Lymphoma and plasma cell neoplasms
B cell lymphoma subtypes
Composite lymphoma (CL)

Author: Guang (Geoff) Yang, M.D., Ph.D. (see Authors page)
Editor: Fouad Abdelhalim, M.D.

Revised: 26 June 2017, last major update June 2017

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: Composite lymphoma [title]

Cite this page: Composite lymphoma (CL). PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/lymphomacompositelymphoma.html. Accessed November 20th, 2017.
Definition / general
  • Defined as two or more morphologically and immunophenotypically distinct lymphomas or lymphoid neoplasms that occur in the same organ or tissue site (Cancer 1977;40:959)
Essential features
  • Two or more distinct lymphomas or lymphoid neoplasms in the same location
  • 1 - 4.7% of all lymphomas
  • One lymphoma component often overshadows the other component
  • Ancillary studies very helpful
Terminology
Epidemiology
  • Accounts for 1% to 4.7% of all lymphomas (J Clin Exp Hematop 2016;56:55)
  • Combinations include (Am J Clin Pathol 2005;123:215):
    • Hodgkin lymphoma (HL) with a B cell or a T cell non-Hodgkin lymphoma (NHL)
    • B cell NHL with a T cell NHL
    • 2 distinct B cell or T cell NHLs at the same anatomic site
  • Most reported cases are B cell lymphoma composite with a Hodgkin lymphoma or two composite B cell lymphomas of different types (Hum Pathol 2014;45:768)
  • Few cases of combined classic and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) also described (Ann Oncol 1994;5 Suppl 1:7)
Sites
  • Lymph node is the most common involved anatomic site
  • Also spleen or other extranodal sites including GI, respiratory system, salivary glands, bone, skin, liver and bone marrow (J Egypt Natl Canc Inst 2007;19:171)
Etiology
  • For composite B cell lymphoma (J Egypt Natl Canc Inst 2007;19:171):
    1. Clonal selection
    2. Genomic instability and congenital predisposition
    3. Common precursor cell
  • For composite B cell NHL and HL: common precursor cell origin (J Egypt Natl Canc Inst 2007;19:171)
  • For composite T cell lymphoma with HL or B cell lymphoma:
    • EBV infection in B cells or RS cells causes reactive T cell proliferation
    • T cell neoplasm first provokes a B cell response with a pathogenic role for EBV; such B cells infected with EBV later transform to RS cells of Hodgkin lymphoma
    • A state of immunosuppression associated with some cases of T cell lymphoma lead to a prominent EBV associated B cell proliferation
    • Origin: (a) from a common EBV infected progenitor cell, (b) from the same clonal IgH gene rearrangement, (c) totally coincidental existence of two independent de novo neoplastic growth with two separate histogenic processes (J Egypt Natl Canc Inst 2007;19:171)
  • For composite AITL and B cell lymphoma:
    • The neoplastic cells in AITL produce B cell stimulatory factors leading to a continuous stimulation of B cells and promoting their malignant transformation
    • EBV is known to be associated with AITL and this specific microenvironment might be associated with the increasing risk of development of an EBV positive B cell lymphoma
    • TET2 mutations are commonly seen in AITL T cell tumor clones
      • These mutations have been identified in some monocytes and hemopoietic precursor cells and might also be shared by the B cell clones
      • As such, this genetic lesion might cause the simultaneous development of both T and B cell lymphomas (Lancet Oncol 2014;15:e435)
    • Chronic exposure to common antigens or carcinogens simultaneously stimulates or transforms B and T cells lineages (Hum Pathol 2014;45:768)
Clinical features
  • Seen in wide age range (26 - 88 years) but more common in elderly people with male predominance (2.5:1)
  • Presents either as concurrent or sequential (metachronous) disease in the same organ
  • In case of sequential disease, the second malignancy may be identified with recurrence of the primary type (J Egypt Natl Canc Inst 2007;19:171)
Diagnosis
  • Biopsy (usually lymph nodes) investigated with morphological, immunohistochemical and molecular techniques
  • The morphological criteria include cytological features of the tumor cells and the bystander cells and the growth pattern of the lymphoma (Lancet Oncol 2014;15:e435)
  • Diagnosis can be challenging because one lymphoma component often overshadows the other component
  • Ancillary studies, such as flow cytometry, immunohistochemistry, oncogenic virus tests, (such as EBV, cytogenetic study and molecular tests) can be very helpful in detection of masked neoplastic components (Hum Pathol 2014;45:768)
Prognostic factors
Case reports
Treatment
  • Overall therapeutic strategy needs to consider both disease components and the treatment goals vary dependent on the histological subtype for lymphomas (Lancet Oncol 2014;15:e435)
Microscopic (histologic) images

Images hosted on other servers:

Composite mantle cell lymphoma and CLL / SLL

Flow cytometry description
  • Usefulness of multiparametric flow cytometry in detecting composite lymphoma: study of 17 cases in a 12 year period (Am J Clin Pathol 2011;135:541)
  • Multiparameter flow cytometry is necessary for detection, characterization and diagnostics of composite mature B cell lymphoproliferative neoplasms (Int J Hematol 2013;98:589)
Differential diagnosis