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T-cell-rich B-cell lymphoma (TCRBCL) is considered a rare variant of aggressive B cell lymphoma characterized by few neoplastic B cells and a large reactive infiltrate with striking similarities to nodular lymphocyte predominant Hodgkin’s lymphoma.
A case of a 46 year old man referred with a 5 months history of generalized lymphadenopathy, weight loss, low grade pyrexia and two separately reported lymph node histology consistent with TCRBCL is described.
The clinical course was indeed aggressive because in spite of initial treatment with four cycles of CHOP combination chemotherapy, followed by Rituximab+CHOP(x 6 cycles), signs of tumor re-growth/infiltration were frequently observed. Also recurrent infection was frequent, troublesome and eventually became overwhelming resulting to the loss of the patient.
This case, being the first case of TCRBCL diagnosed immunohistochemically and managed at this centre with R-CHOP, is presented to highlight the dilemma in making diagnosis (which required meticulous immunohistochemistry), clinical challenges faced and rituximab therapy outcome especially in resource poor country. It will also serve to increase our index of suspicion and the need reinforce immunohistochemistry in the diagnosis of lymphoma.
Keywords:- T-cell-Rich B-cell Lymphoma, Immunohistochemistry, Rituximab, Recurrent infection