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Composite lymphoma in the anterior mediastinum: a case report and review of the literature.

Yu G, Kong L, Qu G, Zhang Q, Wang W, Jiang L - Diagn Pathol (2011)

Bottom Line: We recently encountered an unusual case of Composite lymphoma (CL) in the anterior mediastinum arising in a 37-year-old woman who presented initially with continuous pain in the right shoulder and chest.Chest computed tomography scan revealed the oval space-occupying lesion of anterior mediastinum.Surgery was performed and the disease was diagnosed pathologically as CL which composed of nodular sclerosing Hodgkin lymphoma and diffuse large B-cell lymphoma, via hematoxylin-eosin (H&E), immunohistochemical staining and in situ hybridization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Medical College of Qingdao University, No,20, Yuhuangding East Road, Yantai, 264000, China. ygh0535@hotmail.com

ABSTRACT
We recently encountered an unusual case of Composite lymphoma (CL) in the anterior mediastinum arising in a 37-year-old woman who presented initially with continuous pain in the right shoulder and chest. The woman had been suffered from continuous pain for three months before she went to our department of cardiovascular surgery. Chest computed tomography scan revealed the oval space-occupying lesion of anterior mediastinum. Surgery was performed and the disease was diagnosed pathologically as CL which composed of nodular sclerosing Hodgkin lymphoma and diffuse large B-cell lymphoma, via hematoxylin-eosin (H&E), immunohistochemical staining and in situ hybridization.

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Histological examination. (A)The tumor is nodular and different nodules are separated by collagen fibers. Different nodules show different histologic features (H&E × 40). (B) Pleomorphic cellular infiltrate containing lymphocytes, eosinophils, neutrophils and large Reed-Sternberg cells (arrows) (H&E × 400). (C) Other nodules display sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma (H&E × 100).
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Figure 2: Histological examination. (A)The tumor is nodular and different nodules are separated by collagen fibers. Different nodules show different histologic features (H&E × 40). (B) Pleomorphic cellular infiltrate containing lymphocytes, eosinophils, neutrophils and large Reed-Sternberg cells (arrows) (H&E × 400). (C) Other nodules display sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma (H&E × 100).

Mentions: Histology showed the tumor was nodular and different nodules were separated by collagen fibers (Figure 2A). There were two morphologically and immunophenotypically distinct components. The great mass of nodules showed a pleomorphic cellular infiltrate containing lymphocyte, eosinophile granulocyte, neutrophile granulocyte and numerous large Hodgkin/Reed-Sternberg cells. The Reed-Sternberg cells were positive for CD30, CD15 and MUM1 but negative for CD20, CD79a, CD3, Pax-5, CD68, bcl-6, CD10, CD45, Igκ, Igλ and epithelial membrane antigen (Figure 2B, Figure 3A). Other nodules displayed sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma which showed uniform expression of CD20, CD79a, MUM1, CD45, Igλ, Pax-5 and absence of CD30, CD15, CD3, CD10, bcl-6, Igκ, CD68 and epithelial membrane antigen (Figure 2C, Figure 3B). All the primary antibodies are listed in Table 1. Neither cell population showed makers of EBV infection by EBER in situ hybridization (PanPath Company, Amsterdam, Netherlands). On the basis of histomorphology at light microscopy, the presence of immunohistochemical staining and in situ hybridization, a diagnosis of CL, combination of NSHL and DLBCL, in the anterior mediastinum was made. The patient received six courses of CHOP chemotherapy (a course of treatment every two weeks) and twenty three times radiotherapy (Gross Tumor Volume, GTV = 40Gy/20f; Planning Target Volume, PTV = 36 Gy/20f). After treatment, lymph nodes in the bilateral supraclavicular fossa disappeared. The total follow-up period was thirty three months after surgery. The repeated CT scans, abdominal ultrasonography and tumor specific growth factor every three months revealed no recurring or residual lesion.


Composite lymphoma in the anterior mediastinum: a case report and review of the literature.

Yu G, Kong L, Qu G, Zhang Q, Wang W, Jiang L - Diagn Pathol (2011)

Histological examination. (A)The tumor is nodular and different nodules are separated by collagen fibers. Different nodules show different histologic features (H&E × 40). (B) Pleomorphic cellular infiltrate containing lymphocytes, eosinophils, neutrophils and large Reed-Sternberg cells (arrows) (H&E × 400). (C) Other nodules display sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma (H&E × 100).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3141624&req=5

Figure 2: Histological examination. (A)The tumor is nodular and different nodules are separated by collagen fibers. Different nodules show different histologic features (H&E × 40). (B) Pleomorphic cellular infiltrate containing lymphocytes, eosinophils, neutrophils and large Reed-Sternberg cells (arrows) (H&E × 400). (C) Other nodules display sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma (H&E × 100).
Mentions: Histology showed the tumor was nodular and different nodules were separated by collagen fibers (Figure 2A). There were two morphologically and immunophenotypically distinct components. The great mass of nodules showed a pleomorphic cellular infiltrate containing lymphocyte, eosinophile granulocyte, neutrophile granulocyte and numerous large Hodgkin/Reed-Sternberg cells. The Reed-Sternberg cells were positive for CD30, CD15 and MUM1 but negative for CD20, CD79a, CD3, Pax-5, CD68, bcl-6, CD10, CD45, Igκ, Igλ and epithelial membrane antigen (Figure 2B, Figure 3A). Other nodules displayed sheets of relatively uniform large lymphoid cells with typical morphologic features of large cell lymphoma which showed uniform expression of CD20, CD79a, MUM1, CD45, Igλ, Pax-5 and absence of CD30, CD15, CD3, CD10, bcl-6, Igκ, CD68 and epithelial membrane antigen (Figure 2C, Figure 3B). All the primary antibodies are listed in Table 1. Neither cell population showed makers of EBV infection by EBER in situ hybridization (PanPath Company, Amsterdam, Netherlands). On the basis of histomorphology at light microscopy, the presence of immunohistochemical staining and in situ hybridization, a diagnosis of CL, combination of NSHL and DLBCL, in the anterior mediastinum was made. The patient received six courses of CHOP chemotherapy (a course of treatment every two weeks) and twenty three times radiotherapy (Gross Tumor Volume, GTV = 40Gy/20f; Planning Target Volume, PTV = 36 Gy/20f). After treatment, lymph nodes in the bilateral supraclavicular fossa disappeared. The total follow-up period was thirty three months after surgery. The repeated CT scans, abdominal ultrasonography and tumor specific growth factor every three months revealed no recurring or residual lesion.

Bottom Line: We recently encountered an unusual case of Composite lymphoma (CL) in the anterior mediastinum arising in a 37-year-old woman who presented initially with continuous pain in the right shoulder and chest.Chest computed tomography scan revealed the oval space-occupying lesion of anterior mediastinum.Surgery was performed and the disease was diagnosed pathologically as CL which composed of nodular sclerosing Hodgkin lymphoma and diffuse large B-cell lymphoma, via hematoxylin-eosin (H&E), immunohistochemical staining and in situ hybridization.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology, Affiliated Yantai Yuhuangding Hospital, Medical College of Qingdao University, No,20, Yuhuangding East Road, Yantai, 264000, China. ygh0535@hotmail.com

ABSTRACT
We recently encountered an unusual case of Composite lymphoma (CL) in the anterior mediastinum arising in a 37-year-old woman who presented initially with continuous pain in the right shoulder and chest. The woman had been suffered from continuous pain for three months before she went to our department of cardiovascular surgery. Chest computed tomography scan revealed the oval space-occupying lesion of anterior mediastinum. Surgery was performed and the disease was diagnosed pathologically as CL which composed of nodular sclerosing Hodgkin lymphoma and diffuse large B-cell lymphoma, via hematoxylin-eosin (H&E), immunohistochemical staining and in situ hybridization.

Show MeSH
Related in: MedlinePlus