Leus Hans Jean, Robin Valérie, Molina Thierry J, Forsyth Ramses, Dehou Marie Françoise
Centre de morphologie pathologique, Cerba Path, Anderlecht, Belgique; Département de pathologie, universitair ziekenhuis Brussel, Vrije universiteit Brussel, Brussel, Belgique.
Département d'hématologie, grand hôpital de Charleroi, Charleroi, Belgique.
Ann Pathol. 2021 Apr;41(2):212-215. doi: 10.1016/j.annpat.2020.06.014. Epub 2020 Aug 11.
We report the case of a 46-year-old male patient presenting with a Claude Bernard-Horner Syndrome. Clinical evaluation showed a clonal B-cell population, lambda restricted. PET-scan captured femoral and axillary lymph nodes. Therefore the diagnosis of a marginal zone lymphoma was posted for which an attitude of watchful waiting was suggested. Eighteen months later, the patient developed an inguinal adenopathy. This lymph node led to the diagnosis of a nodular sclerosing Hodgkin lymphoma. Initial treatment with ABVD showed a good response, but the patient relapsed after eight months. A second biopsy confirmed the diagnosis of a marginal zone lymphoma but also identified giant Reed-Sternberg cells, (CD15+, CD30+ and CD20+). The initial biopsy was revised. This last diagnosis of a nodal marginal zone lymphoma with presence of Reed-Sternberg cells is rarely described in the literature. Several scientific theories can be found. Some cases described a transformation of non-Hodgkin lymphoma that presented Reed-Sternberg cells, other cases mentioned a collision or composite tumor. An accidental finding of Reed-Sternberg cells can be seen by after an infectious disease such as EBV. The presence of only Reed-Sternberg cells in a non-Hodgkin lymphoma is not sufficient to make a diagnosis of collision tumor.
我们报告了一例46岁男性患者，表现为Claude Bernard-Horner综合征。临床评估显示存在克隆性B细胞群，λ受限。PET扫描发现股部和腋窝淋巴结。因此初步诊断为边缘区淋巴瘤，并建议采取观察等待的态度。18个月后，患者出现腹股沟淋巴结病。该淋巴结导致诊断为结节硬化型霍奇金淋巴瘤。初始ABVD治疗显示出良好反应，但患者在8个月后复发。再次活检证实为边缘区淋巴瘤，但也发现了巨大的里德-斯腾伯格细胞（CD15+、CD30+和CD20+）。对初始活检结果进行了修正。文献中很少描述这种伴有里德-斯腾伯格细胞的淋巴结边缘区淋巴瘤的最终诊断。有几种科学理论。一些病例描述了出现里德-斯腾伯格细胞的非霍奇金淋巴瘤的转化，其他病例提到了碰撞瘤或复合瘤。在诸如EBV等传染病后可见偶然发现的里德-斯腾伯格细胞。在非霍奇金淋巴瘤中仅出现里德-斯腾伯格细胞不足以诊断为碰撞瘤。
