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Ann Hematol (2012) 91:965967 DOI 10.1007/s00277-011-1342-9
LETTER TO THE EDITOR
Follicular lymphoma with prominent fibrosis complicated by peripheral eosinophilia
Rie Tabata & Chiharu Tabata & Tomoko Nagai &
Ryoji Yasumizu
Received: 28 June 2011 /Accepted: 1 September 2011 /Published online: 22 September 2011 # Springer-Verlag 2011
Dear Editor,Although eosinophilia is occasionally associated with Hodgkin's lymphoma (HL), it only occurs in 5% of non-Hodgkin's lymphoma cases, usually in cases of T-cell lymphoma or anaplastic large cell lymphoma. Follicular lymphoma (FL) combined with marked eosinophil expansion is extremely rare, with only two cases reported in the literature [1, 2].
A 47-year-old man first visited the hospital for multiple lymph node (LN) swellings and was diagnosed as FL grades 1/2 by histologic examination (Fig. 1be). Lymphoma cells showed positive reactivity for CD10, CD19, CD20, CD23, and on flow cytometry. Chromosomal analysis and fluorescence in situ hybridization analysis demonstrated t(14;18)(q32;q21) and IgHBCL2 fusion signals, respectively. Partial response was obtained by nine courses of combination therapy including cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, mitoxantrone, cladribine, prednisolone (PSL), and rituximab, and since then, he has remained in a stable state for over 2 years without chemotherapy. However, he suffered from itchy eruptions with elevated eosinophils (17.3% of 23,840/l
WBC), which were transiently ameliorated by the administration of 10 mg/day PSL. Biopsies of his skin lesions and bone marrow (BM) revealed no lymphoma cell invasion. BM aspiration showed normocellular marrow with no apparent dysplasia and chromosomal analysis demonstrated normal karyotype. Subsequently, multiple LN swellings with increased volumes were observed with markedly elevated eosinophil counts (7,320/l), ALP (572 IU/l), LDH (628 IU/l), C-reactive protein (CRP) (13.5 mg/dl), and soluble interleukin (IL)-2 receptor (3,630 U/ml). No obvious causes of the secondary eosinophilia, such as parasitic infection, drugs, vasculitis, or allergic diseases were observed. Although the...