Metachronous mixed cellularity classical Hodgkin's lymphoma and T-cell leukemia/lymphoma: A case report

Abstract

Background: The development of peripheral T-cell lymphoma (PTCL) after chemotherapy for Hodgkin's lymphoma (HL) is rare, and highly aggressive TCL/leukemia has not been reported to date. The relationship between HL and PTCL needs further exploration to understand the pathogenesis of metachronous lymphoma (ML) and find effective treatment options. We report a patient with ML, whose biopsy of a right cervical lymph node initially confirmed classical HL (CHL).

Case summary: We report a patient with ML, whose biopsy of a right cervical lymph node initially confirmed CHL, with typical reed-sternberg cells expressing CD30 and PAX-5. T-cell leukemia/lymphoma occurred 3 years after treatment, and a lymph node biopsy at the onset confirmed PTCL, nonspecific type, expressing CD3, CD4 and CD8. The patient was treated with standard doses of chemotherapy, programmed cell death-ligand 1 monoclonal antibody, and chidamide, all of which failed to achieve complete remission. The patient was diagnosed with refractory state, and eventually died of leukocyte stasis.

Conclusion: The accuracy of the diagnosis needs to be confirmed when chemotherapeutic drugs are not effective.

Keywords: Bone marrow; Case report; Chemotherapy; Classical Hodgkin’s lymphoma; Drug resistance; T-cell lymphoma/leukemia.

Figure 1

Pathological findings of Hodgkin’s lymphoma and the peripheral T-cell lymphoma. A-D: Pathological findings of Hodgkin’s lymphoma; the lymph node structure was disrupted, and a large number of small lymphocytes and popcorn-like cells were observed, with abundant blood vessels (HE, × 200) (A), positive expression of CD30 (B) and PAX-5 (C) in reed-sternberg (RS) cells, EBER⁺ expression in RS cells (D); E-H: Pathological findings of the peripheral T-cell lymphoma; the lymph node structure was disrupted, and diffuse consistent T-cells were observed, with abundant blood vessels (HE, × 200) (E), CD3⁺ T-cells (F), CD4⁺ (G) and CD8⁺ T-cells (few) (H).

Figure 2

Morphological and biopsy results of peripheral T-cell lymphoma bone marrow. A: Atypical lymphocytes, with irregular, spindle-shaped, small to medium morphology, visible pseudopods and cytoplasmic granules, and no reed-sternberg cells observed (× 100); B: The lymphoma cells were diffusely proliferating, with small cytosol, low cytoplasmic volume, irregular nuclei, and coarse chromatin (HE/periodic acid-schiff, × 40 and × 400).

Figure 3

Immunophenotyping of T/natural killer lymphoma through 8-color flow cytometry. Abnormal T lymphocytes accounted for 57.8% of the nucleated cells and expressed CD3⁺, CD2⁺, CD5⁺, TCRαβ, and CD45RO.

Figure 4

Identification of the T-cell receptor clone gene rearrangement by applying BIOMED-2 primer system. A: TCRβ gene rearrangement were detected; B: TCRγ gene rearrangement were detected.

Figure 5

The possible mechanisms of metachronous B-cell lymphoma and T-cell lymphoma. EBV: Epstein-Barr virus.