Richter transformation: chronic lymphocytic leukaemia to diffuse large B-cell lymphoma

Case contributed by Dr Yair Glick

Presentation

Started haematologic follow-up for CLL two years ago. New-onset cervical lymphadenopathy for the past several weeks. Lymph node biopsy confirmed Richter transformation to diffuse large cell lymphoma. The treating haematologist requested neck-chest-abdomen CT before commencing with R-CHOP therapy.

Patient Data

Age: 75 years
Gender: Female

Previous abdominal CT preceding current study by 1 year and 9 months (done for CLL follow-up), included for comparison.

Case Discussion

Started follow-up two years ago for a clinical and laboratory picture of chronic lymphocytic leukaemia (CLL). Did not require a specific treatment.

Several months ago, hospitalised due to unexplained new-onset anaemia, lymphocytosis was gone, transient aggravation of lymphadenopathy. Accepted workup was done, with the working assumption that the cause was an intercurrent viral infection. New cervical lymphadenopathy for the last few weeks.

Pathology report, cervical lymph node biopsy:

Macroscopic description: Segments of grey flexible tissue measuring 3X2.5X1.5 cm overall.

Microscopic description: Lymph node showing diffuse large B-cell lymphoma, non-germinal centre type. Tumour cells were positive for CD20, MUM-1 and BcL-6, and negative for CD5, CD10, BcL-2, and CD23. The proliferation index (Ki-67 stain) is about 80%. C-myc stains about 30% of tumour cells. In addition, peripheral salivary gland tissue (non-involved) is present.

On the current CT study, the lymphadenopathy is far more striking than on the previous one and reflects the patient's diagnosis.

Richter transformation denotes development of aggressive lymphoid disease, usually high-grade non-Hodgkin lymphoma, in patients with CLL or small lymphocytic lymphoma.

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Case information

rID: 53597
Case created: 25th May 2017
Last edited: 26th May 2017
Inclusion in quiz mode: Excluded

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