Simultaneous development of Philadelphia chromosome-positive and -negative leukemias in the same patient

✍ Scribed by Sarit Assouline; Valerie Benemacher; Carlo Gambacorti-Passerini

• Publisher: John Wiley and Sons
• Year: 2006
• Tongue: English
• Weight: 205 KB
• Volume: 81
• Category: Article
• ISSN: 0361-8609
• DOI: 10.1002/ajh.20629

✦ Synopsis

To the Editor: Primary tonsillary lymphoma accounts for less than 1% of head and neck malignancies. Tonsillectomy is used to mainly establish the diagnosis and can be performed for localized small lesions. In general, the patients are treated by chemotherapy and/or radiotherapy [1,2].

We present a 23-year-old woman who was referred to our ENT clinic with asymmetric tonsillary enlargement and acute bleeding. Tonsillectomy was performed. In paraffin sections; a tumor composed of large lymphoid cells that were positive for CD20, bcl-2, and p53 by immunohistochemistry was identified. Ki-67 index was roughly 80% (Figure ). Polymerase chain reaction for immunoglobulin gene rearrangements was performed using DNA extracted from paraffin-embedded tissue and showed a single band indicating the presence of a clonal B cell proliferation. A diagnosis of ''Diffuse Large B Cell Lymphoma'' was rendered. No clinical or radiological evidence for tumor involvement in any other site was identified and the patient was accepted as Stage I clinically. The patient did not accept any further treatment. The patient was followed periodically every 6 months. Recurrence or systemic involvement was not observed during the 5-year-follow-up.

This case is unusual since only tonsillectomy was curative. In general, radiation therapy is considered the primary mode of therapy for localized disease in tonsil lymphomas (stages I and II) [3,4]. In one study, Jelic et al. reported a cure rate of 80% among their stage I NHL patients, who they followed without any therapy. In light of their experience as well as our observation, therapy options for localized NHL cases should be re-evaluated.