SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Two Lymphomas in a Single Lymph Node

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This report describes a rare case of composite lymphoma, in which two distinct lymphomas are found in the same tissue site. A 71-year-old man presented with abdominal pain, polyuria, night sweats, poor appetite, fatigue, and constipation. Imaging showed extensive lymphadenopathy above and below the diaphragm, raising concern for lymphoma or metastatic disease.<br /><br />An excisional biopsy of a supraclavicular lymph node revealed two malignancies within the same node: follicular large-cell lymphoma, grade IIIa, and focal classic Hodgkin’s lymphoma. Flow cytometry supported a CD10-positive B-cell non-Hodgkin lymphoma. After review by pathologists and oncologists, the diagnosis was determined to be composite lymphoma, specifically follicular lymphoma transformed to diffuse large B-cell lymphoma plus Hodgkin’s lymphoma, stage IIIB, rather than gray zone lymphoma.<br /><br />Because composite lymphoma is rare and lacks a standard treatment approach, the patient was started on aggressive inpatient chemotherapy with dose-adjusted EPOCH, later modified to DA-R-EPOCH after CD20 positivity was identified. The plan was for six 21-day cycles. After five cycles, the patient had significant clinical improvement, returned to baseline function, and remained asymptomatic. A PET scan after cycle 3 showed persistent adenopathy but substantial response to treatment.<br /><br />The case highlights the diagnostic and therapeutic challenges of composite lymphoma, especially when two lymphoma types occur in the same lymph node. It also emphasizes the need for more data to guide management, although this patient has responded well so far.

Asset Subtitle

Tyler Brazee

Meta Tag

Author List Anthony Dominick, Meredith Holt, Tyler Brazee

Category Clinical Vignettes

Concept Composite Lymphoma

Concept Excisional Biopsy

Concept Lymphoma

Concept Imaging

Concept Flow Cytometry

Distinguished Non-Finalist

Presenter Organization Novant New Hanover Regional Medical Center

Presenting Author Tyler Brazee

Track Adult

Keywords

composite lymphoma

follicular lymphoma

Hodgkin lymphoma

diffuse large B-cell lymphoma

lymphadenopathy

supraclavicular lymph node

CD10-positive

DA-R-EPOCH

PET scan

stage IIIB

Composite Lymphoma

Excisional Biopsy

Lymphoma

Imaging

Flow Cytometry