Blood Res.  2014 Dec;49(4):270-274. 10.5045/br.2014.49.4.270.

Case series of precursor B-cell lymphoblastic lymphoma

• Kim JY
• Om SY
• Shin SJ
• Kim JE
• Yoon DH
• Suh C

• KMID: 2270686
• DOI: http://doi.org/10.5045/br.2014.49.4.270

Abstract

Precursor B-cell lymphoblastic lymphoma (B-LBL) is an uncommon subtype of Non-Hodgkin lymphoma (NHL), accounting for only 0.3% of NHL in adults and less than 10% of all LBL cases. Unlike T-cell LBL, it usually presents with extranodal involvement while sparing the bone marrow (BM). Among the 27 patients with LBL treated in the Asan Medical Center between January 2007 and March 2012, 3 had B-LBL. All had a good performance status and low International Prognostic Index. However, unlike most previously reported cases, the patients had lymphoma in their bone marrow and extranodal sites such as bone and lung. After intensive combination chemotherapy, one patient achieved a complete response and the other 2 patients, a partial response. Our experience suggests that multiple extranodal sites may be involved in B-LBL and BM involvement may not be as infrequent as previously thought. Furthermore, intensive chemotherapy seems to be effective.

Keyword

B-cell lymphoblastic lymphoma; Chemotherapy; Bone marrow involvement

MeSH Terms

Adult
Bone Marrow
Chungcheongnam-do
Drug Therapy
Drug Therapy, Combination
Humans
Lung
Lymphoma
Lymphoma, Non-Hodgkin
Precursor B-Cell Lymphoblastic Leukemia-Lymphoma*
T-Lymphocytes

Figure

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  Fig. 1 (A) Post-contrast T2-weighted coronal pelvic magnetic resonance image showing a high T2 signal and enhancement in the left acetabulum and iliac bone. (B) A positron emission tomography (PET) image showing inhomogeneous hypermetabolic activity (maximum SUV=5.6) in the left ilium and acetabulum. (C) PET image showing the disappearance of a hypermetabolic lesion in the left ilium and acetabulum after vincristine, methylprednisolone, daunorubicin, and L-asparaginase (VPDL) induction chemotherapy.

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  Fig. 2 (A) Microscope analysis of the biopsy specimen revealing diffuse infiltration of small-to-medium sized lymphocytes with massive necrosis (×100; hematoxylin and eosin [H&E]). (B) High magnification shows monotonous tumor cells with a moderate amount of cytoplasm, round-to-oval shaped indented nuclei, condensed chromatin and inconspicuous nucleoli (lymphoblast), and nuclear debris with necrosis (×400; H&E). (C) The neoplastic cells show nuclear staining for PAX5, and (D) diffuse membranous staining for CD20.

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  Fig. 3 (A) Chest computed tomography showing conglomerated enlarged lymph nodes in the bilateral mediastinum causing compression of the central airway, and encasement of the left pulmonary artery and descending aorta. (B) A positron emission tomography (PET) image showing a hypermetabolic central lung mass in the left lung with direct invasion of the mediastinum and post-obstructive atelectasis. (C) PET image showing decreased extent and activity of hypermetabolic lesions after rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) chemotherapy.

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  Fig. 4 (A) High magnification shows diffuse infiltration of monotonous tumor cells with a moderate amount of cytoplasm, round-to-oval shaped indented nuclei, condensed chromatin and inconspicuous nucleoli (lymphoblast), and nuclear debris with necrosis (×400; hematoxylin and eosin). (B) The neoplastic cells show diffuse membranous staining for CD20, (C) cytoplasmic staining for CD10, and (D) diffuse membranous staining for leukocyte common antigen (LCA).

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