Trilogy of Lymphomas: A Rare Case of Hodgkin's Lymphoma, DLBCL, and CTCL in Single Patients

The prognosis of lymphomas usually depends on the specific type of malignancy, which is generally categorized into Hodgkin's lymphoma and non-Hodgkin's lymphoma. The prognosis is depend on the stage of the disease, the presence of B symptoms, and other demographic factors. In the United States, the 5-year survival rate of localized HL was 93% and the survival for stage 4 disease is as low as 60%. Regarding non-Hodgkin's lymphoma, the most prevalent subtype is diffuse large B-cell lymphoma.The prognosis of DLBCL is like any other malignancy, dependent on the stage of the disease. The 5-year survival rate for DLBCL patients is estimated to be around 65%. The prognosis of CTCL is dependent upon the stage at which it is diagnosed, with the relative survival of CTCL patients declining as the skin stage advances.We are reporting elderly patients who had three types of lymphoma developed over the years and are still in remission and alive. we are reporting a rare case of a patient diagnosed with three different kinds of multiple lymphomas. This demonstrates the need for further research to study which factors contribute to the survival of such patient. This is a 77-year-old Arab female with a known medical history of diabetes mellitus , dyslipidemia, hypertension, rheumatoid arthritis, hypothyroidism, and ischemic heart disease , at age of 55 years old diagnosed as case Hodgkin's lymphoma, treated with eight sessions of ABVD achieving complete remission, then 2010 she presented again to the hospital complaining of runny nose for three months, she also had three episodes of epistaxis which resolved spontaneously, after that she started experiencing a stabbing headache in the left frontal area, which usually begins at night and early morning, relieved by codeine and paracetamol, the pain was radiating to the left eye with no history of blurry vision or vertigo, her constitutional symptoms were positive for weight loss of six kilograms within one month, and had one episode of seizure in the Emergency Department at that time, and later on she developed left eye proptosis and ptosis, associated with left third cranial nerve palsy. She was then investigated, and the examination was unremarkable except for generalized lymphadenopathy affecting the submandibular lymph nodes. She was vitally stable at that time. After this, she underwent imaging for the paranasal sinuses CT revealed a large mass centered in the left nasal cavity and ethmoid sinus with extension to the oral cavity, oropharynx, nasopharynx, intracranial, intraorbital, masticator space, sphenoid, left maxillary, and left frontal sinuses, with multiple enlarged lymph nodes in the left submandibular (measuring 2x1.6 cm), jugulodigastric (measuring 1.5x0.5 cm bilaterally), and retropharyngeal spaces (measuring 1.8x1 cm), After that, she underwent left paranasal mass excisional biopsy, which was positive for diffuse large B-cell lymphoma. A Gallium-67 scan was done for staging purposes , after that, she was treated with Chemotherapy sessions consisting of rituximab, cyclophosphamide, vincristine, doxorubicin, and prednisone. She went into complete remission and was kept for close observation and follow-up. In 2013, she presented back to the clinic with a new onset scalp lesion. An MRI was done, and it showed a focal enhancing cutaneous/subcutaneous soft tissue nodule at the frontal area of the scalp . A biopsy was taken from the scalp lesion, which revealed that the lesion was, in fact, another primary malignancy of T-cell cutaneous lymphoma. Complete staging done at this visit was found to have a localized scalp lesion, so the decision was to receive only localized radiation and no systemic chemotherapy, however, unfortunately, she became blind as a side effect of radiation. She miraculously went into complete remission after treating her third primary malignancy. Currently, the patient is still alive and doing well. However, she is blind and in remission. The survival rate of patients developing different types of lymphoma over the years is not well reported in the literature, especially in elderly patients with such comorbidities. This demonstrates the need for further research to study which factors contribute to the survival of patients who developed different types of lymphoma over the years.

No relevant conflicts of interest to declare.