滤泡性淋巴瘤转化为弥漫性大 B 细胞淋巴瘤并在复发时转回滤泡性淋巴瘤——一例报告。

Follicular lymphoma transforming to DLBCL and reverting back to follicular lymphoma at relapse-a case report.

机构信息

Department of Medical Oncology, Kidwai Cancer Institute, Dairy Circle, Bengaluru, 560029, India.

Department of Pathology, Kidwai Cancer Institute, Bengaluru, 560029, India.

出版信息

J Egypt Natl Canc Inst. 2020 May 14;32(1):22. doi: 10.1186/s43046-020-00035-3.

DOI:10.1186/s43046-020-00035-3

PMID:32410046

Abstract

BACKGROUND

Transformation of low-grade follicular lymphoma to high-grade diffuse large B cell lymphoma (DLBCL) is known. However, the opposite is not commonly reported. In this report, we present a case of follicular lymphoma that underwent transformation to DLBCL. Three years after treatment for histologic transformation, the patient presented again with low-grade follicular lymphoma at the same site which is unusual in the natural history of follicular lymphoma.

CASE PRESENTATION

A 50-year-old female patient presented to us with complaints of slowly progressing swelling in the neck on the left side for a duration of 1 year. Past history of the patient revealed a diagnosis of follicular lymphoma in 2004 for which the patient had taken prednisolone and chlorambucil. Details of staging were not available with the patient. After a complete work-up, she was diagnosed as DLBCL, stage IIIE. She was treated with 6 cycles of CHOP regimen. She had very good response to chemotherapy. However, she defaulted and was lost to follow-up. She presented again after 3 years with history of painless progressive swelling in the right side of the neck for the last 1 year. Examination revealed cervical lymph nodes and ascites. This time, a repeat biopsy and immunohistochemistry was suggestive of follicular lymphoma. In view of significant ascites, she was started on chemotherapy with CVP regimen. After 6 cycles, she has good partial response and resolution of ascites. She is currently on follow-up.

CONCLUSIONS

We have presented a case of FL that has transformed to DLBCL after 10 years of diagnosis. After HT, she was treated with CHOP chemotherapy and the patient relapsed again after 3 years with follicular lymphoma histology. This case highlights the unique and varied natural history of follicular lymphoma that may be attributed to different subclones of malignant cells that may have arisen from a common progenitor FL cell and differential effect of chemotherapy on these subclones.

摘要

背景

低级别滤泡性淋巴瘤向高级别弥漫性大 B 细胞淋巴瘤（DLBCL）的转化是已知的。然而，相反的情况并不常见。在本报告中，我们介绍了一例滤泡性淋巴瘤转化为 DLBCL 的病例。在组织学转化治疗 3 年后，患者再次在同一部位出现低级别滤泡性淋巴瘤，这在滤泡性淋巴瘤的自然病程中并不常见。

病例介绍

一名 50 岁女性患者因左侧颈部进行性肿胀 1 年就诊。患者既往病史显示 2004 年诊断为滤泡性淋巴瘤，当时患者接受了泼尼松和苯丁酸氮芥治疗。患者未提供分期的详细信息。经过全面检查，她被诊断为 DLBCL，III 期 E 期。她接受了 6 个周期的 CHOP 方案化疗。她对化疗反应非常好。然而，她失访并失去随访。3 年后，她因右侧颈部无痛性进行性肿胀 1 年再次就诊。检查发现颈部淋巴结和腹水。此次重复活检和免疫组化检查提示滤泡性淋巴瘤。鉴于腹水明显，她开始接受 CVP 方案化疗。6 个周期后，她有良好的部分缓解和腹水消退。她目前正在随访中。