Skip to main content
SpringerLink
Log in

Centroblastic lymphoma of the thyroid supervening long-lasting chronic lymphocytic leukemia (B-CLL) demonstration of biclonality by Immunohistochemical and gene rearrangement analysis

  • Case Reports
  • Published:
Klinische Wochenschrift Aims and scope Submit manuscript

Summary

A 67-year-old woman suffering since 5 years from a so far nontreated B-CLL underwent hemithyroidectomy for a rapidly enlarging tumor. Histologically, the coincidence of a centroblastic lymphoma and thyroidal infiltration by the CLL was diagnosed. Immunohistology revealed typical immunoprofils for both, B-CLL and centroblastic lymphoma on the background of B cell differentiation antigens. The bitypical immunoglobulin light chain expression — λ on the B-CLL cells and κ on the centroblasts — suggested biclonality. This was confirmed by gene rearrangement analysis of peripheral leukemia cells and tumor tissue. Thus, the final diagnosis of a primary thyroidal lymphoma of the centroblastic type (stage IE) arising independently from a preexisting B-CLL was achieved. Consequently, the patient received local radiotherapy.

In our opinion, the designation “Richter's Syndrome”, readily applied in the literature, is inappropriate for this tumor constellation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

AEC:

3-amino-9-ethylcarbazole

B-CLL:

B-chronic lymphocytic leukemia

CB:

centroblastic lymphoma

CD:

clusters of monoclonal antibodies to leucocyte differentiation antigens

References

  1. Anscombe AM, Wright DN (1985) Primary malignant lymphoma of the thyroid — a tumor of mucosa — associated lymphoid tissue: review of seventy-six cases. Histopathology 9:81–97

    Google Scholar 

  2. Baumann MA, Libnoch JA, Patrick CW, Choi H, Keller RH (1985) Prolonged survival in Richter's Syndrome with subsequent reemergence of CLL: A case report including serial cell-surface phenotypic analysis. Am J Hematol 20:67–72

    Google Scholar 

  3. Becker W, Müller HA, Reiners C, Wünsch PH, Schäffer R, Gunzer U, Börner W (1983) Malignant lyphoma and the thyroid gland. Tumor Diagnostik and Therapie 4:55–62

    Google Scholar 

  4. Bertoli LF, Kubagawa H, Borzillo GV, Mayumi M, Prchal JT, Kearney JF, Durant JR, Cooper MD (1987) Analysis with antiidiotype antibody of a patient with chronic lymphocytic leukemia and large cell lymphoma (Richter's Syndrome). Blood 70:45–50

    Google Scholar 

  5. Case Records of the Massachusetts General Hospital (Case 15 — 1987). N Engl J Med 316:931–938

  6. Davis JW, Weiss NS, Armstrong BK (1987) Second cancer in patients with chronic lymphocytic leukemia. J Nat Cancer Inst 78:91–94

    Google Scholar 

  7. Dörken B, Pezzutto A, Moldenhauer G, Schwartz R, Möller P (1987) B-cell antigens associated with activation: analysis of the Third International Workshop B-cell and activation antigen panel. In: McMichael AJ et al. (eds) Leucocyte Typing III. White Cell Differentiation Antigens, Oxford University Press, Oxford, pp 414–417

    Google Scholar 

  8. Dongen van JJM, Hooijkaas H, Michiels JJ, Grosveld G, de Klein A, van der Kwast ThH, Prius MEF, Abels J, Hagemeijer A (1984) Richter's Syndrome with different immunoglobulin light chains and different heavy chain gene rearrangements. Blood 64:573–574

    Google Scholar 

  9. Engleman EG, Warnke R, Fox RI, Levy R (1981) Studies of a human T lymphocyte antigen recognized by a monoclonal antibody. Proc Natl Acad Sci USA 78:1791–1795

    Google Scholar 

  10. Gerdes J, Schwab U, Lemke H, Stein H (1983) Production of a mouse monoclonal antibody reactive with a human nuclear antigen associated with cell proliferation. Int J Cancer 31:13–20

    Google Scholar 

  11. Greene MH, Wilson J (1985) Second cancer following lymphatic and hematopoetic cancers in Connecticut, 1935–1982. Natl Cancer Inst Monogr 68:191–217

    Google Scholar 

  12. Heslop HE, Fitzgerald PH, Beard MEJ (1987) Sustained complete remission in Richter's syndrome. Cancer 59:1036–1039

    Google Scholar 

  13. Holm LE, Blomgren H, Löwhagen T (1985) Cancer risks in patients with chronic lymphocytic thyroiditis. N Engl J Med 312:601–604

    Google Scholar 

  14. Kurec AS, Davey FR (1987) Impaired sythesis of immunoglobulin in patients with chronic lymphocytic leukemia. Am J Haematol 25:131–142

    Google Scholar 

  15. Long JC, Aisenberg AC (1975) Richter's Syndrome: a terminal complication of chronic lymphocytic leukemia with distinct clinicopathological features. Am J Clin Pathol 63:786–795

    Google Scholar 

  16. Maurer R, Taylor CR, Terry R, Lukes R (1979) Non-Hodgkin-lymphoma of the thyroid. Virchows Arch Pathol Anat 383:293–317

    Google Scholar 

  17. McDonnell JM, Beschorner WE, Staal SP, Spivak JL, Mann RB (1986) Richter's Syndrome with two different B cell clones. Cancer 58:2031–2037

    Google Scholar 

  18. Möller P, Moldenhauer G, Momburg F, Lämmler B, Eberlein-Gonska M, Kiesel S, Dörken B (1987) Mediastinal lymphoma of clear cell type is a tumor corresponding to terminal steps of B-cell differentiation. Blood 69:1087–1095

    Google Scholar 

  19. Moldenhauer G, Dörken B, Schwartz R, Pezzutto A, Hämmerling GJ, (1986) Characterization of a human B lymphocyte-specific antigen defined by monoclonal antibodies HD6 and HD39. In: Reinherz EL, Hynes BF, Nadler LM, Bernstein JD (eds) Leukocyte Typing II. Volume 2, Human B Lymphocytes, Springer, New York, pp 97–107

    Google Scholar 

  20. Nadler LM, Stashenko P, Hardy R, van Agthoven A, Terhorst C, Schlossman SF (1981) Characterization of a human B cell-specific antigen (B2) distinct from B1. J Immunol 126:1941–1947

    Google Scholar 

  21. Nadler LM (1986) B cell/leukemia workshop: Summary and comments. In: Reinherz EL, Haynes BF, Nadler LM, Bernstein JD (eds) Leucocyte Typing II. Volume 2, Human B Lymphocytes, Springer, New York, pp 3–43

    Google Scholar 

  22. Nowell P, Finan J, Glover D, Guerry D (1981) Cytogenetic evidence for the clonal nature of Richter's syndrome. Blood 58:183–186

    Google Scholar 

  23. Pezzutto A, Dörken B, Feller A, Moldenhauer G, Schwartz R, Wernet P, Thiel E, Hunstein W (1986) HD37 monoclonal antibody: A useful reagent for further characterization on “non-T, non-B” lymphoid malignancies. In: Reinherz EL, Haynes BF, Nadler LM, Bernstein ID (eds) Leucocyte Typing II. Volume 2, Human B Lymphocytes, Springer, New York, pp 391–403

    Google Scholar 

  24. Rai KR, Sawitsky A, Cronkite EP, Chanana A, Levy RN, Pasternak BS (1975) Clinical staging of chronic lymphocytic leukemia. Blood 46:219–234

    Google Scholar 

  25. Richter MN (1928) Generalized reticular cell sarcoma of lymphnodes associated with lymphocytic leukemia. Am J Pathol 4:285–292

    Google Scholar 

  26. Rigby P, Dieckmann M, Rhodes C, Berg P (1977) Labelling deoxyribonucleic acid to high specific activity in vitro by nick-translation with DNA polymerase I. J Mol Biol 113:237–251

    Google Scholar 

  27. Ritz J, Pesando JM, Notis-McConarty J, Schlossman SF (1980) Modulation of human acute lymphoblastic leukemia antigen induced by monoclonal antibody in vitro. J Immunol 125:1506–1514

    Google Scholar 

  28. Royston J, Majda JA, Baird SM, Meserve BL, Griffith JC (1980) Human T cell antigens defined by monoclonal antibodies. The 65.000 Dalton antigen of T cells (T65) on chronic lymphocytic leukemia cells bearing surface immunoglobulin. J Immunol 125:725–731

    Google Scholar 

  29. Schwarze E-W, Papadimitriou CS (1980) Non Hodgkin lymphoma of the thyroid. Path Res Pract 167:346–362

    Google Scholar 

  30. Sklar J, Cleary ML, Thielemans K, Gralow J, Warnke R, Levy R (1984) Biclonal B cell lymphoma. N Engl J Med 311:20–27

    Google Scholar 

  31. Southern E (1975) Detection of specific sequences among DNA fragments separated by gel electrophoresis. J Mol Biol 98:503–513

    Google Scholar 

  32. Splinter TAW, van Noorloos B, van Heerde P (1987) CLL and diffuse histiocytic lymphoma in one patient: clonal differentiation of two different B cells. Scand J Haematol 20:29–36

    Google Scholar 

  33. Stashenko P, Nadler LM, Hardy R, Schlossman SF (1981) Expression of cell surface markers after human B lymphocyte activation. Proc Natl Acad Sci USA 78:3848–3852

    Google Scholar 

  34. Suster S, Rywlin AM (1987) A reappraisal of Richter's Syndrome. Development of two phenotypically destinctive cell lines in a case of chronic lymphocytic leukemia. Cancer 59:1412–1418

    Google Scholar 

  35. Toner GC, Sinclair RA, Sutherland RC, Schwarz MA (1986) Composite lymphoma. Am J Clin Pathol 86:375–378

    Google Scholar 

  36. Trump DL, Mann RB, Phelbs R, Roberts H, Conley CL (1980) Richter's Syndrome: Diffuse histiocytic lymphoma in patients with chronic lymphocytic leukemia. A report of five cases and a review of the literature. Am J Med 68:539–548

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik, Abteilung V, Germany

    L. Trümper & W. Knauf

  2. Pathologisches Institut der Universität Heidelberg, Germany

    D. U. Matthaei-Maurer & P. Möller

Authors
  1. L. Trümper
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. U. Matthaei-Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Knauf
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Möller
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by the Tumorzentrum Heidelberg/Mannheim

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trümper, L., Matthaei-Maurer, D.U., Knauf, W. et al. Centroblastic lymphoma of the thyroid supervening long-lasting chronic lymphocytic leukemia (B-CLL) demonstration of biclonality by Immunohistochemical and gene rearrangement analysis. Klin Wochenschr 66, 736–742 (1988). https://doi.org/10.1007/BF01726417

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01726417

Key words

Search

Navigation