Four Lymphomas in 1 Patient: A Unique Case of Triple Composite Non-Hodgkin Lymphoma Followed by Classical Hodgkin Lymphoma

Abstract

Composite lymphomas consist of 2 or more distinct lymphomas occurring in a single anatomical site or simultaneously in different sites and can be composed of any combination of B-cell non-Hodgkin lymphoma (NHL), T-cell NHL, or Hodgkin lymphoma (HL). Cases of composite lymphomas with more than 2 lymphomas are extremely rare, with only 4 reports in the literature. We report the case of a 49-year-old man with a triple composite lymphoma in a single lymph node, consisting of small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma in situ. The patient received multiple courses of chemotherapy and an autologous stem cell transplant, which resulted in complete remission. Then, 6 years after the stem cell transplant, he developed classical HL. This unique case is, to our knowledge, the first report of a patient with triple composite lymphoma consisting of 3 small mature B-cell NHLs, who subsequently developed a fourth lymphoma.

Composite Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia and Follicular Lymphoma: A Clinicopathological Study of Six Cases

“…Composite SLL/CLL and FL is extremely rare and only 13 cases have been reported in the literature (Table 4). [7][8][9][10][11][12][13][14][15][16] The patients in this group had a median age of 72 years (range = 49-88 years) with a slight male predominance (7 to 6). Lymphadenopathy was the most common presentation, and all the cases had nodal involvement.…”

“…Their clinical course and pathogenesis remain relatively unknown due to a low incidence. [7][8][9][10][11][12][13][14][15][16] In this article, we report 6 composite SLL/CLL and FL cases and studied their clinical, histologic, immunophenotypic, and cytogenetic features. A literature review of the existing cases was also conducted.…”

Classical Hodgkin lymphoma following follicular lymphoma: a case report

“…Notably, FLs do not occur in East Asia as often as they do in Western countries [ 3 ]. We have compiled 35 cases of classical HLs preceded by FLs by reviewing several original articles [ 4 - 17 ] ( Table 1 ). Moreover, nine cases in China and Japan have been reported since 1996.…”

Concurrent Composite Lymphomas Collectively Bearing Three Diagnostic Entities of Shared Clonal Origin

“…The latter 2 entities were derived from a common GCB precursor. Four cases of triple CL in a single lymph node have been reported, with each showing variable histologies 12–15 . Only one of these successfully demonstrated a clonal relationship among its components 12 …”

“…Four cases of triple CL in a single lymph node have been reported, with each showing variable histologies. [12][13][14][15] Only one of these successfully demonstrated a clonal relationship among its components. 12 A fundamental question in CL/DL is whether the tumor components are clonally related, arising from a common ancestor, or instead, are de novo independent events.…”