Department of Hematology, Gifu Prefectural General Medical Center, Gifu, Japan.
First Department of Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
Int J Hematol. 2019 Jun;109(6):723-730. doi: 10.1007/s12185-019-02591-4. Epub 2019 Mar 11.
Follicular lymphoma (FL) is an indolent lymphoma that often transforms into a high-grade lymphoma, mostly diffuse large B-cell lymphoma. A case of FL suggested to transform into plasmablastic lymphoma is presented. A 59-year-old man was admitted to our hospital because of right lower abdominal pain and vomiting. Computed tomography showed a mass in the ileocecum. Colonoscopy showed a mass with an ulcer in the ascending colon, and surgery was performed. Immunohistochemical staining of the biopsied mass showed infiltrated lymphocytes that were positive for CD38, CD45, CD138, and λ chain, and negative for CD4, CD5, CD8, CD10, CD20, CD56, and κ chain. Flow cytometric analysis of the ascites showed similar results. FISH analyses performed using lymph node biopsy specimens, ascite fluid and pleural effusion fluid identified the presence of an IGH/BCL2 translocation. FL was suggested to transform into PBL. Although the patient received three courses of R-CHOP chemotherapy and salvage chemotherapy, the patient died because of lymphoma progression less than 6 months after the diagnosis of PBL. Transformation of FL to PBL is highly unusual. The lack of a standard treatment for PBL results in the poor outcome of this entity. Novel therapeutic approaches are needed.
滤泡性淋巴瘤（FL）是一种惰性淋巴瘤，常转化为高级别淋巴瘤，主要为弥漫性大 B 细胞淋巴瘤。本文报告 1 例疑似转化为浆母细胞淋巴瘤的 FL 病例。1 名 59 岁男性因右下腹痛和呕吐而入院。计算机断层扫描显示回盲部有肿块。结肠镜检查显示升结肠有一肿块伴溃疡，行手术治疗。活检肿块的免疫组织化学染色显示浸润的淋巴细胞 CD38、CD45、CD138 和 λ 链阳性，CD4、CD5、CD8、CD10、CD20、CD56 和 κ 链阴性。腹水的流式细胞术分析也得到了类似的结果。对淋巴结活检标本、腹水和胸腔积液进行 FISH 分析，发现 IGH/BCL2 易位。提示 FL 转化为 PBL。尽管患者接受了 3 个周期的 R-CHOP 化疗和挽救性化疗，但该患者在诊断为 PBL 不到 6 个月后因淋巴瘤进展而死亡。FL 转化为 PBL 非常罕见。由于缺乏针对 PBL 的标准治疗方法，该疾病的预后较差。需要新的治疗方法。
