title: Composite lymphoid neoplasm of B-cell and T-cell origins: a pathologic study of 14 cases.
abstract: We retrospectively analyzed 14 composite lymphoma/lymphoid neoplasms (CL) of B-cell/T-cell origins. These consisted of a spectrum of T-cell neoplasms in combination with different B-cell lymphomas/leukemias, with peripheral T-cell lymphoma and diffuse large B-cell lymphoma encountered most frequently for each respective neoplastic lineage. Histopathologic evaluation demonstrated 6 patterns of neoplastic distribution, including zone, inverted zone, diffuse mixed, regional/nodular mixed, compartmental, and segmental distributions. Four of 9 cases studied were positive for Epstein-Barr virus, all with a mixed pattern, suggesting that this pattern may predict an Epstein-Barr virus association. None of 14 cases was considered CL at the initial histologic evaluation. Only 6 (46.2%) of 13 cases had coexisting B-cell/T-cell neoplasms highlighted by immunohistochemistry, and the other 7 (53.8%) cases had 1 or both of the neoplastic components hidden. Flow cytometry detected both neoplastic lineages in 4 (44%) but failed to detect a clonal B-cell population in 4 (44%) and missed neoplastic T cells in 1 (11.1%) of 9 cases. Molecular testing detected clonal rearrangement of IGH/K gene in 11 (84.6%) of 13 cases, and clonal rearrangement of the TCRG/B gene in 13 (92.9%) of 14 cases, including 8 with identical amplicons detected in separate samples. CLs of B-cell/T-cell origin are heterogeneous in subtype combination and topographic pattern, often with one of the components histologically occult. A multidisciplinary approach is emphasized to establish a definitive diagnosis in these challenging cases.
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710. Electronic address: endi.wang@duke.edu.
authors.forename: Endi
authors.initials: E
authors.lastname: Wang
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710.
authors.forename: Paulie
authors.initials: P
authors.lastname: Papavassiliou
authors.affiliation: Department of Pathology, Tulane University, New Orleans, LA 70118.
authors.forename: Alun R
authors.initials: AR
authors.lastname: Wang
authors.affiliation: Department of Pathology and Laboratory Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114.
authors.forename: Abner
authors.initials: A
authors.lastname: Louissaint
authors.affiliation: Department of Pathology, Loma Linda University, Loma Linda, CA 92350.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710.
authors.forename: Charles Blake
authors.initials: CB
authors.lastname: Hutchinson
authors.affiliation: Department of Pathology, City of Hope National Medical Center, Duarte, CA 91010.
authors.forename: Qin
authors.initials: Q
authors.lastname: Huang
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710.
authors.forename: Deepti
authors.initials: D
authors.lastname: Reddi
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710.
authors.forename: Siby
authors.initials: S
authors.lastname: Sebastian
authors.affiliation: Department of Pathology, Duke University, Durham, NC 27710.
authors.forename: Catherine
authors.initials: C
authors.lastname: Rehder
authors.affiliation: Department of Pathology, University of Southern California, Los Angeles, CA 90089.
authors.forename: Russell
authors.initials: R
authors.lastname: Brynes
authors.affiliation: Department of Pathology, University of Southern California, Los Angeles, CA 90089.
authors.forename: Imran
authors.initials: I
authors.lastname: Siddiqi
mesh_terms: D000293:Adolescent; D000368:Aged; D000818:Animals; D004285:Dogs; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D015448:Leukemia, B-Cell / Q000235:genetics / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000235:genetics / Q000473:pathology*; D016399:Lymphoma, T-Cell / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000235:genetics / Q000473:pathology*; D012189:Retrospective Studies
keywords: B cell; Composite lymphoma; Lymphoid neoplasm; T cell