4. Hrvatski kongres kliniËke citologije 4th Croatian Congress ... - Penta

Clinical Cytology - Oral Presentations
DIFFUSE LARGE B-CELL LYMPHOMA IN PATIENT AFTER TREATMENT OF
ANGIOIMMUNOBLASTIC T-CELL LYMPHOMA
Džeko-Škugor N1 , Perić Z2 , Vrhovac R2 , Radić-Krišto D2 , Kardum-Skelin I3 , Jakšić B2 1 General Hospital Šibenik, Department of Cytology, Šibenik
2 Merkur University Hospital, Department of Medicine, Zagreb
3Merkur University Hospital, Department of Medicine, Laboratory for Cytology and
Hematology, Zagreb,Croatia
Relatively few cases of Epstein-Barr (EBV)-positive B-cell lymphomas arising in patients
with angioimmunoblastic T-cell lymphoma (AITL) have been reported, the most common
of them diffuse large B-cell lymphoma (DLBCL).We report a case of angioimmunoblastic
T-cell lymphoma in which diffuse large B-cell lymphoma arose 13 months after the
initial diagnosis of AITL. A 36-year-old female patient was evaluated in March and April
2008 with moderate leukocytosis, peripheral and abdominal lymphadenopathy. AITL was
diagnosed after a fine-needle aspiration cytology (FNAC) of the enlarged cervical and
supraclavicular lymph nodes was performed and confirmed by an immunophenotyping
and biopsy of the cervical lymph nodes. The patient recieved chemotherapy regimen
FED (fludarabine, endoxane, dexamethasone) and autologous hematopoietic stem cells
transplantation was done. In April 2009 the patient was hospitalized because of fever,
pancytopenia, hyperbilirubinemia and peripheral lymphadenopathy. A computed tomography
(CT) study showed enlarged mediastinal and abdominal lymph nodes. A relapse of
non-Hodgkin lymphoma (NHL) was suspected. The FNAC of the enlarged cervical lymph
nodes was performed again, but this time the smears were composed of polymorphous
population of lymphocytes with the predomination of large cells, CD20¬+ on immunocytochemical
stains. The immunophenotyping confirmed a predomination of monoclonal
mature B-cells. Serologic testing revealed increased titers of EBV VCA IgG and EBV
EBNA IgG; the plasma EBV DNA levels were also increased. The patient showed a positive
response to an additional chemotherapy regimen CHOP-R (cyclophosphamide, doxorubicin,
vincristine, prednisone and rituximab) and there is the possibility of allogenic
stem cell transplantation. AITL is a rare lymphoproliferative disorder in which the neoplastic
T-cells represent the minority of the lymph node cell population and almost all
cases harbor EBV-infected B-cells. Various authors postulated that immunodeficiency
in AITL patients together with immunosupresive efects of cytotoxic drugs, may be responsible
for EBV-induced proliferation of latently or newely EBV-infected B-cells with
eventual clonal selection and proggresion to aggressive B-cell lymphoma.
nivesdzeko@gmail.com
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4 th Croatian Congress of Clinical Cytology / 1 st Croatian Symposium of Analytical Cytology / 2 nd Croatian Symposium of Cytotechnology