title: Coexistence of follicular lymphoma and an unclassifiable myeloproliferative neoplasm in a treatment-naïve patient: A case report.
abstract: Myeloproliferative neoplasms are associated with lymphoproliferative diseases following the administration of cytotoxic drugs or exposure to radiation, but are rare prior to therapy. The present study reports the case of a 61-year-old female with a history of transient ischemic attack. The patient, who presented with a palpable mass in the epitrochlear area of the left arm, was simultaneously diagnosed with follicular lymphoma and an unclassifiable myeloproliferative neoplasm. Excisional lymph node biopsy revealed stage I follicular lymphoma (grade 1). Laboratory findings demonstrated leukocytosis, erythrocytosis, thrombocytosis and decreased erythropoietin. Biopsy of the bone marrow revealed hypercellularity, with predominance of erythroid cells, and large polylobated megakaryocytes with increased mitotic figures, but no evidence of lymphomatous infiltration. The janus kinase 2 V617F mutation was also detected in the cells derived from the bone marrow specimen. Following local excision of the lymph node in the left epitrochlear area, radiation was delivered to the involved field, at a dose of 24 Gy in 12 fractions. The patient was started on hydroxyurea (1 g twice per day, orally) 2 weeks subsequent to radiotherapy, and was administered 500 mg twice per day as maintenance therapy. At the six-month follow-up, the white blood cell count, hemoglobin levels and platelet count had reduced, and the patient was in a healthy condition. A computed tomography scan of the neck, chest and abdomen indicated no abnormalities. To the best of our knowledge, the present study is the first case report of follicular lymphoma coexisting with an unclassifiable myeloproliferative neoplasm in a previously healthy patient. Molecular and genetic studies are required to further evaluate this infrequent disease association.
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Gyeongmin
authors.initials: G
authors.lastname: Jeong
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Jinhyong
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Seeun
authors.initials: S
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Jongmin
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Kyunghye
authors.initials: K
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Chuiyong
authors.initials: C
authors.lastname: Pak
authors.affiliation: Department of Laboratory Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Ji-Hun
authors.initials: JH
authors.lastname: Lim
authors.affiliation: Department of Pathology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Hee Jeong
authors.initials: HJ
authors.lastname: Cha
authors.affiliation: Department of Hematology and Oncology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Hematology and Oncology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682-714, Republic of Korea.
authors.forename: Jae-Cheol
authors.initials: JC
authors.lastname: Jo
keywords: coexistence; follicular lymphoma; unclassifiable myeloproliferative neoplasm