The development of peripheral T-cell lymphoma after successful treatment for diffuse large B-cell lymphoma in a patient with suspected adult onset immunodeficiency: more questions than answers?

Abstract

We present the case of a 60-year-old woman who developed peripheral T-cell lymphoma following successful treatment for high-grade B-cell non-Hodgkin's lymphoma. We consider the possible aetiology of this unusual occurrence. We hypothesise that this case represents one of the undiagnosed adult-onset immunodeficiency, in which the pathogenesis of the patient's T-cell lymphoma may have been in part iatrogenic, namely related to previous immunotherapy with rituximab. We feel this case highlights the importance of rebiopsy in patients with recurrent lymphadenopathy and a history of haematological malignancy and hence acts as an important aide memoir in the investigation of such cases.

Figure 1

(A) 2001—a primary follicle (upper left), a rim epithelioid histiocytes (lower right) and an individual large-cell latent membrane protein (LMP1+; inset, ×600). (B) 2008—Epstein-Barr virus+ diffuse large B-cell lymphoma composed of sheets of large cells CD20+ (right inset, ×400) and LMP1+ (left inset, ×400). (C) 2011—peripheral T-cell lymphoma, not otherwise specified, composed of CD3+ (inset ×400) medium to large cells with high mitotic activity interspersed between numerous epithelioid histiocytes. All sections H&E, magnification ×400.