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      Synchronous Lymphoma: Diagnostic Challenges in a Case of Coexisting Diffuse Large B-cell Lymphoma and Classical Hodgkin Lymphoma

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          Abstract

          Synchronous lymphoma (SL) is the simultaneous occurrence of two or more unique kinds of lymphomas in the same individual at the initial diagnosis. Accurate diagnosis requires histopathological examination, immunohistochemistry (IHC), and molecular studies. We found only a handful of reported cases of SLs involving different anatomical sites in medical literature, and no large-scale studies have specifically addressed the frequency of this combination. Given the rarity of this combination, each case is often reported as a unique case study, and treatment approaches may vary depending on individual circumstances. Here, we report a case of a 60-year-old female patient presenting with pain in the abdomen, vomiting, fever, significant weight loss, and palpable inguinal nodes. Her endoscopic biopsy from the stomach revealed diffuse large B-cell lymphoma (DLBCL) while the inguinal node biopsy showed classical Hodgkin lymphoma (cHL), mixed cellularity type. Our report discusses and highlights the importance of detailed clinical history, investigations, and molecular workups that are essential to diagnosing these rare cases.

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          The 2016 revision of the World Health Organization classification of lymphoid neoplasms.

          Steven H. Swerdlow, Elias Campo, Stefano Pileri … (2016)
          A revision of the nearly 8-year-old World Health Organization classification of the lymphoid neoplasms and the accompanying monograph is being published. It reflects a consensus among hematopathologists, geneticists, and clinicians regarding both updates to current entities as well as the addition of a limited number of new provisional entities. The revision clarifies the diagnosis and management of lesions at the very early stages of lymphomagenesis, refines the diagnostic criteria for some entities, details the expanding genetic/molecular landscape of numerous lymphoid neoplasms and their clinical correlates, and refers to investigations leading to more targeted therapeutic strategies. The major changes are reviewed with an emphasis on the most important advances in our understanding that impact our diagnostic approach, clinical expectations, and therapeutic strategies for the lymphoid neoplasms.
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            Hodgkin lymphoma: A review and update on recent progress

            Satish Shanbhag, Richard F Ambinder (2018)
            Hodgkin lymphoma (HL) is a unique hematopoietic neoplasm characterized by cancerous Reed-Sternberg cells in an inflammatory background. Patients are commonly diagnosed when in their 20s-30s, present with supra-diaphragmatic lymphadenopathy, often with systemic B symptoms. Even in advanced stage disease, HL is highly curable with combination chemotherapy, radiation or combined modality treatment. Although the same ABVD chemotherapeutic regimen has been the mainstay of therapy for over last 30 years, risk adapted approaches have helped de-escalate therapy in low risk patients while intensifying treatment for higher risk patients. Even patients who are not cured with initial therapy can often be salvaged with alternate chemotherapy combinations, the novel antibody-drug conjugate Brentuximab, high dose autologous or allogeneic hematopoietic stem cell transplant (allo-HCT). The Programmed death-1 (PD-1) inhibitors Nivolumab and Pembrolizumab have both demonstrated high response rates and durable remissions in relapse/refractory HL. Alternate donor sources and reduced intensity conditioning have made allo-HCT a viable option for more HL patients. Future research will look to integrate novel strategies into earlier lines of therapy to improve the HL cure rate and minimize long term treatment toxicities.
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              Identification of common germinal-center B-cell precursors in two patients with both Hodgkin's disease and non-Hodgkin's lymphoma.

              Martin Burg, K Rajewsky, J. Strickler … (1999)
              Hodgkin's disease and non-Hodgkin's B-cell lymphoma occasionally occur in the same patient. The identification of a common precursor of the two types of lymphoma would show definitively that Reed-Sternberg cells originate from B cells. We studied lymphomas from two patients, one with a composite lymphoma (classic Hodgkin's disease and a follicular lymphoma in the same lymph node) and the other with a T-cell-rich B-cell lymphoma that was followed by classic Hodgkin's disease. Single Reed-Sternberg cells and non-Hodgkin's lymphoma cells from frozen sections were micromanipulated. The rearranged immunoglobulin variable-region genes (V genes) of the heavy and light chains were amplified by the polymerase chain reaction from genomic DNA and sequenced. In both patients, the Reed-Sternberg cells were related clonally to the non-Hodgkin's lymphoma B cells. The V genes carried somatic mutations (a hallmark of germinal-center B cells and their descendants). In both patients, some somatic mutations were shared by the Reed-Sternberg and non-Hodgkin's lymphoma cells, whereas other somatic mutations were found exclusively in one or the other cell type. In two patients with classic Hodgkin's disease and non-Hodgkin's B-cell lymphoma, we identified a common B-cell precursor, probably a germinal-center B-cell, for both lymphomas. This finding suggests that the two types of lymphoma underwent both shared and distinct transforming events and provides proof of the B-cell derivation of Reed-Sternberg cells in classic Hodgkin's disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 30 January 2025
                Publication date (Electronic, collection): January 2025
                Volume: 17
                Issue: 1
                Electronic Location Identifier: e78248
                Affiliations
                [1 ] Pathology, Tata Main Hospital, Jamshedpur, IND
                [2 ] Medical Oncology, Tata Main Hospital, Jamshedpur, IND
                [3 ] Nuclear Medicine, Tata Main Hospital, Jamshedpur, IND
                Author notes
                Article
                DOI: 10.7759/cureus.78248
                PMC ID: 11871963
                PubMed ID: 40027040
                SO-VID: be1437dc-0473-4b23-b080-57d83864082b
                Copyright © Copyright © 2025, Rana et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 30 January 2025
                Categories
                Subject: Pathology
                Subject: Oncology
                Subject: Hematology

                Keywords: classical hodgkin lymphoma,diffuse large b cell lymphoma,diffuse large b-cell lymphoma,gastric biopsy,immunohistochemistry,inguinal lymph node,mixed cellularity chl,synchronous lymphoma
                Data availability:
                Keywords: classical hodgkin lymphoma, diffuse large b cell lymphoma, diffuse large b-cell lymphoma, gastric biopsy, immunohistochemistry, inguinal lymph node, mixed cellularity chl, synchronous lymphoma

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