Follicular T-cell lymphoma mimicking lymphocyte-rich classic Hodgkin lymphoma: a case report of a diagnostic pitfall

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  • Sakakibara Ayako
    Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan,
  • Suzuki Yuka
    Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan,
  • Kato Harumi
    Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan,
  • Yamamoto Kazuhito
    Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan,
  • Sakata-Yanagimoto Mamiko
    Department of Hematology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan, Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan,
  • Ishikawa Yuichi
    Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan,
  • Furukawa Katsuya
    Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan,
  • Shimada Kazuyuki
    Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan,
  • Kohno Kei
    Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan, Department of Pathology, Kurume University School of Medicine, Kurume, Japan,
  • Nakamura Shigeo
    Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan,
  • Satou Akira
    Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan,
  • Kato Seiichi
    Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan

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<p>Follicular T-cell lymphoma (FTCL), one of the nodal T-cell lymphomas with T follicular helper (TFH) phenotype, is an uncommon disease. The diagnosis of FTCL is challenging on the distinction from the morphological mimics mostly exemplified by follicular lymphoma. Here, we described a case of FTCL that mimicked lymphocyte-rich classic Hodgkin lymphoma (LRCHL). A 47-year-old male presented with cervical lymphadenopathy. The biopsy specimen demonstrated nodular lymphoid proliferation, which included scattered CD30+ CD15- CD20- PAX5 weakly+ Hodgkin and Reed-Sternberg (HRS)-like cells and a rich distribution of CD3+ CD4+ PD1+ T-cells. Epstein Barr virus was not detected in HRS-like cells, but it was detected in a small proportion of the scattered lymphocytes. The large cells were also negative for programmed cell death ligand 1, which appeared to be coincidental as described in our previous report of LRCHL. However, flow cytometry showed a CD3- CD4+ T-cell population that constituted 37.4% of all gated lymphocytes. A PCR analysis showed a clonal T-cell receptor-gamma gene rearrangement, but not a clonal immunoglobulin heavy chain gene rearrangement, and showed RHOA G17V mutation. The constellation of these findings led us to revise the diagnosis to FTCL. This result indicated that our case belonged to a relatively indolent subgroup of nodal peripheral T-cell lymphoma of TFH phenotype, which affects patients ≤60 years old, recently proposed by our group. This case report expands our understanding of the morphologic spectrum of FTCL and its clinicopathologic significance.</p>

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