Clinicopathological analysis of composite lymphoma: A two-case report and literature review

Abstract

Objective: The objective of this study was to evaluate the clinicopathological features and treatment of composite lymphoma (CL) with cervical lymph node enlargement.

Methods: In this study, two cases of CL are presented. Biopsies of enlarged cervical lymph nodes by excision revealed two distinct types of lymphomas. The diagnoses were confirmed by routine histopathology, immunohistochemistry, in situ hybridization, polymerase chain reactions and flow cytometry. Case 1 was diagnosed with Hodgkin's lymphoma and cytotoxic T-cell lymphoma complicated by Epstein-Barr virus infection. Case 2 was diagnosed with diffuse large B-cell lymphoma and angioimmunoblastic T-cell lymphoma.

Results: Case 1 received one cycle of adriamycin, bleomycin, vincristine and dacarbazine (ABVD regimen) combined with chidamide, followed by one cycle of gemcitabine and dexamethasone (GDP regimen) combined with chidamide, and then oral acyclovir. The patient achieved stable disease, but was lost to follow-up. Case 2 received eight cycles of cyclophosphamide, pirarubicin, vincristine and dexamethasone (CTOP regimen) combined with chidamide, and the patient achieved complete remission. Nine months later, relapse was confirmed. She received chidamide monotherapy for 3 months, which was then terminated. One year later, the patient underwent progressive disease and died.

Conclusions: CL is a kind of rare disease. Due to the complexity of CL, clinicians should consider both disease components in order to increase the likelihood of effective treatment. This is important.

Figure 1

Histopathological findings of the lymph node biopsy performed on case 1 showing (a) R–S cells and scattered small T-lymphoid cells (hematoxylin and eosin, 200×), (b) EBER staining by in situ hybridization (100×), (c) R–S cells and T-lymphoid cells (40%) showing positive Ki-67 immunoreactivity (100×), (d) R–S cells showing weak CD15 immunoreactivity (100×), (e) R–S cells showing weak CD30 immunoreactivity (100×), (f) R–S cells showing positive MUM-1 immunoreactivity (100×), (g) T-lymphoid cells showing positive CD2 immunoreactivity (100×), (h) T-lymphoid cells showing positive CD3 immunoreactivity (100×), (i) T-lymphoid cells showing positive CD5 immunoreactivity (100×), (j) T-lymphoid cells showing weak CD7 immunoreactivity (40×), (k) T-lymphoid cells showing weak CD7 immunoreactivity (100×) and (l) T-lymphoid cells showing positive CD8 > CD4 immunoreactivity (40×).

Figure 2

FCM results showing positive CD2, CD3, CD4, CD5, CD7 and CD8 immunoreactivity in BM cells of case 1.

Figure 3

Histopathological findings of the BMB performed on case 2 showing moderate infiltration of cells between trabeculae (hematoxylin and eosin, 100×).