Yc. Liu et al., COMPOSITE CUTANEOUS T-CELL LYMPHOMA AND SMALL B-CELL LYMPHOCYTIC LYMPHOMA - MORPHOLOGIC, IMMUNOLOGICAL, AND MOLECULAR-GENETIC DOCUMENTATIONOF CONCURRENT LYMPH-NODE INVOLVEMENT, Modern pathology, 7(6), 1994, pp. 641-646
Synchronous cutaneous T-cell lymphoma and low-grade B-cell lymphoproli
ferative disorders have rarely been reported in the same patient. Coex
pression of each phenotype in the same lymph node has not, to our know
ledge, been previously documented. We describe an 86-year-old man with
chronic pruritus and erythroderma and recent-onset peripheral lymphad
enopathy and lymphocytosis. Lymph node biopsy provided morphological a
nd immunohistochemical evidence of concurrent small B lymphocytic lymp
homa and small pleomorphic T-cell lymphoma. Immunophenotyping of nodal
lymphocytes demonstrated two distinct clones: IgM-k B-cells with CD5
positivity and CD7 negative T-helper cells. Both immunoglobulin (heavy
and light chains) and T-cell receptor (beta I and beta II) gene rearr
angements were detected by Southern blot analysis of the lymph node. I
n contrast, the immunophenotype of lymphocytes from peripheral blood a
nd bone marrow was exclusively that of T-helper cells with atypical CD
7 deletion. Electron microscopic examination of circulating lymphocyte
s revealed small cerebriform Sezary cells. This case demonstrates that
small lymphocytic lymphoma may coexist intranodally with cutaneous T-
cell lymphoma as a unique form of composite T-and B-cell lymphoma.