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Blood, 15 August 2002, Vol. 100, No. 4, pp. 1425-1429
NEOPLASIA
Clonal relation in a case of CLL, ALCL, and Hodgkin
composite lymphoma
Anke van den Berg,
Ewerton Maggio,
Renata Rust,
Klaas Kooistra,
Arjan Diepstra, and
Sibrand Poppema
From the Department of Pathology and Laboratory
Medicine, University and University Hospital Groningen, Groningen, The
Netherlands.
Large cell lymphomas and Hodgkin disease may develop during the
course of chronic lymphocytic leukemia (CLL). In some cases the
transformed cells are Epstein-Barr virus (EBV)-positive and not
clonally related to the CLL cells. In other cases the transformed cells
have the same clonal rearrangements as the CLL cells. Here we describe
a composite lymphoma in a patient with CLL that exhibits a combination
of CLL/small lymphocytic lymphoma, large cell lymphoma with
anaplastic morphology, and Hodgkin lymphoma (HL). Although the large cell lymphoma cells are CD45R0 and TIA-1-positive,
suggesting a T- or 0-cell anaplastic large cell lymphoma
(ALCL), the genetic analysis demonstrates immunoglobulin heavy chain
(IgH) gene rearrangements for both alleles, carrying the same somatic
mutations as observed in the CLL component. The Reed-Sternberg (R-S)
cells in the Hodgkin component also strongly express TIA-1 but differ
from the anaplastic large cells by the expression of CD15 and TARC and
the presence of a prominent lymphocytic infiltrate. The ALCL and HL
components both are EBV negative. Analysis of the IgH gene
rearrangements in micromanipulated R-S cells revealed identical Ig gene
rearrangements carrying the same somatic mutations as the CLL and the
large cell components. The findings indicate transformation of the CLL
cells into a large cell lymphoma with anaplastic morphology and a
Hodgkin component.
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