A unique composite follicular lymphoma and mantle cell lymphoma with a mixed cell pattern and aggressive course.
OBJECTIVE
There are a limited number of reports of composite follicular lymphoma (FL) and mantle cell lymphoma (MCL) in the literature, and all previous cases report that FL and MCL components are separated, even within a single lymph node. Here we report a case of a patient with a distinctive composite FL and MCL with a mixed cell pattern.


METHODS
A 34-year-old man presented with left supraclavicular lymphadenopathy for one month. The lymph node contained closely packed nodules of lymphocytes. Immunostaining and fluorescence in situ hybridization demonstrated the FL nature of the Bcl-2- and CD10-positive tumor cells, as well as the scattered cyclin D1-positive MCL tumor cells in the nodules. Double immunohistochemical staining showed an unusual mixed pattern of both types of tumor cells.


RESULTS
The patient received a regimen of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy and achieved partial remission following four cycles of chemotherapy but relapsed 1 month after the last treatment and died of meninges involvement 8 months after the first presentation.


CONCLUSIONS
To our knowledge, this is the first report of composite FL and MCL with a mixed pattern. A mixture of grade IIIb FL and MCL may explain the poor prognosis of the patient.
Dept of Pathology, State Key Laboratory of Cancer Biology, Xijing Hospital and School of Basic Medicine, Fourth Military Medical University, Xi'an, 710032, China; zhwang@fmmu.edu.cn or yanqg@fmmu.edu.cn.
Yixiong
Y
Liu
Peifeng
P
Li
Ying
Y
Guo
Linni
L
Fan
Lu
L
Wang
Jin
J
Zhu
Gaosheng
G
Huang
Qingguo
Q
Yan
Zhe
Z
Wang
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D058617:Composite Lymphoma / Q000473:pathology*; D003520:Cyclophosphamide / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004317:Doxorubicin / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D008224:Lymphoma, Follicular / Q000473:pathology* / Q000628:therapy; D020522:Lymphoma, Mantle-Cell / Q000473:pathology* / Q000628:therapy; D008297:Male; D014750:Vincristine / Q000627:therapeutic use
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide
Composite lymphoma; Follicular lymphoma; Mantle cell lymphoma; Mixed cell pattern