Ogata Y, Setoguchi M, Tahara T, Takahashi M
Department of Otolaryngology, Yamaguchi University, School of Medicine, Yamaguchi, Japan.
ORL J Otorhinolaryngol Relat Spec. 1998 Sep-Oct;60(5):295-300. doi: 10.1159/000027613.
While the histologic progression from low-grade non-Hodgkin's lymphoma (NHL) to intermediate- or high-grade NHL has been well documented, a rare phenomenon called downgrading in which the histologic conversion of a low-grade NHL occurs after treatment for intermediate- or high-grade NHL has recently been recognized. We report the clinical, immunologic, and genetic features of a patient with a diffuse NHL (intermediate grade) who initially achieved complete remission by both chemotherapy and radiation therapy and then presented with a follicular NHL (low grade) 14 years later. The immunohistochemical study of the lymphoma cells showed B lymphocytes in biopsied lymph nodes at both the initial and the second diagnosis. However, a polymerase chain reaction (PCR) analysis for the immunoglobulin gene rearrangement indicated that the clone of the initial intermediate-grade NHL showed monoclonal cell population, and was distinct from that of the second downgraded form. Given the PCR results and the clinical features, we suggest that a follicular NHL can occur as a secondary malignancy following combined therapy for a diffuse NHL.
虽然从低级非霍奇金淋巴瘤（NHL）到中级或高级NHL的组织学进展已有充分记录，但最近人们认识到一种罕见的现象，即所谓的降级，即在对中级或高级NHL进行治疗后，低级NHL发生组织学转化。我们报告了一名弥漫性NHL（中级）患者的临床、免疫和遗传特征，该患者最初通过化疗和放疗实现了完全缓解，14年后出现滤泡性NHL（低级）。对淋巴瘤细胞的免疫组织化学研究显示，在初次诊断和第二次诊断时，活检淋巴结中的细胞均为B淋巴细胞。然而，免疫球蛋白基因重排的聚合酶链反应（PCR）分析表明，最初的中级NHL克隆显示单克隆细胞群，与第二次降级后的形式不同。鉴于PCR结果和临床特征，我们认为滤泡性NHL可能是弥漫性NHL联合治疗后的继发性恶性肿瘤。
