From brain to testis: immune escape and clonal selection in a B cell lymphoma with selective outgrowth in two immune sanctuaries [correction of sanctuariesy]

Haematologica. 2007 Jun;92(6):e69-71. doi: 10.3324/haematol.11421.

Abstract

We describe a patient with a primary diffuse large B-cell lymphoma of the central nervous system who developed a localized testicular relapse after 8 years. Both tumours lacked HLA-DR expression, the relapse additionally lost HLA class I expression. Immunoglobulin heavy chain gene rearrangements were identical in both lymphomas with extensive and ongoing somatic hypermutations resulting in extensive idiotype modulation. We hypothesize that these immune sanctuaries initially provided a safe haven for the tumour cells. When the environment becomes more permissive for an anti-tumour response, the continuous idiotype modulation and progressive loss of HLA expression on the tumour cells facilitates further immune escape.

Publication types

  • Case Reports

MeSH terms

  • Base Sequence
  • Brain Neoplasms / genetics
  • Brain Neoplasms / immunology*
  • Brain Neoplasms / secondary
  • Cell Differentiation / immunology*
  • Clone Cells
  • Humans
  • Lymphoma, B-Cell / genetics
  • Lymphoma, B-Cell / immunology*
  • Lymphoma, B-Cell / pathology*
  • Male
  • Middle Aged
  • Molecular Sequence Data
  • Testicular Neoplasms / genetics
  • Testicular Neoplasms / immunology*
  • Testicular Neoplasms / secondary
  • Tumor Escape / genetics
  • Tumor Escape / immunology*