Abstract
B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma (BCLu-DLBCL/CHL), also known as gray-zone lymphoma, has overlapping clinical and biological characteristics of both diffuse large B-cell lymphoma and classical Hodgkin lymphoma (CHL). These lymphomas are typically associated with mediastinal disease, and extranodal involvement is rare. In the present report, we describe a case of a 78-year-old woman with BCLu-DLBCL/CHL found to have extranodal lesions and no evidence of mediastinal disease. Although biopsy specimens were histologically similar to nodular sclerosis CHL, the tumor cells were positive for CD30 and mature B-cell markers, such as CD20, CD79a, PAX5, BOB.1, and OCT-2, but negative for CD15. Furthermore, the patient had extranodal lesions and an increased level of soluble IL-2 receptor. These findings are unusual in CHL. Therefore, we diagnosed the patient with BCLu-DLBCL/CHL. She received adriamycin, bleomycin, vincristine, and dacarbazine therapy and exhibited partial response. Some cases without mediastinal disease, such as our case, have been reported; however, these cases are rare and further studies are required.
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Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW (2008) WHO Classification of tumours of haematopoietic and lymphoid tissues: International Agency for Research on Cancer. WHO, Lyon
Traverse-Glehen A, Pittaluga S, Gaulard P, Sorbara L, Alonso MA, Raffeld M, Jaffe ES (2005) Mediastinal gray zone lymphoma: the missing link between classic Hodgkin’s lymphoma and mediastinal large B-cell lymphoma. Am J Surg Pathol 29:1411–1421
Garcia JF, Mollejo M, Fraga M, Forteza J, Muniesa JA, Perez-Guillermo M, Perez-Seoane C, Rivera T, Ortega P, Piris MA (2005) Large B-cell lymphoma with Hodgkin’s features. Histopathology 47:101–110
Grant C, Dunleavy K, Eberle FC, Pittaluga S, Wilson WH, Jaffe ES (2011) Primary mediastinal large B-cell lymphoma, classic Hodgkin lymphoma presenting in the mediastinum, and mediastinal gray zone lymphoma: what is the oncologist to do? Curr Hematol Malig Rep 6:157–163
Gualco G, Natkunam Y, Bacchi CE (2012) The spectrum of B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma: a description of 10 cases. Mod Pathol 25:661–674
Eberle FC, Salaverria I, Steidl C, Summers TA Jr, Pittaluga S, Neriah SB, Rodriguez-Canales J, Xi L, Ylaya K, Liewehr D, Dunleavy K, Wilson WH, Hewitt SM, Raffeld M, Gascoyne RD, Siebert R, Jaffe ES (2011) Gray zone lymphoma: chromosomal aberrations with immunophenotypic and clinical correlations. Mod Pathol 24:1586–1597
Minami J, Dobashi N, Asai O, Yano S, Osawa H, Takei Y, Yahagi Y, Takahara S, Ogasawara Y, Yamaguchi Y, Kobayashi T, Morikawa N, Nikaido T, Aiba K, Usui N (2010) Two cases of mediastinal gray zone lymphoma. J Clin Exp Hematop 50:143–149
Ogura M, Itoh K, Kinoshita T, Fukuda H, Takenaka T, Ohtsu T, Kagami Y, Tobinai K, Okamoto M, Asaoku H, Sasaki T, Mikuni C, Hirano M, Chou T, Ohnishi K, Ohno H, Nasu K, Okabe K, Ikeda S, Nakamura S, Hotta T, Shimoyama M (2010) Phase II study of ABVd therapy for newly diagnosed clinical stage II–IV Hodgkin lymphoma: Japan Clinical Oncology Group study (JCOG 9305). Int J Hematol 92:713–724
Savage KJ, Monti S, Kutok JL, Cattoretti G, Neuberg D, De Leval L, Kurtin P, Dal Cin P, Ladd C, Feuerhake F, Aguiar RC, Li S, Salles G, Berger F, Jing W, Pinkus GS, Habermann T, Dalla-Favera R, Harris NL, Aster JC, Golub TR, Shipp MA (2003) The molecular signature of mediastinal large B-cell lymphoma differs from that of other diffuse large B-cell lymphomas and shares features with classical Hodgkin lymphoma. Blood 102:3871–3879
Rosenwald A, Wright G, Leroy K, Yu X, Gaulard P, Gascoyne RD, Chan WC, Zhao T, Haioun C, Greiner TC, Weisenburger DD, Lynch JC, Vose J, Armitage JO, Smeland EB, Kvaloy S, Holte H, Delabie J, Campo E, Montserrat E, Lopez-Guillermo A, Ott G, Muller-Hermelink HK, Connors JM, Braziel R, Grogan TM, Fisher RI, Miller TP, LeBlanc M, Chiorazzi M, Zhao H, Yang L, Powell J, Wilson WH, Jaffe ES, Simon R, Klausner RD, Staudt LM (2003) Molecular diagnosis of primary mediastinal B cell lymphoma identifies a clinically favorable subgroup of diffuse large B cell lymphoma related to Hodgkin lymphoma. J Exp Med 198:851–862
Browne P, Petrosyan K, Hernandez A, Chan JA (2003) The B-cell transcription factors BSAP, OCT-2, and BOB.1 and the pan-B-cell markers CD20, CD22, and CD79a are useful in the differential diagnosis of classic Hodgkin lymphoma. Am J Clin Pathol 120:767–777
Garcia-Cosio M, Santon A, Martin P, Camarasa N, Montalban C, Garcia JF, Bellas C (2004) Analysis of transcription factor OCT.1, OCT.2 and BOB.1 expression using tissue arrays in classical Hodgkin’s lymphoma. Mod Pathol 17:1531–1538
Oyama T, Ichimura K, Suzuki R, Suzumiya J, Ohshima K, Yatabe Y, Yokoi T, Kojima M, Kamiya Y, Taji H, Kagami Y, Ogura M, Saito H, Morishima Y, Nakamura S (2003) Senile EBV + B-cell lymphoproliferative disorders: a clinicopathologic study of 22 patients. Am J Surg Pathol 27:16–26
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Iwaki, N., Sato, Y., Kurokawa, T. et al. B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma without mediastinal disease: mimicking nodular sclerosis classical Hodgkin lymphoma. Med Mol Morphol 46, 172–176 (2013). https://doi.org/10.1007/s00795-013-0038-8
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DOI: https://doi.org/10.1007/s00795-013-0038-8