Two cases of acquired immunodeficiency syndrome-related lymphoma with simultaneous clonal rearrangements of B-cell and T-cell genes.

Persons infected with the human immunodeficiency virus (HIV) are at increased risk for the development of malignant lymphoma.' When analyzed with molecular techniques, all of these acquired immunodeficiency syndrome (AIDS)-related lymphomas (ARL) have been shown to contain clonal rearrangements of portions of B-cell genes such as Ig heavy chain (JH) and K-lg light chain Clonal rearrangements of T-cell genes such as the T-cell receptor (TCR,) have generally not been detected in ARL2,4 except in rare cases of T-cell lymphoma developing in AIDS patient^.'.^ To our knowledge, simultaneous clonal rearrangements of B-cell and T-cell genes have not been previously documented in ARL. In this report, we describe the molecular and phenotypic features of two cases of ARL that contained simultaneous clonal rearrangements of B-cell and T-cell genes. Clinical specimens from I O HIV-infected persons were used in this study. Each case was evaluated by routine microscopy as well as by phenotyping studies (flow cytometry; immunoperoxidase staining) to establish a diagnosis. The study set included four cases of small noncleaved cell lymphoma and 6 cases of large cell lymphoma (3 immunoblastic, plasmacytoid type: 3 large cell lymphoma). Frozen cell suspensions from each case were submitted to Collaborative Diagnostics(Waltham, MA) for DNA clonality studies. Ten probe/enzyme combinations (J,/BamHI; JH/EcoRI; C,/BumHI; CJEcoRI; TCR,/BarnHI; TCRp/EcoRI; TCR,/ZIindIII; JdHindIIl; TCRB,/BarnHI; TCRJBghlI) were used to test for antigen receptor gene rearrangements in an isotopic Southern blot. The results of each analysis were reviewed and interpreted by Dr Jeffrey Sklar (Medical Director of Collaborative Diagnostics). All of the ARL cases had clonal rearrangements of JH, and 9/10 had clonal rearrangements of C. as well. Unexpectedly, two ARL cases also had clonal rearrangements of TCR,. The first case, from a 38-year-old man with disseminated large cell immunoblastic lymphoma and ascites, had clonal rearrangements of JH, C,, CA, and TCR, (Fig I ) . Flow cytometric analysis indicated the following pro-