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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Coexistence of diffuse large B-cell lymphoma, acute myeloid leukemia, and untreated lymphoplasmacytic lymphoma/waldenström macroglobulinemia in a same patient: A case report
Liu-Bo Zhang, Lu Zhang, Hong-Lei Xin, Yan Wang, Hong-Yu Bao, Qing-Qi Meng, Su-Yu Jiang, Xue Han, Wan-Ru Chen, Jian-Ning Wang, Xiao-Feng Shi
Liu-Bo Zhang, Lu Zhang, Hong-Lei Xin, Hong-Yu Bao, Qing-Qi Meng, Su-Yu Jiang, Xue Han, Wan-Ru Chen, Jian-Ning Wang, Xiao-Feng Shi, Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
Yan Wang, Department of Pathology, Second Affiliated Hospital of Nanjing Medical University, Nanjing 210003, Jiangsu Province, China
Author contributions: Zhang LB collected the sample and analyzed the clinical data; Zhang L analyzed the morphology of bone marrow; Xin HL collected the sample and performed gene sequencing; Wang Y analyzed the histopathology of tissue; Bao HY, Meng QQ, Jiang SY, Han X, and Chen WR analyzed the clinical data; Wang JN and Shi XF provided the conception, analyzed the data, and wrote the manuscript.
Supported by the National Natural Science Foundation of China, No. 81700130; and Nanjing Medical University Science and Technology Development Fund.
Informed consent statement: Informed written consent was obtained from the patient’s family for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Xiao-Feng Shi, MD, PhD, Chief Physician, Director, Department of Hematology, Second Affiliated Hospital of Nanjing Medical University, No. 262 North Zhongshan Road, Nanjing 210003, Jiangsu Province, China. shixiaofeng1977@163.com
Received: January 4, 2023
Peer-review started: January 4, 2023
First decision: April 19, 2023
Revised: April 25, 2023
Accepted: May 9, 2023
Article in press: May 9, 2023
Published online: June 26, 2023
BACKGROUND
The Coexistence of myeloid and lymphoid malignancies is rare. Myeloid leukemia occurs more frequently as a secondary event in patients receiving chemotherapy agents for lymphoid malignancies. Synchronous diagnoses of diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML), and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) in the same patient have not been reported. Here we report one such case.
CASE SUMMARY
An 89-year-old man had a chest wall mass histopathologically diagnosed as DLBCL. The bone marrow and peripheral blood contained two groups of cells. One group of cells fulfilled the criteria of AML, and the other revealed the features of small B lymphocytic proliferative disorder, which we considered LPL/WM. Multiple chromosomal or genetic changes were detected in bone marrow mononuclear cells, including ATM deletion, CCND1 amplification, mutations of MYD88 (L265P) and TP53, WT1 overexpression, and fusion gene of BIRC2-ARAP1, as well as complex chromosomal abnormalities. The patient refused chemotherapy because of old age and died of pneumonia 1 mo after the final diagnosis.
CONCLUSION
The coexistence of DLBCL, AML, and untreated LPL/WM in the same patient is extremely rare, which probably results from multiple steps of genetic abnormalities. Asymptomatic LPL/WM might have occurred first, then myelodysplastic syndrome-related AML developed, and finally aggressive DLBCL arose. Therefore, medical staff should pay attention to this rare phenomenon to avoid misdiagnoses.
Core Tip: The coexistence of myeloid and lymphoid malignancies is rare. Synchronous diagnosis of diffuse large B-cell lymphoma (DLBCL), acute myeloid leukemia (AML), and untreated lymphoplasmacytic lymphoma/Waldenström macroglobulinemia (LPL/WM) in the same patient has not yet been reported. Herein, we report one such case. We assumed that the three diseases have been occurred in a stepwise manner. Asymptomatic indolent LPL/WM might have occurred earlier, then insidious myelodysplastic syndrome developed into AML, while chest wall DLBCL grew separately.
