title: Discordant lymphocyte-depleted classical Hodgkin's and peripheral T-cell lymphoma arising in a patient 11 years after diagnosis of multicentric Castleman's disease.
abstract: Castleman's disease (CD) is thought to be related with an initially benign viral disease with cytokine-driven propagation and malignant transformation. This paper reports the first case of a simultaneous discordant lymphoma consisting of lymphocyte-depleted classical Hodgkin's lymphoma (LDCHL) and peripheral T-cell lymphoma (PTCL) arising in a patient with multicentric CD (MCD). PTCL occurred 4 years after the diagnosis of MCD, and LDCHL was developed 6 years after the treatment of PTCL, sequentially. The following year, the patient presented with a relapse of a simultaneous discordant lymphoma. On excisional cervical LN biopsy, immunohistochemical stain pattern was identical with previously diagnosed LDCHL, which expressed CD30, CD15, PAX5, and Epstein-Barr virus (EBV)-encoded RNA. PTCL was positive for CD3, CD4, CD5, CD10, and CD56, and showed identical TCRB and TCRG gene rearrangements to those detected initially. MCD was thought to be the major contributing factor leading to initial PTCL, while EBV-positive LDCHL is thought to have promoted the development of PTCL, as a persistently abnormal immune microenvironment may induce the recurrence of PTCL. MCD runs a more aggressive course and can progress to Hodgkin's lymphoma (HL), non-Hodgkin's lymphoma (NHL), or combined HL/NHL. Due to its malignant potential, prompt recognition and therapy is critical for these situations, which may be life threatening.
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Joonhong
authors.initials: J
authors.lastname: Park
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Lee
authors.forename: Myungshin
authors.initials: M
authors.lastname: Kim
authors.forename: Jihyang
authors.initials: J
authors.lastname: Lim
authors.forename: Yonggoo
authors.initials: Y
authors.lastname: Kim
authors.forename: Kyungja
authors.initials: K
authors.lastname: Han
authors.forename: Gyeongsin
authors.initials: G
authors.lastname: Park
authors.forename: Young Hee
authors.initials: YH
authors.lastname: Jung
authors.forename: Sang Young
authors.initials: SY
authors.lastname: Roh
authors.forename: Young Seon
authors.initials: YS
authors.lastname: Hong
mesh_terms: D000328:Adult; D005871:Castleman Disease / Q000503:physiopathology* / Q000628:therapy; D058617:Composite Lymphoma / Q000209:etiology* / Q000628:therapy; D018450:Disease Progression; D017809:Fatal Outcome; D006689:Hodgkin Disease / Q000209:etiology* / Q000628:therapy; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000209:etiology* / Q000628:therapy; D008297:Male; D012008:Recurrence