Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2018; 6(6): 121-126
Published online Jun 16, 2018. doi: 10.12998/wjcc.v6.i6.121
T-cell/histiocyte-rich large B-cell lymphoma in a child: A case report and review of literature
Chapman Wei, Chaplin Wei, Omar Alhalabi, Lei Chen
Chapman Wei, George Washington University School of Medicine and Health Sciences at Washington, DC 20052, United States
Chaplin Wei, St. George’s University School of Medicine, West Indies, Grenada
Omar Alhalabi, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center at Houston, TX 77030, United States
Lei Chen, Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, TX 77030, United States
Author contributions: Chen L designed the study; Alhalabi O and Chen L collected patient’s clinical data; Wei C performed literature search and constructed table; all authors contributed in manuscript preparation.
Informed consent statement: This study was exempted by the IRB Committee for Protection of Human Subjects.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lei Chen, MD, Associate Professor, Department of Pathology and Laboratory Medicine, University of Texas McGovern Medical School at Houston, 6431 Fannin, MSB2.250, Houston, TX 77030, United States. lei.chen.1@uth.tmc.edu
Telephone: +1-713-5005374 Fax: +1-713-5000733
Received: January 12, 2018
Peer-review started: January 14, 2018
First decision: February 9, 2018
Revised: April 8, 2018
Accepted: April 16, 2018
Article in press: April 17, 2018
Published online: June 16, 2018
ARTICLE HIGHLIGHTS
Case characteristics

Patient presented to the hospital with 3 mo of persistent intermittent headaches, fevers, nausea/vomiting, cough, swollen neck lymph nodes, and weight loss.

Clinical diagnosis

Patient had multilevel neck lymphadenopathy on exam, significant splenomegaly, swelling of lower extremities upon examination, concerned for malignancy.

Differential diagnosis

Neoplastic etiology, such lymphoma and other malignancies were considered in the differential diagnoses.

Laboratory diagnosis

Complete blood cell count showed anemia.

Imaging diagnosis

Magnetic resonance imaging of the abdomen revealed significant, small bilateral pleural effusions, splenomegaly of 19 cm and multiple retroperitoneal nodes.

Pathological diagnosis

A cervical lymph node biopsy revealed entirely effaced nodal architecture with scattered neoplastic large lymphoid cells in the background of small T-cell and histiocytes, consistent with T-cell/histiocyte-rich large B cell lymphoma.

Treatment

The patient was treated with cyclophosphamide, oncovin, prednisone (COP), and prophylactic intrathecal therapy with methotrexate alternating with cytarabine.

Related reports

T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL) is rare in pediatric population. Previous reports have also shown that pediatric patients with THRLBCL may also present with head and neck lymphadenopathy, splenomegaly, and similar rates of bone marrow involvement compared to adult patients. Pediatric patients tend to have a better prognosis and respond better to therapy compared to adult patients despite there being an overall 3-year survival rate of 50%-64%. Despite knowing pediatric patients do better than adult patients, it is imperative to diagnose THRLBCL as early as possible because prognosis worsens if treatment delayed. Barriers to proper diagnosis of THRLBCL in a pediatric patient are misdiagnosing it as NLPHL and cHL.

Term explanation

HL: Hodgkin lymphoma; NHL: Non-Hodgkin lymphoma; THRLBCL: T-cell/histiocyte-rich large B-cell lymphoma; DLBCL: Diffuse large B-cell lymphoma; LAD: Lymphadenopathy; NLPHL: Nodular lymphocyte-predominant Hodgkin lymphoma; cHL: Classic Hodgkin lymphoma; COP: Cyclophosphamide, oncovin, prednisone; H and E: Hematoxylin and Eosin stain.

Experiences and lessons

THRLBCL should be considered as a differential diagnosis in a pediatric patient presenting with persistent head and neck lymphadenopathy.