Researchers presented a very rare case of an elderly woman with T-cell lymphoma with concurrent acute monoblastic leukemia (AMoL) and diffuse large B-cell lymphoma (DLBCL) in a study published in the Annals of Dermatology.
In this case, a 70-year-old woman was referred to a dermatologist with multiple skin lesions on her legs. She was previously diagnosed with DLBCL in her stomach, and myelodysplastic syndrome (MDS) by biopsy. She underwent chemotherapy, and following four cycles of chemo, she achieved full remission of DLBCL, but suffered a relapse in her small bowel three years later.
The patient then underwent an additional four rounds of chemo, but only achieved partial remission, and her complete blood cell counts showed an abnormal increase in white blood cells, suggesting leukemia. Following a bone marrow biopsy, she was diagnosed with progression of MDS to AMoL.
During chemo to treat the leukemia, she developed skin lesions on her lower legs, and dark-colored papules and nodules. The researchers noted that the woman had diffuse, dense, atypical lymphocytic infiltration throughout the entire dermis. Immunohistochemical stains revealed positive results for CD3, CD4, and CD5, and negative results for CD20, CD138, CD8, Bcl2, PAX-5, MPO, and C-kit. A terminal deoxynucleotidyl transferase (TdT) stain was performed to differentiate precursor T-cell lymphoblastic leukemia/lymphoma, which showed a negative result; however, a re-biopsy of the patient’s bone marrow still showed monoblastic proliferation. The researchers noted that according to the World Health Organization-European Organisation for Research and Treatment of Cancer classification, her diagnosis was most likely to be primary cutaneous peripheral T-cell lymphoma, unspecified.
Ergo, the coexistence of three different types of malignancies—cutaneous T-cell lymphoma (CTCL), AMoL, and DLBCL—was most likely, rather than a switch from myeloid to lymphoid leukemia. Unfortunately, during chemotherapy, the patient died due to sepsis.
“In conclusion, coexistence of CTCL, AMoL, and DLBCL is extremely rare. It is difficult to conclude whether a CTCL involves a lineage switch from AMoL or another primary neoplasm due to the lack of further evaluation, but it seems more likely to be CTCL accompanied by AMoL and DLBCL rather than a lineage switch,” the researchers concluded.