*Massachusetts General Hospital †Brigham and Women's Hospital, Boston, MA.
Am J Surg Pathol. 2014 Feb;38(2):279-88. doi: 10.1097/PAS.0000000000000140.
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is relatively common, and patients occasionally develop other neoplasms; however, patients who develop other types of lymphomas are rare. We encountered 3 patients with CLL/SLL (one 59-y-old man and 2 women aged 56 and 66 y) who developed T-cell lymphomas. Both women developed ALK anaplastic large cell lymphomas (ALCLs), whereas the man developed CD8 peripheral T-cell lymphoma, not otherwise specified. All 3 T-cell lymphomas expressed granzyme B and perforin, indicating a cytotoxic immunophenotype. In 1 case, the first presentation was a lymph nodal composite lymphoma. In the other 2 cases, the T-cell lymphomas arose <1 year after the diagnosis of CLL/SLL and were identified in a lymph node in one case and in the spleen in the other. The patient with a composite lymphoma (SLL/ALK ALCL) was treated and was free of disease at last follow-up, whereas the other 2 patients succumbed to their disease, 1 month and 7 months after the diagnosis of T-cell lymphoma. Peripheral T-cell lymphomas rarely occur in CLL/SLL patients. On the basis of our small series, those with a cytotoxic phenotype appear to be more common in this setting. The occurrence of ALK ALCL in 2 older patients was especially surprising and suggested that CLL/SLL may have played a role in the development of ALCL.
慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）较为常见，患者偶尔会发生其他肿瘤；然而，发生其他类型淋巴瘤的患者则较为少见。我们遇到了 3 例 CLL/SLL（1 例 59 岁男性和 2 例 56 岁和 66 岁女性）患者发展为 T 细胞淋巴瘤。这 2 例女性均发生了间变性大细胞淋巴瘤（ALCL），而男性则发生了 CD8 外周 T 细胞淋巴瘤，非特指型。所有 3 例 T 细胞淋巴瘤均表达颗粒酶 B 和穿孔素，表明为细胞毒性免疫表型。在 1 例中，首次表现为淋巴结复合性淋巴瘤。在另外 2 例中，T 细胞淋巴瘤在 CLL/SLL 诊断后 <1 年内发生，分别在 1 例患者的淋巴结中和另 1 例患者的脾脏中被发现。发生复合性淋巴瘤（SLL/ALK ALCL）的患者接受了治疗，在最后一次随访时无疾病，而另外 2 例患者在诊断 T 细胞淋巴瘤后 1 个月和 7 个月时死亡。外周 T 细胞淋巴瘤在 CLL/SLL 患者中罕见发生。基于我们的小系列研究，在这种情况下，具有细胞毒性表型的 T 细胞淋巴瘤似乎更为常见。2 例老年患者发生 ALK ALCL 尤其令人惊讶，提示 CLL/SLL 可能在 ALCL 的发生中起作用。
