Clinical Report: Coexisting Diffuse Large B-Cell Lymphoma and Splenic PTCL

Overview

This case study presents a 71-year-old man with coexisting diffuse large B-cell lymphoma (DLBCL) and peripheral T-cell lymphoma (PTCL), highlighting the diagnostic challenges posed by atypical clinical manifestations such as persistent splenomegaly and cytopenia, which led to the discovery of the second lymphoma after splenectomy.

Background

Composite and discordant lymphomas, particularly those involving B-cell and T-cell lineages, are rare but clinically significant due to their potential to alter diagnostic interpretation and treatment planning. Persistent splenomegaly and cytopenia in patients with DLBCL may mask the presence of a second lymphoma, complicating management.

Data Highlights

Key Findings

• A 71-year-old man presented with symptoms including fever, splenomegaly, and cytopenia.
• Initial diagnosis was stage IVB DLBCL, confirmed by bone marrow and immunohistochemistry.
• Persistent thrombocytopenia and splenomegaly led to a splenectomy, revealing peripheral T-cell lymphoma.
• Subsequent treatment included R-GemOx and R-ICE with zanubrutinib, but the patient experienced multiple relapses.
• The case illustrates the importance of repeat tissue sampling when atypical symptoms arise during lymphoma treatment.

Clinical Implications

Healthcare professionals should consider the possibility of coexisting lymphomas in patients with atypical presentations, particularly when persistent splenomegaly and cytopenia are present.

Conclusion

This case highlights the necessity of integrated pathological reassessment in patients with discordant lymphoma presentations to ensure accurate diagnosis.

Related Resources & Content

1. Author(s)/Org, Source, Year -- Title
2. First Results of Phase III OLYMPIA-3: Odronextamab Plus CHOP in Untreated DLBCL - The ASCO Post
3. Frontiers in Oncology — Coexistence of lymphoplasmacytic lymphoma and multiple myeloma: a case report and review of literature
4. Frontiers in Oncology — Concurrent B-cell acute lymphoblastic leukemia and plasma cell neoplasm with plasmablastic features supporting divergent evolution from a shared precursor: a case report
5. Blood Cancer Journal — Multi-Omics Analysis of Three Hematological Cancers in a Patient Identifies Their Origin from Clonal Hematopoietic Stem Cells
6. Infection — Surprising Co-Infections Acquired in the Community During a Continuing Pandemic: An Overabundance of Concurrent Diagnoses
7. Large B-cell lymphoma (LBCL): EHA Clinical Practice Guidelines for diagnosis, treatment, and follow-up - The European Hematology Association (EHA)
8. First Results of Phase III OLYMPIA-3: Odronextamab Plus CHOP in Untreated DLBCL - The ASCO Post
9. Frontiers | Unusual symptoms reveal a rare splenic lymphoma: a case report of PS-DLBCL with neck and shoulder pain as the initial presentation