Alternate clonal dominance in richter transformation presenting as extranodal diffuse large B-cell lymphoma and synchronous classic hodgkin lymphoma

Andrea Di Bernardo, Alberto Mussetti, Antonella Aiello, Elena De Paoli, Antonello Domenico Cabras

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: Richter transformation (RT) represents the rare occurrence of a secondary aggressive lymphoma in the setting of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL).

Methods: Here we describe the peculiar case of a patient with trisomy 12+ and atypical (CD5+, CD23-) CLL/SLL who developed a two-step RT with complex morphologic and molecular features.

Results: Molecular analysis of a CLL/SLL population detected two different immunoglobulin rearrangement patterns corresponding to a main peak and a minor peak. Transformation took place both as gastric diffuse large B-cell lymphoma and as a synchronous bone marrow classic Hodgkin lymphoma with the same immunoglobulin rearrangement pattern corresponding to the minor peak detected in CLL/SLL at diagnosis. During chemotherapy, progression occurred as axillary nodal involvement by a CD5+ high-grade lymphoma with an immunoglobulin rearrangement pattern corresponding to the main CLL peak.

Conclusions: In this case, the elaborate clinical and molecular picture may be correlated to an alternate dominance of two distinct clonal populations probably influenced by therapeutic and environmental factors.

Original languageEnglish
Pages (from-to)227-232
Number of pages6
JournalAmerican Journal of Clinical Pathology
Volume142
Issue number2
DOIs
Publication statusPublished - Aug 1 2014

Keywords

  • Clonal dominance
  • Diffuse large B-cell lymphoma
  • Hodgkin lymphoma
  • Richter syndrome

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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