Ann Lab Med.  2023 Mar;43(2):200-203. 10.3343/alm.2023.43.2.200.

A Patient With CD20-positive T-cell Lymphoma Concurrently Exhibiting B-cell Neoplasm-related Genetic Abnormalities Shows Clonal Escape Post CD20-targeting Treatment

• Kim J
• Kim M
• Cho YU
• Hwang SH
• Jang S
• Seo EJ
• Yoon DH
• Go H
• Park CJ

• KMID: 2551698
• DOI: http://doi.org/10.3343/alm.2023.43.2.200

Figure

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  Fig. 1 Analysis and karyotyping of the patient. At the time of initial diagnosis, immunohistochemical staining of a BM biopsy sample was performed for (A) CD3 (100×) and (B) CD20 (100×), and flow-cytometric immunophenotyping of a peripheral blood sample was performed for (C) CD45 (with side scatter plot), (D) CD3 and CD20, (E) CD5 and CD20, and (F) CD3 and CD4. The karyotype at the time of diagnosis (G) was 44,XX,der(1)del(1)(p13p21)add(1)(q12),?add(8)(q24.3),der(8)t(8;15)(p23;q15),-10,der(11)t(1;11)(q12;q22),del(13)(q14q21),-15,del(16)(q22),add(17)(p13)[15]/46,XX[15]. The black arrows indicate the breakpoint in structural abnormalities. After CD20-targeted therapy, immunohistochemical analysis of a BM biopsy was performed for (H) CD3 (100×) and (I) CD20 (100×); flow-cytometric immunophenotyping of the BM was performed for (J) CD20 and (K) CD3 and CD4, whereas flow cytometric immunophenotyping of pleural fluid was performed for (L) CD3 and CD20 and (M) CD3 and CD4. Abbreviation: BM, bone marrow.

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  Fig. 2 Suggested model describing the clonal evolution of our patient’s immunophenotype. The horizontal axis represents time and vertical axis represents the relative tumor burden. The black and blue arrows at the top indicate the times at which BM examinations and pleural fluid analysis were performed, respectively. The therapy regimens that the patient received in the respective time periods are highlighted in green and blue. Abbreviation: BM, bone marrow.

Reference

1. Yao X, Teruya-Feldstein J, Raffeld M, Sorbara L, Jaffe ES. 2001; Peripheral T-cell lymphoma with aberrant expression of CD79a and CD20: a diagnostic pitfall. Mod Pathol. 14:105–10. DOI: 10.1038/modpathol.3880265. PMID: 11235901.

2. Mangogna A, Cox MC, Ruco L, Lopez G, Belmonte B, Di Napoli A. 2020; Rituximab plus chemotherapy provides no clinical benefit in a peripheral T-cell lymphoma not otherwise specified with aberrant Expression of CD20 and CD79a: a case report and review of the literature. Diagnostics (Basel). 10:341. DOI: 10.3390/diagnostics10060341. PMID: 32466492. PMCID: PMC7344438.

3. Imai M, Jiang JG, Wu Z, Dabbas B, Ni H. 2013; CD20-positive T-cell lymphoma involving bone marrow: report of four cases. J Hematopathol. 6:201–5. DOI: 10.1007/s12308-013-0177-9.

4. Manso R, Rodríguez-Pinilla SM, González-Rincón J, Gómez S, Monsalvo S, Llamas P, et al. 2015; Recurrent presence of the PLCG1 S345F mutation in nodal peripheral T-cell lymphomas. Haematologica. 100:e25–7. DOI: 10.3324/haematol.2014.113696. PMID: 25304611. PMCID: PMC4281331.

5. The Atlas of Genetics and Cytogenetics in Oncology and Haematology. https://atlasgeneticsoncology.org/. Updated on Aug 2022.

6. Magro CM, Seilstad KH, Porcu P, Morrisson CD. 2006; Primary CD20+CD10+ CD8+ T-cell lymphoma of the skin with IgH and TCR beta gene rearrangement. Am J Clin Pathol. 126:14–22. DOI: 10.1309/HPYGFLNXKFBHDQEV. PMID: 16753590.

7. Zhang Y, Wang K, Tan Q, Yang K, Wu D, Xu Y, et al. 2021; Primary breast CD20-positive extranodal NK/T cell lymphoma with stomach involvement: a case report and literature review. Diagn Pathol. 16:103. DOI: 10.1186/s13000-021-01166-4. PMID: 34749754. PMCID: PMC8573996.

8. Lazzi S, Bellan C, Onnis A, De Falco G, Sayed S, Kostopoulos I, et al. 2009; Rare lymphoid neoplasms coexpressing B- and T-cell antigens. The role of PAX-5 gene methylation in their pathogenesis. Hum Pathol. 40:1252–61. DOI: 10.1016/j.humpath.2009.01.007. PMID: 19368954.

9. van Dongen JJ, Langerak AW, Brüggemann M, Evans PAS, Lavender FL, Delabesse E, et al. 2003; Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia. 17:2257–317. DOI: 10.1038/sj.leu.2403202. PMID: 14671650.

10. Shao Y, Bai C, Sun J, Goa X. 2018; T-cell lymphoma with abundant CD20 expression showing a good response to rituximab with gemcitabine, oxiplatin, and L-asparaginase (R-pGEMOX): A case report. Medicine (Baltimore). 97:e0199. DOI: 10.1097/MD.0000000000010199. PMID: 29561444. PMCID: PMC5895354.