Resumen
Introducción: La asociación en tiempo de forma sincrónica de linfoma Hodgkin y linfoma no Hodgkin en un mismo paciente es muy rara.
Caso clínico: Paciente de sexo masculino de 68 años que comienza su padecimiento con adenomegalias cervicales y axilares, se realiza biopsia excisional y se encuentra linfoma Hodgkin tipo celularidad mixta, se inicia quimioterapia. Durante el transcurso del tratamiento se observa la continuidad de lesiones refractarias en piel y músculo, el servicio de radiooncología decide rebiopsar al paciente y se demuestra que se trata de una nueva entidad, linfoma no Hodgkin difuso de células B grandes.
Conclusiones: Este caso nos ejemplifica como cuando se tiene un paciente con un cuadro clínico típico y con una evolución tórpida se debe de replantear el diagnóstico e incluso repetir estudios realizados previamente para descartar diagnósticos alternos que puedan alterar el curso de la enfermedad.
Abstract
Background: The synchronous association of Hodgkin lymphoma and non-Hodgkin lymphoma in the same patient is very rare.
Case report: A 68 years old male patient who began his disease with cervical and axillary adenomegaly, it was performed an excisional biopsy and a mixed cell-type Hodgkin lymphoma was found. Chemotherapy with partial response was initiated. During the course of the treatment, refractory lesions were observed in skin and muscle. Radiation oncology service decided to make a second biopsy which confirms the presence of a large diffuse B cell non-Hodgkin lymphoma.
Conclusions: This case is an example of how when you have a patient with a typical clinical picture of bad prognosis, the diagnosis should be reconsidered and laboratory studies previously done must be repeated to rule out alternative diagnoses that may change the course of the disease.
Pérez-Zúñiga JM,Aguilar-Andrade C, Álvarez-Vera JL, Augusto-Pacheco M, Báez-Islas PE, Bates-Martín RA, et al. Generalidades sobre linfomas. Rev Hematol Mex. 2018 19(4):174-188.
Labardini Méndez JR, Cervera Ceballos E, Corrales Alfaro C, Balbuena Martínez M, Barbosa Ibarra AA, Espinoza Zamora JR, et al. Oncoguía. Linfoma de Hodgkin. Cancerología. 2011;6(1):133 - 138
Labardini Méndez JR, Cervera Ceballos E, Corrales Alfaro C, Balbuena Martínez M, Barbosa Ibarra AA, Espinoza Zamora JR, et al. Oncoguía. Linfoma de Hodgkin. Cancerología. 2011;(6):139 - 152
Bowzyk-AlNaeeb A, Ajithkumar T, Behan S, James-Hodson D. Non-Hodgkin lymphoma. BMJ 2018 Aug 362:k3204 doi: 10.1136/bmj.k3204
Armitage JO, Gascoyne RD, Lunning MA, Cavalli F. Non-Hodgkin lymphoma. The Lancet 2017 Jan doi:10.1016/s0140-6736(16)32407-2
Schaapveld M, Aleman BM, van Eggermond AM, Janus CP, Krol AD, van der Maazen RW, et-al. Second Cancer Risk Up to 40 Years after Treatment for Hodgkin’s Lymphoma. N Eng J Med 2015 Dec 373:2499-511. doi: 10.1056/NEJMoa1505949
Wang HW, Yang W, Wang L, Lu YL, Lu JY. Composite diffuse large B-cell lymphoma and classical Hodgkin’s lymphoma of the stomach: Case report and literature review. World J Gastroenterol 2013 Oct doi:10.3748/wjg.v19.i37.6304
Nishioka A, Ureshino H, Ando T, Kizuka H, Kusaba K, Sano H, et al. Three coexisting lymphomas in a single patient: composite lymphoma derived from a common germinal center B‑cell precursor and unrelated discordant lymphoma. Int J Hematol 2017 Nov https://doi.org/10.1007/s12185-017-2370-6
Park J, Eun-Lee J, Kim M, Lim J, Kim Y, Han K, et al. Discordant lymphocyte-depleted classical Hodgkin’s and peripheral T-cell lymphoma arising in a patient 11 years after diagnosis of multicentric Castleman’s disease. Int J Hematol 2013 Jun doi: 10.1007/s12185-013-1358-0
Lloverasa N, Pleusaa E, Batllea M, Mateb JL. Linfoma compuesto. Med Clin (Barc) 2003;121(8):316-9
Vicente-Baz D, Ruiz-Borrego M, Medina M, Moreno-Nogueira JA. Linfoma Compuesto. Med Clin (Barc) 2003;120(6):236-9
Zhang C, Yi Y, Chen C, Wang J, Liu Z. Discordant lymphoma consisting of mediastinal large B-cell lymphoma and nodular sclerosis Hodgkin lymphoma in the right supraclavicular lymph nodes: a case report. Diagn Pathol Open Access 2015 Dec doi: 10.1186/s13000-015-0450-6
Coyne J, Kealy WF, Hogan F, Murphy C. Discordant lymphoma: a case report. Irish journal of medical science.1987:156(3):104-105.
Cannizzo E, Sohani AR, Ferry JA, Hochberg EP, Kluk MJ, Dorn ME, et al. Carcinoma and multiple lymphomas in one patient: establishing the diagnoses and analyzing risk factors. J Hematopathol. 2009 Jul 2:163–170 doi: 10.1007/s12308-009-0041-0
Shingaki S, Yoshiki Y, Yamamoto K, Ota Y,Suzuki K. Coexistent adrenal diffuse large B cell lymphoma in a patient with Waldenström’s macrogloblinemia/lymphoplasmacytic lymphoma. Ann Hematol 2016 Jun 95:1723–1724 doi:10.1007/s00277-016-2735-6
Pérez-Montanña A, Sancho JM, Mate JL, Ribera JM. Asociacio´n temporal de linfoma de Hodgkin y linfoma no hodgkiniano: estudio de 6 pacientes en un solo centro. Med Clin (Barc) 2012;139(15):694–697
Kendric K, Goyal G, Caponetti G. Synchronous Hodgkin Lymphoma and Diffuse Large B Cell Lymphoma: A Rare Coexistence. Abstract 605. Journal of Hospital Medicine [Internet] 2016 Mar [Citado 10 Jun 19];11 (suppl 1). Disponible en: https://www.shmabstracts.com/abstract/synchronous-hodgkinlymphoma-and-diffuse-large-b-cell-lymphoma-a-rarecoexistence