International Journal of Hematology

, Volume 107, Issue 6, pp 703–708 | Cite as

Three coexisting lymphomas in a single patient: composite lymphoma derived from a common germinal center B-cell precursor and unrelated discordant lymphoma

  • Atsujiro Nishioka
  • Hiroshi Ureshino
  • Toshihiko Ando
  • Haruna Kizuka
  • Kana Kusaba
  • Haruhiko Sano
  • Hidekazu Itamura
  • Yasushi Kubota
  • Kensuke Kojima
  • Koichi Ohshima
  • Shinya Kimura
Case Report


Composite lymphoma (CL) is a rare disorder defined as the coexistence of two or more distinct lymphoma subtypes at a single anatomic site. Discordant lymphoma (DL), which is the simultaneous occurrence of two or more distinct lymphoma subtypes at different sites, is also rare. CL complicated with DL involving three distinct subtypes of lymphoma in the same patient is an extremely rare disease. Clonal relationships in CL and DL are commonly investigated by molecular analysis using mutational status with t(14;18)BCL2/IgH translocation and immunoglobulin heavy chain variable-region (IgVH) gene rearrangement. A 73-year-old woman was admitted to our hospital with systemic lymphadenopathy and was initially diagnosed with diffuse large B-cell lymphoma based on pathological features of the biopsied esophageal tumor. However, the results of inguinal lymph node biopsy led to a revised pathological diagnosis CL consisting of Hodgkin lymphoma and follicular lymphoma. Three distinct coexisting lymphomas were identified in this individual patient. Molecular analysis revealed CL derived from common germinal center B-cell precursors, while clonal relationship between CL and DL was not clarified. This case suggests a mechanism underlying B-cell lymphoma pathogenesis involving two pivotal somatic mutations, t(14;18)BCL2/IgH translocation and IgVH rearrangement.


Composite lymphoma Discordant lymphoma t(14;18)BCL2/IgH IgVH rearrangement 



The authors greatly thank the members of the Department of Pathology, Kurume University, School of Medicine, for pathological analyses.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest (COI).

Informed consent

All authors contributed to patient care and wrote the report. Informed consent was obtained from the patient for publication of this case report.

Supplementary material

12185_2017_2370_MOESM1_ESM.pdf (278 kb)
Computed tomographic findings. No enlarged lymph node was detected. A, Neck; B, Chest; C, Abdomen; D, Inguinal (PDF 277 kb)


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Copyright information

© The Japanese Society of Hematology 2017

Authors and Affiliations

  • Atsujiro Nishioka
    • 1
    • 2
  • Hiroshi Ureshino
    • 2
  • Toshihiko Ando
    • 2
  • Haruna Kizuka
    • 2
  • Kana Kusaba
    • 2
  • Haruhiko Sano
    • 2
  • Hidekazu Itamura
    • 2
  • Yasushi Kubota
    • 2
  • Kensuke Kojima
    • 2
  • Koichi Ohshima
    • 3
  • Shinya Kimura
    • 2
  1. 1.Department of HematologyCommunity Health Care Organization (JCHO) Saga Central HospitalSagaJapan
  2. 2.Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of MedicineSaga UniversitySagaJapan
  3. 3.Department of Pathology, School of MedicineKurume UniversityKurumeJapan

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