Collision Anaplastic Large Cell Lymphoma (T-Cell/Histiocyte-Rich) and Diffuse Large B Cell Lymphoma: A Pathologic and Clinical Evaluation

Lakshmi Rajappannair,Steven Devine,Don Benson,Elaine Lam,Frederick Racke,Weiqiang Zhao

doi:10.4236/jct.2012.36138

Lakshmi Rajappannair, Steven Devine + Show 4 more

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https://doi.org/10.4236/jct.2012.36138

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Abstract

A collision tumor of T and B-cell lymphomas occur rarely. In this article we report a collision tumor of anaplastic large cell lymphoma and diffuse large B cell lymphoma in a 46 year old female. The tumor showed predominantly neoplastic anaplastic large cell lymphoma (ALCL) component expressing CD30 and ALK with smaller areas of CD20+ diffuse large B cell lymphoma component. Polymerase chain reaction for T-cell receptor beta and IgH (VDJ) gene rearrangements detected a clonal T cell and a clonal B cell population. The patient developed CSF involvement approximately 3 months after treatment. CSF analysis at this time showed only monoclonal T cells, probably due to clearing of the B cell component by the chemotherapy. To the best of our knowledge this is the first case report of a composite tumor of ALCL (lymphohistiocytic variant) and DLBCL. This case raises issues related to the classification of these composite lymphomas and the treatment on initial presentation and during relapse.

Highlights

Collision tumors are rare disease entities in which two histologically distinct tumor types occur simultaneously at the same anatomic site
In this article we report a collision tumor of anaplastic large cell lymphoma and diffuse large B cell lymphoma in a 46 years old female
A composite lymphoma composed of anaplastic large cell lymphoma (ALCL) and Anaplastic lymphoma kinase (ALK)-negative diffuse large B-cell lymphoma (DLBCL) has not been described in literature

Summary

Introduction

Collision tumors are rare disease entities in which two histologically distinct tumor types occur simultaneously at the same anatomic site. Collision tumors have been described between chronic lymphocytic leukemia (CLL) and invasive ductal carcinoma of the breast [1], T-cell lymphoma and squamous cell carcinoma of the lung [2], Hodgkin’s disease and metastatic breast or cervical cancer [3,4], Non-Hodgkin lymphoma and Kaposi sarcoma [5], mucosa-associated lymphoid tissue (MALT) lymphoma with gastric adenocarcinoma [6,7,8] or breast invasive ductal carcinoma [9], among other combinations Collision lymphomas, especially those between T and B-cell lymphomas occur rarely. A composite ALCL and Hodgkin lymphoma developed in the set-

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