Matsuo Toshihiko, Ichimura Kouichi, Shinagawa Katsuji
Departments of Ophthalmology, Okayama University Medical School and Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama City, Japan.
J Clin Exp Hematop. 2012;52(1):41-9. doi: 10.3960/jslrt.52.41.
In February 2002, a 42-year-old woman developed ocular adnexal extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), MALT lymphoma, in the bilateral orbits involving lacrimal glands. She underwent 30 Gy external beam irradiation to the orbital lesions on both sides. She was well until November 2008 when she developed abdominal lymphadenopathy and transabdominal excisional biopsy showed mixed cellularity classical Hodgkin lymphoma at stage II. She underwent standard combination chemotherapy. In July 2010, she developed systemic lymphadenopathy and was diagnosed with diffuse large B-cell lymphoma (DLBCL) by cervical lymph node biopsy. She underwent rituximab monotherapy and finally allogeneic hematopoietic stem cell transplantation in October 2010, but died of renal failure in February 2011. Amplification by polymerase chain reaction of the immunoglobulin heavy chain gene gave rise to dominant discrete fragments of the same size between the orbital lesion with MALT lymphoma in 2002 and the cervical lymph node lesion with DLBCL in 2010. The sequential development of MALT lymphoma, Hodgkin lymphoma, and DLBCL in the long-term course of this patient suggests the common origin of the neoplastic cells, changing their pathological faces in response to irradiation and combination chemotherapy.
2002年2月，一名42岁女性患上了黏膜相关淋巴组织（MALT）的眼附属器结外边缘区B细胞淋巴瘤，即MALT淋巴瘤，双侧眼眶受累，累及泪腺。她接受了30 Gy的双侧眼眶病变外照射。直到2008年11月她情况良好，之后出现腹部淋巴结病，经腹切除活检显示为II期混合细胞型经典霍奇金淋巴瘤。她接受了标准的联合化疗。2010年7月，她出现全身淋巴结病，经颈部淋巴结活检诊断为弥漫性大B细胞淋巴瘤（DLBCL）。她接受了利妥昔单抗单药治疗，最终于2010年10月进行了异基因造血干细胞移植，但于2011年2月死于肾衰竭。通过聚合酶链反应对免疫球蛋白重链基因进行扩增，在2002年患有MALT淋巴瘤的眼眶病变与2010年患有DLBCL的颈部淋巴结病变之间产生了大小相同的显性离散片段。该患者长期病程中依次出现MALT淋巴瘤、霍奇金淋巴瘤和DLBCL，提示肿瘤细胞起源相同，在放疗和联合化疗作用下其病理表现发生改变。
