Monoclonalidad T en paciente con linfoma de Hodgkin. ¿Linfoma compuesto o linfoma de Hodgkin con población T monoclonal reactiva?

Introduction: The diagnosis and management of malignant lymphoma should be based on clinical, morphological, immunohistochemical and molecular information. Particularly in cases with morphological and/or immunohistochemistry overlapping, molecular biology provides important diagnostic clues. Material and methods: A 72 year-old male with mycosis fungoides, pancitopenia and hepatosplenomagly without lymph node enlargement, underwent both hepatic and bone marrow biopsies and histopathological, immunohistochemical and molecular studies were performed. Results: The bone marrow and hepatic biopsies showed two different populations, one composed of large cells including typical Reed-Sternberg cells and their variant, with expression of CD30, CD15, MUM1 and EBV. The other was more extensive and revealed polymorphic medium to small cells with convoluted nuclei positive for CD3, CD4, CD2, CD7. Clonal T cell receptor gamma and monoclonal immunoglobulin H gene were detected in the bone marrow infiltration. Conclusion: The interpretation of the molecular results in the diagnosis of lymphoma should be strictly correlated with the clinical evolution and the morphological and immunohistochemical findings.