Composite Lymphoma of Follicular B-cell and Peripheral T-cell Types with Distinct Zone Distribution in a 75-year-old Male Patient: a Case Study

Publication date: Available online 6 December 2017
Source:Human Pathology
Author(s): John Tanaka, Pu Su, Catherine Luedke, Rachel Jug, Lian-He Yang, Kristen Deak, Sarah Horn, Yang Zhang, Marc Delos Angeles, Yi Xie, Endi Wang
Composite lymphoma (CL) of T−/B-cell type is rare, and follicular lymphoma composite with peripheral T-cell lymphoma (PTCL) has not previously been reported. We report such a case with both neoplastic components displaying a unique zone of distribution. A 75-year-old male patient presented with generalized lymphadenopathy. Sections of axillary lymph node demonstrated potentially two clonal processes, PTCL with aberrant CD20 expression and follicular lymphoma. Interestingly, the two neoplastic components were confined to their respective classic distribution zones, with PTCL occupying the interfollicular areas and follicular lymphoma residing in follicles. Both populations were detected by flow cytometry, but their immunophenotypes were insufficient to define clonality. Nonetheless, biclonality was demonstrated by lymphoid receptor gene rearrangement analyses. Molecular cytogenetics showed IGH/BCL2 fusion in the follicular lymphoma and amplification of IGH gene or trisomy/tetrasomy 14 in the PTCL. The current case underscores the complexity of CL and advocates a multimodal approach to establishing the diagnosis.



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