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Case Reports
. 2018 Apr 15;57(8):1135-1139.
doi: 10.2169/internalmedicine.9280-17. Epub 2017 Dec 21.

Lymph Node Collision Tumor Consisting of Metastatic Pulmonary Adenocarcinoma and Diffuse Large B-cell Lymphoma

Shinnosuke Ikemura  1 , Mitsuru Moriyama  1 , Kimihiro Matsumoto  2 , Shingo Nakayama  1 , Tatsu Matsuzaki  1 , Takahiro Nakajima  1 , Aya Sasaki  3 , Jun Miyauchi  3 , Takeshi Terashima  1
Affiliations
Case Reports

Lymph Node Collision Tumor Consisting of Metastatic Pulmonary Adenocarcinoma and Diffuse Large B-cell Lymphoma

Shinnosuke Ikemura et al. Intern Med. .

Abstract

A 67-year-old man presented with a fever and general malaise. Computed tomography showed multiple nodules in the lungs and liver, associated with mediastinal and para-aortic lymphadenopathy. Bone marrow aspiration revealed diffuse large B-cell lymphoma (DLBCL). Renal and liver dysfunction and pancytopenia inhibited chemotherapy administration; the patient subsequently died of multiorgan failure. An autopsy revealed pulmonary adenocarcinoma with metastases to the lungs, liver, and adrenal glands; the DLBCL spread to the liver, spleen, and bone marrow. Adenocarcinoma and DLBCL collision was observed in the mediastinal and para-aortic lymph nodes. This was a rare case of collision metastasis occurring in the lymph node.

Keywords: adenocarcinoma; collision tumor; diffuse large B-cell lymphoma; lung cancer; malignant lymphoma.

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Figures

Figure 1.
Figure 1.
A computed tomography image showing a nodule in the right lower lobe, miniscule nodules in the left lower lobe (a), right hilar and mediastinal lymphadenopathy (arrow) (b), and para-aortic lymphadenopathy (arrow) (c).
Figure 2.
Figure 2.
Histopathological findings of bone marrow aspiration. (a) Hematoxylin and Eosin staining, (b) CD20 staining. Bone marrow aspiration showed moderate-to-large atypical lymphocytes. Atypical lymphocytes showed positive staining for CD20, suggesting B-cell origin (b).
Figure 3.
Figure 3.
Histopathological findings of the autopsy specimens from para-aortic lymph node. (a) Hematoxylin and Eosin staining, (b) CD20 staining, and (c) Epstein-Barr virus (EBV) encoding region in situ hybridization (EBER ISH). Extensive large lymphocytes with an atypical nucleolus were seen, and immunohistochemistry of the lymphocytes revealed strong and diffuse positivity for B-cell markers (CD20). EBER ISH was positive in the atypical lymphocytes.
Figure 4.
Figure 4.
A bone marrow specimen obtained by an autopsy (Hematoxylin and Eosin staining) showed large atypical lymphocytes and histiocytes with phagocytosis (arrows).
Figure 5.
Figure 5.
Histopathological findings of the collision tumor in the mediastinal lymph node. (a) Hematoxylin and Eosin staining, (b) CD20 staining, (c) cytokeratin 7 staining, and (d) cancer antigen (CA) 19-9 staining. In all panels, the diffuse large B-cell lymphoma metastasis is visible in the middle of the image. CD20 positivity can be observed, indicating B-cell origin. In the upper right and bottom left of the image can be seen a dysplastic cell with a large nucleus that is cytokeratin 7- and CA19-9-positive, indicating adenocarcinoma.
See this image and copyright information in PMC

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