title: Discordant lymphoma consisting of mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes: a case report.
abstract: BACKGROUND
  Discordant lymphoma is defined by the simultaneous presence of two or more distinct types of lymphomas at different anatomic sites. With fewer than 20 studies reporting cases of discordant lymphoma to date, the incidence of this condition is believed to be very low.
  
  
  METHODS
  Here, we report a case of discordant lymphoma in a 34-year-old female patient that involved mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes. The patient presented with a mass in the mediastinum and enlargement of the right supraclavicular lymph nodes, but no obvious signs of lymphoma. Histological examination revealed that the encapsulated mediastinal mass contained medium- or large-size tumor cells with lightly stained cytoplasm and round vesicular nuclei as well as a high percentage of mitotic cells; strongly positive immunohistochemical staining for PAX5, CD20, and CD79a also was observed. Examination of biopsied right supraclavicular lymph node tissues revealed separation by collagen fibers, extensive inflammatory cell infiltration, and large-size tumor cells, such as Reed-Sternberg cells. These tissues stained strongly positive for PAX5 and CD30, weakly positive for CD15, and negative for Epstein-Barr viral RNA. We also found monoclonal gene rearrangement in the immunoglobulin heavy chain gene in the mediastinal large B-cell lymphoma, but no monoclonal gene rearrangement in the nodular sclerosis Hodgkin lymphoma. These findings suggested that these two lymphomas were not of a common clonal origin. The patient was treated by surgical excision of the mediastinal mass followed by radio-chemotherapy, and no metastasis or recurrence occurred during a follow-up period of 32 months.
  
  
  CONCLUSIONS
  A review of previously reported cases indicated that the clinical manifestations and pathological features of discordant lymphoma are diverse due to variation in the types of lymphomas involved. Physicians must have an awareness of discordant lymphoma to avoid incorrect and missed diagnoses, especially considering that the true incidence may not be as low as previously believed.
authors.affiliation: Department of Pathology, Chongqing Corps Hospital of Chinese People's Armed Polices, No. 90 Wei-guo Road, Nan'an, Chongqing, China. 34193382@qq.com.
authors.forename: Chun
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Pathology, Chongqing Corps Hospital of Chinese People's Armed Polices, No. 90 Wei-guo Road, Nan'an, Chongqing, China. wjyysci@163.com.
authors.forename: Yuanxue
authors.initials: Y
authors.lastname: Yi
authors.affiliation: Department of Pathology, Chongqing Corps Hospital of Chinese People's Armed Polices, No. 90 Wei-guo Road, Nan'an, Chongqing, China. lunwenyx@126.com.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Pathology, Chongqing Corps Hospital of Chinese People's Armed Polices, No. 90 Wei-guo Road, Nan'an, Chongqing, China. 15922567884@163.com.
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Chongqing Corps Hospital of Chinese People's Armed Polices, No. 90 Wei-guo Road, Nan'an, Chongqing, China. zcmq_xxm@163.com.
authors.forename: Zhu
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics; D001706:Biopsy; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D015321:Gene Rearrangement; D050438:Genes, Immunoglobulin Heavy Chain; D006689:Hodgkin Disease / Q000235:genetics / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000737:chemistry / Q000473:pathology*; D016393:Lymphoma, B-Cell / Q000737:chemistry / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D008479:Mediastinal Neoplasms / Q000737:chemistry / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D018193:Neoplasms, Complex and Mixed / Q000737:chemistry / Q000235:genetics / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor