Abstract：
Diffuse large B-cell lymphoma (DLBCL) is the most common and aggressive subtype of non-Hodgkin lymphoma. The overall risk of developing DLBCL is increased in patients with other lymphomas, such as mycosis fungoides (MF). In this report, we present an 81-year-old female with early-stage MF who simultaneously progressed to tumor stage, large-cell transformed (LCT) MF and developed a primary DLBCL in a lymph node (LN). She presented with a tumor on her leg and new lymphadenopathy in her right axilla. Skin biopsy of the tumor revealed infiltration of large atypical CD3+, CD4+, and CD30+ cells, and a smaller portion of CD8+ cells in the dermis, consistent with LCT MF. Biopsy of the axillary LN revealed diffuse sheets of CD20+, BCL-2+, c-MYC+, and CD10- cells, highly suggestive of double expressor DLBCL. High-throughput sequencing revealed monoclonal T cells in the skin tumor and a monoclonal B-cell population in the LN. The above findings led to simultaneous diagnoses of LCT MF and nodal double expressor DLBCL. Our case demonstrates the importance of performing a full pathological workup in cutaneous T-cell lymphoma patients presenting with lymphadenopathy.
摘要：
弥漫性大B细胞淋巴瘤(DLBCL)是非霍奇金淋巴瘤最常见的侵袭性亚型。其他淋巴瘤患者发生DLBCL的总体风险增加，如真菌病（MF）。在这份报告中,我们介绍了一名81岁的女性，患有早期MF，同时进展到肿瘤阶段，大细胞转化（LCT）MF，并在淋巴结（LN）中发展出原发性DLBCL。她的腿上有肿瘤，右腋下有新的淋巴结病。肿瘤皮肤活检显示大量非典型CD3+浸润，CD4+,和CD30+细胞，真皮中有一小部分CD8+细胞，与LCTMF一致。腋窝LN活检显示CD20+弥漫性片层，BCL-2+,c-MYC+,和CD10细胞，高度暗示双表达DLBCL。高通量测序显示皮肤肿瘤中的单克隆T细胞和LN中的单克隆B细胞群。上述发现导致同时诊断LCTMF和淋巴结双表达DLBCL。我们的病例证明了对表现为淋巴结肿大的皮肤T细胞淋巴瘤患者进行全面病理检查的重要性。
