Rysenga E, Linden M D, Carey J L, Ross C W, Schnitzer B, Sawdyk M, Maeda K
Henry Ford Hospital, Department of Pathology, Detroit, MI 48202.
Arch Pathol Lab Med. 1995 Jan;119(1):88-91.
Previous reports have suggested that nodular lymphocyte predominance Hodgkin's disease (NLPHD) is a germinal center-derived B-cell lymphoma that is distinct from other types of Hodgkin's Disease. A relationship between NLPHD and simultaneous or subsequent development of large-cell (LC) non-Hodgkin's lymphoma (NHL) has been established. Both Reed-Sternberg cell variants in NLPHD and NHL cells in these cases express B-cell-associated antigens, and in some cases the B-cell lineage of the NHL has been confirmed by immunoglobulin gene rearrangement studies. The B-cell phenotype and the indolent course of both lymphomas suggest histologic progression of NLPHD to B-cell NHL, rather than a de novo LCNHL unrelated to Hodgkin's Disease. We report a unique case of T-large-cell lymphoma (TLCL) following successful chemotherapy of NLPHD. A 54-year-old male was treated with seven cycles of mechlorethamine, vincristine, procarbazine, prednisone chemotherapy for NLPHD and 4 years later developed recurrent adenopathy. Lymph node biopsy showed a diffuse LCNHL. Frozen section immunotyping and gene rearrangement studies confirmed the diagnosis of TLCL. To our knowledge, this case represents only the second report of TLCL associated with NLPHD and is of significance in that: (1) it demonstrates that T-cell neoplasia can occur in the setting of NLPHD; (2) this case does not appear to represent histologic progression of NLPHD and most likely represents de novo disease that may be secondary to chemotherapy; and (3) the clinical course may differ from the favorable prognosis seen in NLPHD associated with B-cell NHL.
既往报道提示，结节性淋巴细胞为主型霍奇金淋巴瘤（NLPHD）是一种生发中心来源的B细胞淋巴瘤，与其他类型的霍奇金淋巴瘤不同。NLPHD与同时或随后发生的大细胞（LC）非霍奇金淋巴瘤（NHL）之间的关系已得到证实。NLPHD中的里德-斯特恩伯格细胞变异型和这些病例中的NHL细胞均表达B细胞相关抗原，在某些病例中，通过免疫球蛋白基因重排研究证实了NHL的B细胞谱系。两种淋巴瘤的B细胞表型和惰性病程提示NLPHD向B细胞NHL的组织学进展，而非与霍奇金淋巴瘤无关的新发LCNHL。我们报告1例NLPHD成功化疗后发生T大细胞淋巴瘤（TLCL）的独特病例。一名54岁男性因NLPHD接受了7个周期的氮芥、长春新碱、丙卡巴肼、泼尼松化疗，4年后出现复发性腺病。淋巴结活检显示为弥漫性LCNHL。冰冻切片免疫分型和基因重排研究确诊为TLCL。据我们所知，该病例是与NLPHD相关的TLCL的第二例报道，其意义在于：（1）它表明T细胞肿瘤可在NLPHD背景下发生；（2）该病例似乎不代表NLPHD的组织学进展，很可能代表可能继发于化疗的新发疾病；（3）临床病程可能与NLPHD相关B细胞NHL的良好预后不同。
