DOI: 10.12890/2026_006191

B-cell lymphoma following an indolent course over 30 years with immunophenotypic changes at each recurrence

Authors

  • Shintaro Yamanaka Cancer Center, Ehime University Hospital, Toon city, Japan
  • Shinji Hasebe Cancer Center, Ehime University Hospital, Toon city, Japan
  • Tomomi Fujii Palliative Care Center, Ehime University Hospital, Toon city, Japan
  • Toshikazu Gondo Department of Diagnostic Pathology, Fujisawa City Hospital, Fujisawa city, Japan
  • Riko Kitazawa Department of Diagnostic Pathology, Ehime University Hospital, Toon City, Japan
  • Sohei Kitazawa Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toon City, Japan
  • Yoshihiro Yakushijin Cancer Center, Ehime University Hospital, Toon city, Japan; Department of Clinical Oncology, Ehime University Graduate School of Medicine, Toon City, Japan

yoshiyak@m.ehime-u.ac.jp

Keywords

Diffuse large B-cell lymphoma (DLBCL), GCB type, ABC type, immunophenotype, gene expression profiling

Abstract

Introduction: Diffuse large B-cell lymphoma (DLBCL) comprises biologically distinct subtypes, but whether cell-of-origin–related features remain stable over long disease courses is unclear.
Case description: A woman was initially diagnosed with CD20-positive B-cell lymphoma in 1988 and treated with cyclophosphamide, vincristine and prednisolone (COP) chemotherapy. She experienced a first relapse in 1998 and received cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) chemotherapy. The second relapse occurred in 2008 and was managed with rituximab. At the third relapse in 2011, rituximab plus bendamustine (RB) was administered. During the fourth relapse in 2015, R-pirarubicin (THP)-COP chemotherapy was given. At the fifth relapse in 2017, at 80 years of age, RB therapy was administered again. A sixth relapse occurred in 2019, and the patient died within the same year. Histopathological evaluation throughout the disease course consistently demonstrated DLBCL. Notably, the immunophenotype showed sequential changes from a germinal centre B-cell-like pattern to an activated B-cell-like pattern and ultimately to a CD30-positive anaplastic B-cell variant.
Discussion: This unusually long clinical course highlights stepwise immunophenotypic evolution during repeated relapses, suggesting that surrogate subtype profiles may change over time.
Conclusion: Repeat biopsies with comprehensive pathological (and, when available, molecular) re-evaluation are important to accurately characterize relapsed DLBCL and inform treatment selection.

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Published

2026-02-03

Issue

Vol. 13 No. 2 (2026)

Categories

How to Cite

1.
Yamanaka S, Hasebe S, Fujii T, Gondo T, Kitazawa R, Kitazawa S, et al. B-cell lymphoma following an indolent course over 30 years with immunophenotypic changes at each recurrence. EJCRIM [Internet]. 2026 Feb. 3 [cited 2026 Nov. 3];13(2). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6191