Department of Pathology and Cell Biology, Graduate School of Medicine and Faculty of Medicine, University of the Ryukyus, Okinawa, Japan.
Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Aichi, Japan.
Pathol Int. 2020 Nov;70(11):893-898. doi: 10.1111/pin.13012. Epub 2020 Sep 3.
Although cases with metachronous or synchronous co-occurrence of classic Hodgkin lymphoma (CHL) and B-cell non-Hodgkin lymphoma (B-NHL) have been reported, few reports have analyzed the clonal relationship between both lesions in detail, especially in Epstein-Barr virus (EBV)-positive settings. Here, we report a case of a 38-year-old male with CHL, followed by the recurrence of EBV-positive mucocutaneous ulcers of the large intestine and EBV-positive diffuse large B-cell lymphoma in the liver. Surprisingly, polymerase chain reaction analysis for immunoglobulin heavy chain gene rearrangement revealed that all lesions were clonally distinct. We further reviewed the literature on synchronous and metachronous co-occurrence of CHL and B-NHL in EBV-positive settings. In contrast to EBV-negative settings, all evaluable cases showed clonally distinct multiple lesions. These findings suggest that histologically and clonally distinct B-cells could simultaneously proliferate in EBV-associated settings, providing a new insight into the pathogenesis of EBV-associated lymphoproliferative disorders.
虽然已有报道称经典霍奇金淋巴瘤（CHL）和 B 细胞非霍奇金淋巴瘤（B-NHL）同时或先后发生的病例，但很少有报道详细分析两者病变之间的克隆关系，尤其是在 Epstein-Barr 病毒（EBV）阳性的情况下。在这里，我们报告了一例 38 岁男性 CHL 病例，随后大肠 EBV 阳性黏膜溃疡和肝脏 EBV 阳性弥漫性大 B 细胞淋巴瘤复发。令人惊讶的是，免疫球蛋白重链基因重排的聚合酶链反应分析显示所有病变均具有明显的克隆差异。我们进一步回顾了 EBV 阳性环境中 CHL 和 B-NHL 同时和先后发生的文献。与 EBV 阴性环境不同，所有可评估的病例均显示具有明显克隆差异的多个病变。这些发现表明，在 EBV 相关环境中，具有明显组织学和克隆差异的 B 细胞可以同时增殖，为 EBV 相关淋巴增殖性疾病的发病机制提供了新的见解。
