Sequential occurrence of a splenic marginal zone lymphoma, extranodal MALT lymphoma, and Hodgkin lymphoma.

Although Hodgkin lymphoma (HL) has been rarely reported to occur simultaneously with non-HLs (NHLs) in “composite lymphomas,” the sequential occurrence of HL after splenic marginal zone lymphoma (SMZL) is extremely rare. In this situation, the lymphomas could be clonally unrelated and represent an incidental simultaneous occurrence, or can be clonally related and represent transformation of 1 lymphoma to the other or the development of both lymphomas from a common precursor. The development of laser capture microdissection (LCM) techniques and polymerase chain reaction (PCR) amplification allow study of the immunoglobulin (Ig) gene rearrangements and somatic mutations, therefore facilitating the elucidation of the clonal relations between these lymphomas. We describe the sequential occurrence of SMZL, extranodal mucosa-associated lymphoid tissue (MALT) lymphoma, and HL in the same patient over a 12-year period and discuss the clonal relation between these lymphomas.