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M9460359.TXT
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1994-06-12
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Document 0359
DOCN M9460359
TI The interrelationship between Hodgkin's disease and non-Hodgkin's
lymphomas.
DT 9408
AU Jaffe ES; Zarate-Osorno A; Kingma DW; Raffeld M; Medeiros LJ;
Hematopathology Section, National Cancer Institute, National; Institutes
of Health, Bethesda, Maryland.
SO Ann Oncol. 1994;5 Suppl 1:S7-11. Unique Identifier : AIDSLINE
MED/94226948
AB BACKGROUND: While Hodgkin's disease (HD) and the non-Hodgkin's lymphomas
(NHLs) have long been regarded as distinct disease entities, recent
observations suggest a closer association. The analysis of cases in
which both diseases are present in the same anatomic site (composite
lymphomas), or in separate sites (simultaneous or sequential HD and
NHL), indicates that this phenomenon occurs more frequently than would
be expected by chance alone. DESIGN: We reviewed our experience with
composite, simultaneous, and sequential cases of HD and NHL, including
both nodular lymphocyte-predominant HD (NLPHD) and the other (so-called
'usual') subtypes of HD. Cases analyzed included 43 cases of NLPHD and
large-cell lymphoma (LCL); 14 cases of NHL following HD; 12 cases of
composite lymphoma; 2 cases of simultaneous HD and NHL involving
different sites; 8 cases of chronic lymphocytic leukemia (CLL) with
Reed-Sternberg (RS) cells; and 22 cases of HD following NHL.
Immunophenotypic analysis of both components (HD & NHL) was performed
when possible. In addition, in situ hybridization for Epstein-Barr virus
(EBV) EBER1 mRNA was performed in 35 cases of usual HD associated with
NHL. RESULTS: The most common form of composite lymphoma was coexistent
NLPHD with LCL of B-cell immunophenotype. With the abnormal cells of
NLPHD also being of B-cell lineage, this finding suggests the existence
of a clonal relationship between the two components. The association of
nodular sclerosis or mixed cellularity HD and NHL was less common but
still significant. The vast majority of the NHL associated with HD were
of B-cell origin, most commonly follicular lymphomas. EBV was identified
more frequently in the NHL of composite NHL + HD (4/12 cases; 33%) than
the other patient groups studied (2/23; 9%). Moreover, in 4/5 composite
lymphomas both the HD and NHL component were EBV-positive, suggesting an
origin from a common EBV-infected progenitor cell. CONCLUSION: These
findings suggest that, at least in some cases, HD may be clonally
related to an underlying B-cell malignancy, and that the Reed-Sternberg
cell may be an altered B lymphocyte. A process that may have a different
pathogenesis is the late occurrence of aggressive, usually EBV-negative
(12/14 cases), B-cell NHL in patients successfully treated for HD. Such
tumors may be related to an underlying and persistent immunodeficiency
in these patients, and may be of similar pathogenesis to the
Burkitt-like lymphomas associated with HIV-infection.
DE Diagnosis, Differential Hodgkin's Disease/*PATHOLOGY Human Leukemia,
Lymphocytic, Chronic/PATHOLOGY Lymphoma, Large-Cell/PATHOLOGY
Lymphoma, Non-Hodgkin's/*PATHOLOGY Neoplasms, Multiple
Primary/*PATHOLOGY JOURNAL ARTICLE REVIEW REVIEW, TUTORIAL
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).