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Published on: March 30, 2018
[Occurrence of follicular small cleaved cell lymphoma following chemotherapy for diffuse large cell lymphoma]
Insights
A rare case of low-grade follicular lymphoma developing after aggressive diffuse large cell lymphoma is presented. This converse phenomenon highlights the importance of histological examination in relapsing lymphoma cases.
Area of Science:
- Oncology
- Hematology
- Pathology
Background:
- Diffuse large cell lymphoma (DLCL) is an aggressive non-Hodgkin lymphoma.
- Complete remission (CR) is achievable with chemotherapy, such as CHOP therapy.
- Relapse of DLCL typically involves recurrence of the aggressive histology.
Observation:
- A 59-year-old man with DLCL achieved CR after CHOP therapy.
- Years later, he presented with lymphadenopathy and splenomegaly.
- Biopsy revealed follicular small cleaved cell lymphoma, a low-grade histology.
Findings:
- The patient experienced a histological transformation from high-grade DLCL to low-grade follicular lymphoma.
- This converse phenomenon, the development of low-grade lymphoma after aggressive lymphoma, is rarely reported.
- Spontaneous regression of enlarged lymph nodes and spleen was observed.
Implications:
- Histological examination is crucial for accurate diagnosis in relapsing lymphoma.
- This case challenges the typical understanding of lymphoma progression.
- Further research into the mechanisms of lymphoma dedifferentiation is warranted.
Abstract:
A 59-year-old man was admitted in July, 1985 because of generalized lymphadenopathy and hypercalcemia. The biopsy specimen of the left inguinal lymph node showed diffuse large cell lymphoma. He achieved a complete remission (CR) in July, 1986 by CHOP therapy. In January, 1992, he visited the outpatient clinic with splenomegaly, and swelling of the left axillary and left supraclavicular lymph nodes. The biopsy specimen of the axillary lymph node showed follicular small cleaved cell lymphoma. Because the spleen and the lymph nodes regressed after the biopsy, he has been followed up without any specific treatment for lymphoma. Histologic change from low-grade lymphoma into more aggressive histologic pattern is well documented. However the converse phenomenon, occurrence of low-grade lymphoma after intermediate-, or high-grade lymphoma has rarely been reported. Histological examination is mandatory when a patient with diffuse large cell lymphoma is suspected to have relapsing disease after the long-term CR.
