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Case Reports
. 2018 Oct 31:2018:1583925.
doi: 10.1155/2018/1583925. eCollection 2018.

Composite Lymphoma Comprising Extranodal NK/T-Cell Lymphoma and Diffuse Large B-Cell Lymphoma

Shin Nagai  1 , Junji Hiraga  1 , Noriyuki Suzuki  1 , Naruko Suzuki  1 , Yusuke Takagi  1 , Michihiko Narita  2 , Yoshitoyo Kagami  1
Affiliations
Case Reports

Composite Lymphoma Comprising Extranodal NK/T-Cell Lymphoma and Diffuse Large B-Cell Lymphoma

Shin Nagai et al. Case Rep Hematol. .

Abstract

We report a rare case of composite lymphoma comprising extranodal NK/T-cell lymphoma, nasal type, (ENKL) and diffuse large B-cell lymphoma (DLBCL) in a 70-year-old man complaining of fatigue. Computed tomography showed multiple consolidations in both lungs, and ENKL was diagnosed from transbronchial lung biopsy. Positron emission tomography also detected abnormal uptake in the stomach, and DLBCL was diagnosed from subsequent gastroscopy. Two courses of chemotherapy including rituximab achieved reduction in DLBCL, but ENKL proved resistant to this treatment and progressed. Concomitant ENKL and DLBCL have not been previously described among reports of composite lymphomas.

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Figures

Figure 1
Figure 1
(a) CT of both lungs detects multifocal nodular lesions with ground-glass shadows. (b) PET detects abnormal uptake in multifocal lung lesions and the gastric body. (c) Before treatment, gastroscopy reveals an ulcerative lesion in the gastric body. (d) After treatment, gastroscopy shows improvement of the gastric lesion.
Figure 2
Figure 2
Pathological examinations of the lung (a–e) and gastric (f–j) lesions. (a, f) 100× magnification; (b, g) 400× magnification; other images 200× magnification. (a, b, f, g) Hematoxylin and eosin staining; (c–e, h–j) immunohistochemical staining. (a, b) Multiple lesions in the lungs show destruction of the pulmonary lobes and replacement with large tumor cells. (c) Tumor cells appear CD3-positive. (d) Tumor cells appear CD20-negative. (e) Tumor cells appear EBER-positive. (f, g) In the gastric lesion, tumor cells have infiltrated the mucosal epithelium. (h) Tumor cells appear CD3-negative. (i) Tumor cells appear CD20-positive. (j) Tumor cells appear EBER-negative.
See this image and copyright information in PMC

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