Coexistence of follicular lymphoma and an unclassifiable myeloproliferative neoplasm in a treatment-naïve patient: 
A case report

Jeong,Gyeongmin; Kim,Jinhyong; Han,Seeun; Lee,Jongmin; Park,Kyunghye; Pak,Chuiyong; Lim,Ji‑Hun; Cha,Hee  Jeong; Kim,Hawk; Jo,Jae‑Cheol

doi:10.3892/ol.2015.4040

Coexistence of follicular lymphoma and an unclassifiable myeloproliferative neoplasm in a treatment-naïve patient: A case report

Authors:
- Gyeongmin Jeong
- Jinhyong Kim
- Seeun Han
- Jongmin Lee
- Kyunghye Park
- Chuiyong Pak
- Ji‑Hun Lim
- Hee Jeong Cha
- Hawk Kim
- Jae‑Cheol Jo
View Affiliations

Affiliations: Department of Internal Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682‑714, Republic of Korea, Department of Laboratory Medicine, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682‑714, Republic of Korea, Department of Pathology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682‑714, Republic of Korea, Department of Hematology and Oncology, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan 682‑714, Republic of Korea
Published online on: December 21, 2015 https://doi.org/10.3892/ol.2015.4040
Pages: 1469-1473

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Myeloproliferative neoplasms are associated with lymphoproliferative diseases following the administration of cytotoxic drugs or exposure to radiation, but are rare prior to therapy. The present study reports the case of a 61‑year‑old female with a history of transient ischemic attack. The patient, who presented with a palpable mass in the epitrochlear area of the left arm, was simultaneously diagnosed with follicular lymphoma and an unclassifiable myeloproliferative neoplasm. Excisional lymph node biopsy revealed stage I follicular lymphoma (grade 1). Laboratory findings demonstrated leukocytosis, erythrocytosis, thrombocytosis and decreased erythropoietin. Biopsy of the bone marrow revealed hypercellularity, with predominance of erythroid cells, and large polylobated megakaryocytes with increased mitotic figures, but no evidence of lymphomatous infiltration. The janus kinase 2 V617F mutation was also detected in the cells derived from the bone marrow specimen. Following local excision of the lymph node in the left epitrochlear area, radiation was delivered to the involved field, at a dose of 24 Gy in 12 fractions. The patient was started on hydroxyurea (1 g twice per day, orally) 2 weeks subsequent to radiotherapy, and was administered 500 mg twice per day as maintenance therapy. At the six‑month follow‑up, the white blood cell count, hemoglobin levels and platelet count had reduced, and the patient was in a healthy condition. A computed tomography scan of the neck, chest and abdomen indicated no abnormalities. To the best of our knowledge, the present study is the first case report of follicular lymphoma coexisting with an unclassifiable myeloproliferative neoplasm in a previously healthy patient. Molecular and genetic studies are required to further evaluate this infrequent disease association.

View Figures

View References

1	Freedman A: Follicular lymphoma: 2014 update on diagnosis and management. Am J Hematol. 89:429–436. 2014. View Article : Google Scholar : PubMed/NCBI
2	Morton LM, Wang SS, Devesa SS, Hartge P, Weisenburger DD and Linet MS: Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood. 107:265–276. 2006. View Article : Google Scholar : PubMed/NCBI
3	Guadagnolo BA, Li S, Neuberg D, Ng A, Hua L, Silver B, Stevenson MA and Mauch P: Long-term outcome and mortality trends in early-stage, Grade 1-2 follicular lymphoma treated with radiation therapy. Int J Radiat Oncol Biol Phys. 64:928–934. 2006. View Article : Google Scholar : PubMed/NCBI
4	Advani R, Rosenberg SA and Horning SJ: Stage I and II follicular non-Hodgkin's lymphoma, long-term follow-up of no initial therapy. J Clin Oncol. 22:1454–1459. 2004. View Article : Google Scholar : PubMed/NCBI
5	Hiddemann W, Kneba M, Dreyling M, Schmitz N, Lengfelder E, Schmits R, Reiser M, Metzner B, Harder H, Hegewisch-Becker S, et al: Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: Results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood. 106:3725–3732. 2005. View Article : Google Scholar : PubMed/NCBI
6	Marcus R, Imrie K, Belch A, Cunningham D, Flores E, Catalano J, Solal-Celigny P, Offner F, Walewski J, Raposo J, et al: CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood. 105:1417–1423. 2005. View Article : Google Scholar : PubMed/NCBI
7	Marcus R, Imrie K, Solal-Celigny P, Catalano JV, Dmoszynska A, Raposo JC, Offner FC, Gomez-Codina J, Belch A, Cunningham D, et al: Phase III study of R-CVP compared with cyclophosphamide, vincristine, and prednisone alone in patients with previously untreated advanced follicular lymphoma. J Clin Oncol. 26:4579–4586. 2008. View Article : Google Scholar : PubMed/NCBI
8	Dickstein JI and Vardiman JW: Hematopathologic findings in the myeloproliferative disorders. Semin Oncol. 22:355–373. 1995.PubMed/NCBI
9	Tefferi A and Barbui T: Polycythemia vera and essential thrombocythemia: 2015 update on diagnosis risk-stratification and management. Am J Hematol. 90:162–173. 2015. View Article : Google Scholar : PubMed/NCBI
10	Montefusco E, Fazi F, Cordone I, Ariola C, Nanni M, Spadea A, Spiriti MA, Fenu S, Mandelli F, Petti MC, et al: Molecular remission following high-dose hydroxyurea and fludarabine plus cytarabine in a patient with simultaneous acute myeloid leukemia and low-grade lymphoma. Leuk Lymph. 40:671–674. 2001. View Article : Google Scholar
11	De Souza Ornellas MH, de Souza Fernandez T, Diamond HR, Maioli MC, Pitanga Bacha PC and De Lucena SB: Cytogenetic and immunophenotypic evidence of independent clonal origins of concomitant chronic lymphocytic leukaemia and acute myeloid leukaemia. Eur J Haematol. 66:281–283. 2001. View Article : Google Scholar : PubMed/NCBI
12	Solal-Céligny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R, Au WY, Bellei M, Brice P, Caballero D, et al: Follicular lymphoma international prognostic index. Blood. 104:1258–1265. 2004. View Article : Google Scholar : PubMed/NCBI
13	Friedberg JW, Byrtek M, Link BK, Flowers C, Taylor M, Hainsworth J, Cerhan JR, Zelenetz AD, Hirata J and Miller TP: Effectiveness of first-line management strategies for stage I follicular lymphoma, Analysis of the National LymphoCare Study. J Clin Oncol. 30:3368–3375. 2012. View Article : Google Scholar : PubMed/NCBI
14	Rizzi R, Liso A, Pannunzio A, Carluccio P, Specchia G and Liso V: Concomitant primary polycythemia vera and follicle center cell non-Hodgkin lymphoma, A case report and review of the literature. Leuk Lymph. 43:2217–2220. 2002. View Article : Google Scholar
15	Guzzini F, Cozzi C, Gasparini P, Giussani R and Tomasi A: Spontaneous association of a chronic lympho- and myeloproliferative disease in the same patient. Histopathology. Recenti Prog Med. 79:365–369. 1988.PubMed/NCBI
16	Kurchan A, Somoza N, Pascuccelli H, Mide S, Padros MR, Santiago J, Satz ML and Fainboim L: T lymphoma of immature phenotype associated with polycythemia vera. Medicina (B Aires). 51:151–154. 1991.PubMed/NCBI
17	Cottrill C, Geller A, diSpaltro FX, Weissglass B, Klainer AS and Bisaccia E: Control of polycythaemia vera with photochemotherapy in a patient with cutaneous T-cell lymphoma. Br J Haematol. 86:225–226. 1994. View Article : Google Scholar : PubMed/NCBI
18	Stolinsky DC: Twelve-year remission of polycythemia vera followingH odgkin's disease and chemotherapy. CA Cancer J Clin. 31:57–60. 1981. View Article : Google Scholar : PubMed/NCBI
19	Chievitz E and Thiede T: Complications and causes of death in polycythaemia vera. Acta Medica Scand. 172:513–523. 1962. View Article : Google Scholar
20	Patrono C, Rocca B and De Stefano V: Platelet activation and inhibition in polycythemia vera and essential thrombocythemia. Blood. 121:1701–1711. 2013. View Article : Google Scholar : PubMed/NCBI
21	Hensley B, Geyer H and Mesa R: Polycythemia vera, Current pharmacotherapy and future directions. Expert Opin Pharmacother. 14:609–617. 2013. View Article : Google Scholar : PubMed/NCBI
22	Oh ST and Gotlib J: JAK2 V617F and beyond: Role of genetics and aberrant signaling in the pathogenesis of myeloproliferative neoplasms. Expert Rev Hematol. 3:323–337. 2010. View Article : Google Scholar : PubMed/NCBI
23	Muxi PJ and Oliver AC: Jak-2 positive myeloproliferative neoplasms. Curr Treat Options Oncol. 15:147–156. 2014. View Article : Google Scholar : PubMed/NCBI
24	Cross NC: Genetic and epigenetic complexity in myeloproliferative neoplasms. Hematology Am Soc Hematol Educ Program. 2011:208–214. 2011. View Article : Google Scholar : PubMed/NCBI
25	Jones AV, Kreil S, Zoi K, Waghorn K, Curtis C, Zhang L, Score J, Seear R, Chase AJ, Grand FH, et al: Widespread occurrence of the JAK2 V617F mutation in chronic myeloproliferative disorders. Blood. 106:2162–2168. 2005. View Article : Google Scholar : PubMed/NCBI
26	Ceesay MM, Lea NC, Ingram W, Westwood NB, Gäken J, Mohamedali A, Cervera J, Germing U, Gattermann N, Giagounidis A, et al: The JAK2 V617F mutation is rare in RARS but common in RARS-T. Leukemia. 20:2060–2061. 2006. View Article : Google Scholar : PubMed/NCBI
27	Levine RLI, Loriaux M, Huntly BJ, Loh ML, Beran M, Stoffregen E, Berger R, Clark JJ, Willis SG, Nguyen KT, et al: The JAK2V617F activating mutation occurs in chronic myelomonocytic leukemia and acute myeloid leukemia, but not in acute lymphoblastic leukemia or chronic lymphocytic leukemia. Blood. 106:3377–3379. 2005. View Article : Google Scholar : PubMed/NCBI
28	Kuroda HI, Abe T, Jomen W, Yoshida≈ M, Matsuno T, Sato M, Yamada M, Sakurai T, Fujii S, Maeda M, et al: [Follicular lymphoma complicated with myelofibrosis and macroglobulinemia at initial presentation]. Rinsho ketsueki. 54:2068–2073. 2013.(In Japanese). PubMed/NCBI
29	Vannucchi AM, Masala G, Antonioli E, Susini MC, Guglielmelli P, Pieri L, Maggi L, Caini S, Palli D, Bogani C, et al: Increased risk of lymphoid neoplasms in patients with Philadelphia chromosome-negative myeloproliferative neoplasms. Cancer Epidemiol Biomarkers Prev. 18:2068–2073. 2009. View Article : Google Scholar : PubMed/NCBI
30	Rumi E, Passamonti F, Elena C, Pietra D, Arcaini L, Astori C, Zibellini S, Boveri E, Pascutto C and Lazzarino M: Increased risk of lymphoid neoplasm in patients with myeloproliferative neoplasm, A study of 1,915 patients. Haematologica. 96:454–458. 2011.(In Italian). View Article : Google Scholar : PubMed/NCBI