Sternberg cells and their variants, with expression of CD30, CD15, PAX5, and LMP-1. The other component was more abundant and comprised polymorphic medium-sized cells with convoluted nuclei; CD3, CD5, CD2, and CD4 expression; and negativity for CD30, cytotoxic granules, and B-cell markers. Epstein-Barr virus DNA of subtype A was identified only in the Hodgkin cells. Clonal T-cell receptor gamma and beta gene rearrangements were detected in the T-cell component, whereas monoclonal immunoglobulin H gene rearrangement was found in the Hodgkin cells.
authors.affiliation: Consultoria em Patologia, Botucatu, São Paulo, Brazil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Gualco
authors.forename: Lucimara
authors.initials: L
authors.lastname: Chioato
authors.forename: Anke
authors.initials: A
authors.lastname: Van Den Berg
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Weiss
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Bacchi
mesh_terms: D005260:Female; D015321:Gene Rearrangement; D015333:Gene Rearrangement, beta-Chain T-Cell Antigen Receptor; D015334:Gene Rearrangement, gamma-Chain T-Cell Antigen Receptor; D004854:Herpesvirus 4, Human; D006689:Hodgkin Disease / Q000175:diagnosis / Q000473:pathology* / Q000821:virology; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D008198:Lymph Nodes / Q000473:pathology; D016411:Lymphoma, T-Cell, Peripheral / Q000175:diagnosis / Q000473:pathology*; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis*; D016539:Reed-Sternberg Cells
chemical_list: D007143:Immunoglobulin Heavy Chains