Composite lymphoma of T-cell rich, histiocyte-rich diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma: a case report

Abstract

Background Composite lymphoma is a rare entity where two or more distinct subtypes of lymphoma coexist within a single organ or tissue. Case presentation We report a new case of a 67-year-old Caucasian male patient, who presented with fatigue, weakness, weight loss, and polyuria. He also had epigastric and left lumbar pain, enlarged spleen, and enlarged left axillary lymph node on examination, with no relevant medical or familial history. A biopsy from the node showed an appearance of T-cell rich, histiocyte-rich diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma. The patient was initially treated with adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine chemotherapy regimen, then switched to rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone regimen. During the therapy, some regression was noticed, especially in the size of the splenic enlargement; however, the patient died 2 months after completing the regimen. Conclusion Composite lymphomas should continue to be studied. Also, treatment is still debatable in type, efficacy, and outcomes.

Plasticity in Classical Hodgkin Composite Lymphomas: A Systematic Review

“…Among the remaining 99 articles, 26 were excluded from the final analysis because they met at least one exclusion criterion: (i) six NLPHL/NHL composite lymphomas without cHL contingent [ 27 , 28 , 29 , 30 , 31 , 32 ]; (ii) two cHL with an Epstein–Barr virus (EBV) post-transplant lymphoproliferative disorder [ 33 ] or EBV mucocutaneous ulcer [ 34 ]; (iii) one with CD30 negative Hodgkin cells [ 35 ]; (iv) four with Hodgkin-like cells within an NHL [ 36 , 37 , 38 , 39 ]; (v) two sequential lymphomas [ 40 , 41 ]; (vi) ten probable transformations of CCL into cHL [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]; and (vii) one because the final diagnosis could be considered ambiguous [ 52 ].…”

Splenic Micronodular T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: The Corticosteroid Pretreatment Hypothesis

“…A recent case report on a patient from Syria [22] even presents a "composite" lymphoma elaborated by THRLBL combined with NLPHL; we should be aware that in rare instances, authors might unnecessarily split a single clinical entity into two separate pathological diagnoses, based on subtle and perhaps insignificant variations. It is of note, that the spleen is involved much less frequently in NLPHL and that, only in advanced stages.…”

Primary Cutaneous B-Cell Lymphoma Co-Existing with Mycosis Fungoides—A Case Report and Overview of the Literature

“…In regard to prognosis, most CL have an aggressive clinical course, and little data is available about treatment options and their outcomes [12]. A recent study reported a recovery rate of 60% when using a protocol including rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone (R-CHOP) [20]. The patient presented here, followed the local curative radiotherapy for PMZBCL located on the antero-lateral part of the lower left leg, and the lesions of MF and the second PMZBCL, were excised within safety limits, without the need for another associated therapy.…”