Composite Angioimmunoblastic T-Cell Lymphoma and B-Cell Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Involving Both Lymph Node and Bone Marrow With Digital Gangrene

Composite lymphomas (CLs) containing both T- and B-cell lymphomas are very rare. We describe an unusual case of a CL consisting of angioimmunoblastic T-cell lymphoma (AITL) and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (B-CLL/SLL). A 68-year old male presented with skin rash, hand pain and lymphadenopathy. The lymph node contained small lymphocytes intermixed with medium to large-sized atypical cells, and arborizing blood vessels. Flow cytometry, immunohistochemistry, EBER and molecular studies confirmed the presence of CL: predominantly AITL with small portion of B-CLL/SLL. In bone marrow, multiple lymphoid aggregates were identified and proved to be composite B-CLL/SLL and AITL. The patient received R-CHOP (Rituxan, cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy. His skin rash improved but he developed bilateral finger gangrene and nine affected digits were amputated. To the best of our knowledge, this is the first report of CL containing concurrent AITL and B-CLL/SLL involving both lymph node and bone marrow.