PERIPHERAL T-CELL NON-HODGKINS-LYMPHOMA FOLLOWING TREATMENT OF NODULAR LYMPHOCYTE PREDOMINANCE HODGKINS-DISEASE

Previous reports have suggested that nodular lymphocyte predominance H odgkin's disease (NLPHD) is a germinal center-derived B-cell lymphoma that is distinct from other types of Hodgkin's Disease. A relationship between NLPHD and simultaneous or subsequent development of large-cel l (LC) non-Hodgkin's lymphoma (NHL) has been established. Both Reed-St ernberg cell variants in NLPHD and NHL cells in these cases express B- cell-associated antigens, and in some cases the B-cell lineage of the NHL has been confirmed by immunoglobulin gene rearrangement studies. T he B-cell phenotype and the indolent course of both lymphomas suggest histologic progression of NLPHD to B-cell NHL, rather than a de novo L CNHL unrelated to Hodgkin's Disease. We report a unique case of T-larg e-cell lymphoma (TLCL) following successful chemotherapy of NLPHD. A 5 4-year-old male was treated with seven cycles of mechlorethamine, vinc ristine, procarbazine, prednisone chemotherapy for NLPHD and 4 years l ater developed recurrent adenopathy. Lymph node biopsy showed a diffus e LCNHL. Frozen section immunotyping and gene rearrangement studies co nfirmed the diagnosis of TLCL. To our knowledge, this case represents only the second report of TLCL associated with NLPHD and is of signifi cance in that: (1) it demonstrates that T-cell neoplasia can occur in the setting of NLPHD; (2) this case does not appear to represent histo logic progression of NLPHD and most likely represents de novo disease that may be secondary to chemotherapy; and (3) the clinical course may differ from the favorable prognosis seen in NLPHD associated with B-c ell NHL.