Yang Xubo, Min Xiaoxue, He Weimin
Department of Ophthalmology Department of Optometry and Visual Science, West China Hospital of Sichuan University, Chengdu, Sichuan, P.R. China.
Medicine (Baltimore). 2018 May;97(21):e10845. doi: 10.1097/MD.0000000000010845.
Diffuse large B-cell lymphoma (DLBCL) and extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT) belong to Non-Hodgkin's lymphoma (NHL). DLBCL rarely involves the orbit. MALT lymphomas, which account for 8.0% of NHLs, rarely involve parotid gland, trachea and bronchus.
We present a rare case of a long-surviving patient (≥10 years) with sequential development of multifocal recurrent non-Hodgkin's lymphoma of mucosa-associated lymphoid tissue (MALT) and diffuse large B-Cell lymphoma (DLBCL). In August 2007, a 41-year-old man developed MALT lymphoma in the parotid gland and local irradiation was administered. In July 2008, he exhibited systemic multifocal lymphadenopathy and was diagnosed with DLBCL. He received standard combination chemotherapy and autologous hematopoietic stem cell transplantation. He was well until February 2013 when he developed MALT lymphoma of the bronchus. Subsequently, he received standard combination chemotherapy. In November 2013, the patient had a relapse of the MALT lymphoma by tracheal biopsy and received local radiation. He was well until March 2015 when he developed a MALT lymphoma of the left thigh. He underwent surgery, local irradiation and rituximab monotherapy. In September 2015, surgical resection of the left orbital masses was performed, and the biopsy revealed the presence of DLBCL. One month later, lymphadenopathy was palpated in the neck, the lower left region of the umbilicus, and the left calf. Then he received chemotherapy with rituximab and lenalidomide. In March 2016, the patient underwent surgical resection for a right popliteal mass, and the resection biopsy revealed DLBCL. To date, the patient is still alive.
The patient was diagnosed as multifocal recurrent MALT and DLBCL.
Repeated positron emission tomography-computed tomography (CT) and biopsy were performed.
CT and biopsy revealed sequential development of multifocal recurrent NHLs of MALT lymphoma and DLBCL. The correlation between MALT and DLBCL may represent a Richter transformation. Standard treatments, such as combination chemotherapy, autologous hematopoietic stem cell transplantation, and irradiation, may be driving factors for phenotypic changes in neoplastic cells.
Physicians should pay particular attention to the long-term development of other types of NHL after achieving complete remission of one type of NHL.
弥漫性大B细胞淋巴瘤（DLBCL）和黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALT）均属于非霍奇金淋巴瘤（NHL）。DLBCL很少累及眼眶。MALT淋巴瘤占NHL的8.0%，很少累及腮腺、气管和支气管。
我们报告了1例生存期较长（≥10年）的罕见病例，该患者先后发生多灶性复发性黏膜相关淋巴组织边缘区B细胞淋巴瘤（MALT）和弥漫性大B细胞淋巴瘤（DLBCL）。2007年8月，1名41岁男性在腮腺发生MALT淋巴瘤，并接受了局部放疗。2008年7月，他出现全身多灶性淋巴结病，被诊断为DLBCL。他接受了标准联合化疗和自体造血干细胞移植。在2013年2月发生支气管MALT淋巴瘤之前，他情况良好。随后，他接受了标准联合化疗。2013年11月，患者经气管活检发现MALT淋巴瘤复发，并接受了局部放疗。在2015年3月发生左大腿MALT淋巴瘤之前，他情况良好。他接受了手术、局部放疗和利妥昔单抗单药治疗。2015年9月，对左侧眼眶肿物进行了手术切除，活检显示存在DLBCL。1个月后，在颈部、脐下左侧区域和左小腿触及淋巴结肿大。然后他接受了利妥昔单抗和来那度胺化疗。2016年3月，患者对右侧腘窝肿物进行了手术切除，切除活检显示为DLBCL。迄今为止，该患者仍然存活。
该患者被诊断为多灶性复发性MALT和DLBCL。
进行了多次正电子发射断层扫描-计算机断层扫描（CT）和活检。
CT和活检显示MALT淋巴瘤和DLBCL的多灶性复发性NHL先后发生。MALT与DLBCL之间的关联可能代表里氏转化。联合化疗、自体造血干细胞移植和放疗等标准治疗可能是肿瘤细胞表型改变的驱动因素。
在一种类型的NHL完全缓解后，医生应特别关注其他类型NHL的长期发展情况。
