Sakakibara Ayako, Kohno Kei, Iwakoshi Akari, Moritani Suzuko, Fujishiro Aya, Kito Katsuyuki, Suzuki Yuka, Shimada Satoko, Nakaguro Masato, Shimoyama Yoshie, Takahara Taishi, Takahashi Emiko, Ohashi Akiko, Satou Akira, Kato Seiichi, Asano Naoko, Nakamura Shigeo
Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan.
Department of Pathology, National Hospital Organization Nagoya Medical Center, Aichi, Japan.
Pathol Int. 2020 Feb;70(2):116-122. doi: 10.1111/pin.12891. Epub 2020 Jan 2.
Composite lymphoma is a well-known diagnostic entity exhibiting the synchronous occurrence of two or more distinct types of lymphomas in the same specimen. Here we report two patients, a 14-year-old female (Case 1) and a 45-year-old male (Case 2), with mediastinal composite lymphoma, comprising nodular sclerosis classic Hodgkin lymphoma (NSCHL) and primary mediastinal large B-cell lymphoma (PMBL). Both patients had a mediastinal mass, and manifested two different histologic components in the same biopsy, one characteristic of NSCHL and the other PMBL. The NSCHL areas included Hodgkin and Reed-Sternberg (HRS) cells with typical immunophenotypic features (CD30-positive and CD20-negative), whereas the sheets of large tumor cells characteristic of PMBL were strongly and uniformly CD20-positive. Interestingly, although both cases showed neoplastic PD-L1 (nPD-L1) positivity on the HRS cells of NSCHL, they differed regarding nPD-L1 expression on the PMBL tumor cells. In Case 1, the nPD-L1-negative PMBL component was anatomically situated outside the NSCHL lesion. On the other hand, in Case 2, the nPD-L1-positive PMBL component was characterized by transitional or continuous areas with the NSCHL component. These findings suggested that nPD-L1 expression may define two subtypes of PMBL that are more similar to or distinct from classic Hodgkin lymphoma.
复合淋巴瘤是一种众所周知的诊断实体，表现为在同一标本中同时出现两种或更多不同类型的淋巴瘤。在此，我们报告两例纵隔复合淋巴瘤患者，一例为14岁女性（病例1），另一例为45岁男性（病例2），其均由结节硬化型经典霍奇金淋巴瘤（NSCHL）和原发性纵隔大B细胞淋巴瘤（PMBL）组成。两名患者均有纵隔肿块，且在同一次活检中表现出两种不同的组织学成分，一种具有NSCHL特征，另一种具有PMBL特征。NSCHL区域包括具有典型免疫表型特征（CD30阳性和CD20阴性）的霍奇金和里德-斯腾伯格（HRS）细胞，而PMBL特征性的大片大肿瘤细胞则呈强而均匀的CD20阳性。有趣的是，尽管两例患者NSCHL的HRS细胞均显示肿瘤性PD-L1（nPD-L1）阳性，但它们在PMBL肿瘤细胞上的nPD-L1表达有所不同。在病例1中，nPD-L1阴性的PMBL成分在解剖学上位于NSCHL病变之外。另一方面，在病例2中，nPD-L1阳性的PMBL成分的特征是与NSCHL成分有过渡或连续区域。这些发现表明，nPD-L1表达可能定义了两种与经典霍奇金淋巴瘤更相似或不同的PMBL亚型。
