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Peripheral T Cell Non-Hodgkin's Lymphoma following Treatment of Hodgkin's Lymphoma.

Chang SH, Lee HR - Case Rep Oncol Med (2015)

Bottom Line: Previous reports have suggested that non-Hodgkin's lymphoma (NHL) is more likely to develop in patients with Hodgkin lymphoma (HL) compared to the general population.Although it is rare, synchronous or metachronous HL and NHL may occur.Therefore, we may need to ensure pathological confirmation, especially in case of lymphoma that did not respond to chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Inje University Ilsan Paik Hospital, 170 Joohwa-ro, Ilsanseo-gu, Goyang 411-706, Republic of Korea.

ABSTRACT
Previous reports have suggested that non-Hodgkin's lymphoma (NHL) is more likely to develop in patients with Hodgkin lymphoma (HL) compared to the general population. These two can occur synchronously or metachronously. We report here on a case of nodular sclerosis classical HL and T cell NHL that occurred in a patient metachronously. Peripheral T cell lymphoma (PTCL) of the patient was found about 2 years after treatment of classical HL. When the patient was diagnosed with HL, biopsy revealed typical RS cells, presenting positive for CD30 and CD15 and negative for CD79a and CD3 in immunohistochemistry. And PCR analysis showed IgH gene rearrangement; however, T cell receptor gene rearrangement and Epstein-Barr virus (EBV) were not detected on PCR analysis. After 2 years of treatment of HL, colonoscopic biopsy and lymph node biopsy showed CD3 positive atypical cells intermixed with small reactive lymphoid cells and plasma cells, indicating T cell lymphoma. PCR analysis demonstrated T cell receptor gene rearrangement and did not detect EBV. Although it is rare, synchronous or metachronous HL and NHL may occur. Therefore, we may need to ensure pathological confirmation, especially in case of lymphoma that did not respond to chemotherapy.

No MeSH data available.


Related in: MedlinePlus

A chest CT (a) and an AP CT (b) show increased sizes of lymph nodes on mediastinum and retroperitoneal space after 12 months of follow-up loss.
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Related In: Results  -  Collection


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fig4: A chest CT (a) and an AP CT (b) show increased sizes of lymph nodes on mediastinum and retroperitoneal space after 12 months of follow-up loss.

Mentions: A 64-year-old female patient came to the hospital complaining of abrupt weight loss of 10 kg in 2 months. She became 40 kg from 50 kg. She also complained of abdominal pain and bloating that has been annoying her for several months. She has been taking medicines for hypertension and diabetes. Multiple lymph nodes were palpable on right and left supraclavicular areas, right cervical area, and both inguinal areas. The largest one was measured 2.5 cm × 1.5 cm on left supraclavicular area. She had no history of fever and sweating. A neck computed tomography (CT) was performed and showed multiple lymphadenopathies on both supraclavicular and right jugular chains. A chest CT also showed multiple enlarged lymph nodes in mediastinum with small amount of pericardial effusion. An abdominal pelvis CT (AP CT) revealed enhanced multiple enlarged lymph nodes in abdominal retroperitoneal space (Figure 1). Excisional biopsy was performed on left supraclavicular lymph node and revealed Hodgkin's lymphoma (HL), nodular sclerosis type (NS) (Figure 2(a)). The biopsy revealed typical Reed-Sternberg (RS) cells and their variants (usually mononuclear cells and occasional lacunar cells) (Figure 2(b)). RS cells were immunohistochemically positive for CD30 (Figure 2(c)) and CD15 and negative for CD79a and CD3. Surrounding T cells were normal morphologically. PCR analysis showed IgH gene rearrangement. T cell receptor gene rearrangement was not detected. Epstein-Barr virus (EBV) was not detected on PCR analysis. Bone marrow examination showed no involvement of lymphoma. The echocardiography was performed to reevaluate pericardial effusion. It revealed that the ejection fraction was 60% and pericardial effusion was too small to be drained. Therefore, she was diagnosed with classical HL of nodular sclerosis type, stage IIIB, or possibly stage IV/BE due to pericardial involvement. According to International Prognostic Score (IPS) for risk stratification, she had 1 point by age of 64 years. Chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) was administered. After 3 cycles of chemotherapy, a follow-up chest CT and an APCT were taken and showed partial response by RECIST criteria (Figure 3). However further chemotherapy was not given because she was intolerable to chemotherapy due to gastrointestinal (GI) symptoms including diarrhea and abdominal bloating. In order to find out the causes of GI symptoms, colonoscopy was performed and colonoscopic biopsy showed chronic nonspecific colitis with focal erosion on rectosigmoid colon. After 12 months of follow-up loss, CT showed slightly increased sizes of lymph nodes on neck, mediastinum, and retroperitoneal space (Figure 4). She was retreated again with 3 cycles of chemotherapy of ABVD regimen. Following APCT showed that size and numbers of multiple enlarged lymph nodes in retroperitoneal space and mesentery were decreased but persistently remained. It also showed diffuse edematous thickening of sigmoid colonic wall and rectal wall. Colonoscopic biopsy was reperformed and revealed malignant lymphoma of T cell phenotype with active ulcer along with necrosis on rectum and sigmoid colon, which was consistent with peripheral T cell lymphoma (TCL) involving rectum and sigmoid colon. In order to confirm peripheral TCL, enlarged right inguinal lymph node was excised for biopsy. Biopsy specimen of inguinal lymph node revealed effacement of nodal architecture by an atypical lymphoid infiltrate. The infiltrates consisted of medium to large sized lymphoid cells. The atypical cells showed hyperchromatic nuclei and discernible cytoplasm (Figure 2(d)). Some atypical cells had open chromatin and nuclear convolution, but nuclear pleomorphism was not evident. These atypical cells were intermixed with small reactive lymphoid cells and plasma cells. The atypical cells were positive for CD3, indicating T cell lymphoma. PCR analysis demonstrated T cell receptor gene rearrangement. EBV was not detected on PCR analysis. She received 3 cycles of chemotherapy with etoposide containing regimen. PTCL was regressed partially after 3 cycles of chemotherapy, but she refused to receive more chemotherapy. She died of disease progression 6 months later.


Peripheral T Cell Non-Hodgkin's Lymphoma following Treatment of Hodgkin's Lymphoma.

Chang SH, Lee HR - Case Rep Oncol Med (2015)

A chest CT (a) and an AP CT (b) show increased sizes of lymph nodes on mediastinum and retroperitoneal space after 12 months of follow-up loss.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4309292&req=5

fig4: A chest CT (a) and an AP CT (b) show increased sizes of lymph nodes on mediastinum and retroperitoneal space after 12 months of follow-up loss.
Mentions: A 64-year-old female patient came to the hospital complaining of abrupt weight loss of 10 kg in 2 months. She became 40 kg from 50 kg. She also complained of abdominal pain and bloating that has been annoying her for several months. She has been taking medicines for hypertension and diabetes. Multiple lymph nodes were palpable on right and left supraclavicular areas, right cervical area, and both inguinal areas. The largest one was measured 2.5 cm × 1.5 cm on left supraclavicular area. She had no history of fever and sweating. A neck computed tomography (CT) was performed and showed multiple lymphadenopathies on both supraclavicular and right jugular chains. A chest CT also showed multiple enlarged lymph nodes in mediastinum with small amount of pericardial effusion. An abdominal pelvis CT (AP CT) revealed enhanced multiple enlarged lymph nodes in abdominal retroperitoneal space (Figure 1). Excisional biopsy was performed on left supraclavicular lymph node and revealed Hodgkin's lymphoma (HL), nodular sclerosis type (NS) (Figure 2(a)). The biopsy revealed typical Reed-Sternberg (RS) cells and their variants (usually mononuclear cells and occasional lacunar cells) (Figure 2(b)). RS cells were immunohistochemically positive for CD30 (Figure 2(c)) and CD15 and negative for CD79a and CD3. Surrounding T cells were normal morphologically. PCR analysis showed IgH gene rearrangement. T cell receptor gene rearrangement was not detected. Epstein-Barr virus (EBV) was not detected on PCR analysis. Bone marrow examination showed no involvement of lymphoma. The echocardiography was performed to reevaluate pericardial effusion. It revealed that the ejection fraction was 60% and pericardial effusion was too small to be drained. Therefore, she was diagnosed with classical HL of nodular sclerosis type, stage IIIB, or possibly stage IV/BE due to pericardial involvement. According to International Prognostic Score (IPS) for risk stratification, she had 1 point by age of 64 years. Chemotherapy with doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD regimen) was administered. After 3 cycles of chemotherapy, a follow-up chest CT and an APCT were taken and showed partial response by RECIST criteria (Figure 3). However further chemotherapy was not given because she was intolerable to chemotherapy due to gastrointestinal (GI) symptoms including diarrhea and abdominal bloating. In order to find out the causes of GI symptoms, colonoscopy was performed and colonoscopic biopsy showed chronic nonspecific colitis with focal erosion on rectosigmoid colon. After 12 months of follow-up loss, CT showed slightly increased sizes of lymph nodes on neck, mediastinum, and retroperitoneal space (Figure 4). She was retreated again with 3 cycles of chemotherapy of ABVD regimen. Following APCT showed that size and numbers of multiple enlarged lymph nodes in retroperitoneal space and mesentery were decreased but persistently remained. It also showed diffuse edematous thickening of sigmoid colonic wall and rectal wall. Colonoscopic biopsy was reperformed and revealed malignant lymphoma of T cell phenotype with active ulcer along with necrosis on rectum and sigmoid colon, which was consistent with peripheral T cell lymphoma (TCL) involving rectum and sigmoid colon. In order to confirm peripheral TCL, enlarged right inguinal lymph node was excised for biopsy. Biopsy specimen of inguinal lymph node revealed effacement of nodal architecture by an atypical lymphoid infiltrate. The infiltrates consisted of medium to large sized lymphoid cells. The atypical cells showed hyperchromatic nuclei and discernible cytoplasm (Figure 2(d)). Some atypical cells had open chromatin and nuclear convolution, but nuclear pleomorphism was not evident. These atypical cells were intermixed with small reactive lymphoid cells and plasma cells. The atypical cells were positive for CD3, indicating T cell lymphoma. PCR analysis demonstrated T cell receptor gene rearrangement. EBV was not detected on PCR analysis. She received 3 cycles of chemotherapy with etoposide containing regimen. PTCL was regressed partially after 3 cycles of chemotherapy, but she refused to receive more chemotherapy. She died of disease progression 6 months later.

Bottom Line: Previous reports have suggested that non-Hodgkin's lymphoma (NHL) is more likely to develop in patients with Hodgkin lymphoma (HL) compared to the general population.Although it is rare, synchronous or metachronous HL and NHL may occur.Therefore, we may need to ensure pathological confirmation, especially in case of lymphoma that did not respond to chemotherapy.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Inje University Ilsan Paik Hospital, 170 Joohwa-ro, Ilsanseo-gu, Goyang 411-706, Republic of Korea.

ABSTRACT
Previous reports have suggested that non-Hodgkin's lymphoma (NHL) is more likely to develop in patients with Hodgkin lymphoma (HL) compared to the general population. These two can occur synchronously or metachronously. We report here on a case of nodular sclerosis classical HL and T cell NHL that occurred in a patient metachronously. Peripheral T cell lymphoma (PTCL) of the patient was found about 2 years after treatment of classical HL. When the patient was diagnosed with HL, biopsy revealed typical RS cells, presenting positive for CD30 and CD15 and negative for CD79a and CD3 in immunohistochemistry. And PCR analysis showed IgH gene rearrangement; however, T cell receptor gene rearrangement and Epstein-Barr virus (EBV) were not detected on PCR analysis. After 2 years of treatment of HL, colonoscopic biopsy and lymph node biopsy showed CD3 positive atypical cells intermixed with small reactive lymphoid cells and plasma cells, indicating T cell lymphoma. PCR analysis demonstrated T cell receptor gene rearrangement and did not detect EBV. Although it is rare, synchronous or metachronous HL and NHL may occur. Therefore, we may need to ensure pathological confirmation, especially in case of lymphoma that did not respond to chemotherapy.

No MeSH data available.


Related in: MedlinePlus