Nodal follicular helper T-cell lymphoma may present with different patterns. A case report

SummaryWe report the case of a 62-year-old patient presenting with 3 different patterns of follicular helper T-cell lymphoma. The patient initially presented with angioimmunoblastic T-cell lymphoma. A nodal relapse in the form of follicular T-cell lymphoma with a progressively transformed germinal center pattern occurred 8 years later. Two years later, this was followed by another relapse presenting as a predominantly large-cell peripheral T-cell lymphoma, unspecified. All neoplastic cells expressed CD3, CD5, and CD2, with some neoplastic cells also expressing CD7. These cells also expressed CD4, with some expressing CD10, bcl-6, CXCL13, and programmed death-1, all of which are characteristic of the normal subset of follicular T-helper cells. The immunophenotype showed a progressive increase in the proportion of cells expressing CD10, bcl-6, CXCL13, and programmed death-1 from the first to the last lymphoma. In addition, neoplastic T cells from the last biopsy sample expressed CD20.