Ishida Taiki, Sato Michiaki, Kamoda Yoshimasa, Hirao Masako, Iizuka Hiromitsu, Kida Michiko, Hashimoto Hirotsugu, Miura Sakiko, Morikawa Teppei, Usuki Kensuke
Department of Hematology, NTT Medical Center Tokyo.
Department of Hematology and Oncology, the University of Tokyo Hospital.
Rinsho Ketsueki. 2022;63(6):544-549. doi: 10.11406/rinketsu.63.544.
A 44-year-old female was diagnosed with follicular lymphoma (FL), grade 3A stage III, by right cervical lymph node biopsy at the age of 43 years. The patient chose to not receive the treatment despite the high tumor burden. The patient came back after 18 months with respiratory distress and had systemic infiltration and pleural effusion. Positron emission tomography (PET)/computed tomography (CT) showed fluorine-18 deoxyglucose accumulation with maximum standardized uptake value ranging from 10 to 18 in bone marrow, liver, spleen, lung, and systemic lymph nodes (cervical, supraclavicular, infraclavicular, axillary, mediastinal, hilar, para-aortic, iliac, and inguinal). Left inguinal lymph node biopsy revealed mixed cellularity classical Hodgkin lymphoma (CHL), which was thought to be an FL transformation or a composite condition. The patient was treated with A + AVD and achieved lymph node shrinkage as well as improvement of tumor fever and pleural effusion. Interim PET/CT showed improvement in most parts after two courses; however, it revealed some new or progressive lesions in the bone marrow and left cervical lymph nodes. Left cervical lymph node biopsy revealed nodular sclerosis CHL. The patient was treated with ESHAP, which resulted in stable disease; following this, the patient was treated with nivolumab, which was highly effective. FL transformation to CHL is rare, and this is the first report of such transformation without treatment.
一名44岁女性在43岁时经右颈淋巴结活检被诊断为3A 级三期滤泡性淋巴瘤（FL）。尽管肿瘤负荷高，但患者选择不接受治疗。18个月后患者因呼吸窘迫复诊，出现全身浸润和胸腔积液。正电子发射断层扫描（PET）/计算机断层扫描（CT）显示骨髓、肝脏、脾脏、肺和全身淋巴结（颈部、锁骨上、锁骨下、腋窝、纵隔、肺门、腹主动脉旁、髂部和腹股沟）有氟-18脱氧葡萄糖积聚，最大标准化摄取值为10至18。左腹股沟淋巴结活检显示为混合细胞型经典型霍奇金淋巴瘤（CHL），考虑为FL转化或复合型。患者接受A + AVD方案治疗后淋巴结缩小，肿瘤热和胸腔积液有所改善。两个疗程后中期PET/CT显示大部分部位有改善；然而，骨髓和左颈淋巴结出现了一些新的或进展性病变。左颈淋巴结活检显示为结节硬化型CHL。患者接受ESHAP方案治疗后病情稳定；此后，患者接受纳武单抗治疗，效果显著。FL转化为CHL罕见，这是首例未经治疗发生此类转化的报告。
