Coexistence of diffuse large B cell lymphoma and lung adenocarcinoma in one lymph node: a case report and literature review

Coexistence of diffuse large B cell lymphoma and lung adenocarcinoma in one lymph node: a case report and literature review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Coexistence of diffuse large B cell lymphoma and lung adenocarcinoma in one lymph node: a case report and literature review Huichao Zhang, Dongmei Yuan, Yawen Ding, Hongfang Yang, Xiao Wang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7718956/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Older males demonstrate heightened susceptibility to both diffuse large B-cell lymphoma (DLBCL) and lung adenocarcinoma. Nevertheless, synchronous presentation of DLBCL and adenocarcinoma within the same lymph node remains exceptionally rare. We report a case of a 70-year-old male patient in whom histopathological examination of a lymph node revealed co-existing DLBCL (non-germinal center B-cell subtype) and metastatic lung adenocarcinoma components. The patient received four cycles of R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone), achieving disease stabilization with no progression observed at five-month follow-up. This unusual coexistence of DLBCL and metastatic carcinoma poses a significant diagnostic challenge, underscoring the critical need for precise early histopathological evaluation to guide optimal therapeutic intervention. Adenocarcinoma Diffuse large B cell lymphoma Multiple primary malignant neoplasms Figures Figure 1 Figure 2 Introduction Diffuse large B-cell lymphoma (DLBCL) represents the most prevalent histological subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 30–40% of NHL cases worldwide (Siegel, Rebecca et al. 2013). The disease demonstrates a male predominance and is typically diagnosed at a median age of 60 years. Lung adenocarcinoma, constituting approximately 40% of all lung carcinomas(McGuire, Shelley. 2016), is commonly diagnosed in older patients with a median age at presentation of 70 years(O'Rourke, M A et al. 1987). Advances in diagnostic imaging and histopathological techniques have increased the detection of multiple primary malignancies(Nishino, Hiroto et al. 2016). Nevertheless, synchronous occurrence of DLBCL and lung adenocarcinoma within the same anatomical site remains exceptionally rare. We report the first documented case of primary DLBCL with concurrent metastatic lung adenocarcinoma components in a cervical lymph node, confirmed through comprehensive histopathological evaluation. Case presentation A 70-year-old Chinese man had coughed with white sputum more than one year, but without any other symptom. The patient visited our hospital because of his consistent cough, shortness of breath and tightness, and nodules in his right neck. The patient never smoked and had no relatives with cancer. Chest and neck computed tomography(CT) scan imaging demonstrated bilateral lung nodules with a suspicion of lung cancer. The nodules in right neck were hard, movable, and painless (2 cm*3 cm and 1 cm*2 cm). There were multiple lung nodules and pulmonary metastasis. Enlarged mediastinal lymph nodes were considered metastasis. The CT imaging also showed bilateral pleural effusion. Superficial lymph node ultrasonic double probe found multiple hypoechoic nodules of varying sizes in the necks, two largest 1.4 cm*0.5 cm and 2.4 cm*0.6 cm at left and right side, respectively (Fig. 1 A-D). The neck nodules were resected as biopsy of cervical lymph node. Microscope examination showed that a great amount of atypical lymphoid cells that was large, or medium-sized with oval nuclear. The cells contained rough chromatin, visible nucleoli, mitoses, and focal infiltration of atypical glands (Fig. 2 A). The Histological result indicated adenocarcinoma accompanying with lymphoma. After consultation with other hospitals, the diagnosis of lymph node DLBCL (non-GCB) with lung adenocarcinoma metastasis in lymphoma was confirmed. Immunohistochemical staining showed expression of cluster of differentiation(CD) 20 (Fig. 2 B)in the large cells, as well as B-cell lymphoma(BCL)-2, ki-67positive cells accounted for over 50%(Fig. 2 C), BCL-6and multiple myeloma oncogene 1(MUM-1) were positive(Fig. 2 D);CD10 negative,The cells showed positive in CK-L, CK-H (Fig. 2 E), CK7(Fig. 2 F), hyroid transcription factor-1(TTF-1) (Fig. 2 G) and Napsin A (Fig. 2 H). Discussion Multiple primary malignant neoplasms, also named MPMNs, was first reported by Warren and Gateshas more than 80 years ago (Warren S. 1932 ). A patient with MPMNs has two or more simultaneous or successive primary cancers that are not related to each other. They may grow in the same organ, different parts of the same system, different organs, or different systems. The diagnostic criteria include malignancy, different positions, unsuccessiveness, and unique pathological morphology, which can rule out the possibility of metastasis (Ueno M. et al. 1998 ). In the systematic analysis conduct by Moertel et al. in 1961, MPMMs are generally divided into two categories: synchronous, when the second primary malignancy arises simultaneously or within 6 months after the detection of the first primary, and metachronous, when the second tumor follows primary detection after 6 months or more (MOERTEL, C G et al. 1961). Metachronous are more frequent than synchronous tumors. The patient described in this study belongs to synchronous MPMNs. The pathogenesis for MPMNs was unknown. Available evidence involves host’s susceptibility, immune deficiency, environmental factors, side effect of chemoradiotherapy, smoking and unhealthy lifestyle (Grady, William M. 2003). In a retrospective study, Tihan and Filippa evaluated the coexistence of primary malignant neoplasms. The authors suggested that multiple neoplasms may develop due to genetic predisposition to cancer and/or similar immunrelated mechanisms(Tihan T, et al. 1996). Recently, with the improvement of diagnosis and treatment to malignant cancer, patients have longer survival than before, and MPMNs are increasingly common in clinical medicine. It is easier to confirm metaehronous multiple cancers because of the uniqueness presenting of diseases at different time or positions, whereas it is somewhat difficult to diagnose synchronous cancers and to avoid misdiagnose. When primary cancer is found, the doctors should try to take biopsies for pathology diagnoses, just like this case. The comprehensive check and biopsy examination help to confirm synchronous MPMN. Pathological diagnosis is very important to the diagnosis and guides the treatment of MPMNs. The therapeutic schedule should be determined on pathological types and clinical status. There are only 13 reported cases (Table 1 ), in the literature (Mir-Madjlessi, S H et al.1984, Moriya, Y et al. 1985 , Hopster, D et al.1995, Wagle, S D et al. 1997, Kanehira, K et al. 2001 , Padmanabhan, Vijayalakshmi et al. 2003, Sztarkier, Ignacio et al. 2009, Silvestris, Nicola et al. 2011, Eshra, A et al. 2010 , Devi, Padmalaya et al. 2011, Lee, Deuk Young et al. 2012, Tseng, Chih-En et al. 2013). All these cases, with the exception of two (14-year-old and 32-year-old) were older than 50 years with a mean age of 63.7 years. Synchronous mantle cell lymphoma and adenocarcinoma (5 cases) were the most frequent diagnoses followed by synchronous extranodal marginal zone lymphoma of mucosa associated lymphoid tissue and adenocarcinoma (3 cases). Synchronous adenocarcinoma and malignant lymphoma is rare. Coexistence of lymphoma and adenocarcinoma in the same lymph node has not yet been reported. Table 1 Cases of lymphoma and adenocarcinoma Reference Age (Year) Gender Tumor1/tumor2 site Survival time (mo) Mir-Madjlessi, S H et al.1984 14 Male Adenoca/large cell L immunoblastic Rectosigmoid/cecum 1 Moriya, Y et al. 1985 52 Female Adenoca/ML Ascending/ascending 5 Hopster, D et al. 1995 74 Female Adenoca/MCL Cecum, rectum/ileum,colon, rectum - Wagle, S D et al. 1997 32 Female Adenoca/MALToma Sigmoid/cecum 17 Kanehira, K et al. 2001 74 Male Adenoca/MCL Rectum/sigmoid 4 mo alive Kanehira, K et al. 2001 54 Male Adenoca/MCL Ascending/terminal ileum 6 mo alive Padmanabhan V et al. 2003 85 Male Adenoca/MCL Cecum/colon + terminal ileum 1 Sztarkier, Ignacio et al. 2009 80 Male Adenoca/MCL Sigmoid/pericolic LN 14 Silvestris, Nicola et al. 2011 86 Male Adenoca/SLL/CLL R,t colon/mesenteric LN - Eshra, A et al. 2010 67 Male Adenoca + MALToma/FL Ascending/terminal ileum - Devi, Padmalaya et al. 2011 68 Female Adenoca/MALToma Ascending/ascending Alive Lee, Deuk Young et al. 2012 79 Female Adenoca/AITL Cecum/pericolic LN - Tseng, Chih-En et al. 2013 63 Male Adenoca/ENKTL Ascending/sigmoid 4.5 Hong Li et al. (the current case) 70 Male Adenoca/DLBCL Lung/superficial lymph node 5 mo alive Currently, DLBCL is the most common malignant lymphoma in the world. Rituximab and CHOP chemotherapy is used to treat DLBCL currently. For lung cancer, surgical operation should be done firstly, followed by radiotherapy and chemotherapy depending on the pathological types, and tumor location. In this case, DLBCL and adenocarcinoma coexist in the same lymph node, and multiple metastases should not be operated again. Therefore, 4 courses of R-CHOP chemotherapy were performed, and the cervical lymph nodes were significantly reduced. The patients were followed up for 5 months and survived. Abbreviation DLBCL Diffuse large B cell lymphoma NHL Non-Hodgkin’s lymphoma CT Computed tomography MPMNs Multiple primary malignant neoplasms BCL-6 B-cell lymphoma 6 BCL-2 B-cell lymphoma 2 CD20 Cluster of differentiation 20 CD10 Cluster of differentiation 10 TTF-1 Thyroid transcription factor-1 Declarations Ethics approval and consent to participate The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was granted by the Ethics Committee of the Fourth Hospital of Hebei Medical University (Approval No.: [2025KS110]). Written informed consent was obtained from the patient. Consent for publication The patient consented to the publication of this case report and all relevant imaging data. Conflict of interest The authors state no conflict of interest. Funding Not available. Author Contribution Huichao Zhang and Hong Li and Jing Shang for conception and design of the study; Jianguang Ji and Wenfeng Ning for acquisition and analysis of data; Hongfang Yang and Xiao Wang and Jianguang Ji for drafting the manuscript or figures. Dongmei Yuan help emendation manuscript and edit figures. All authors reviewed the manuscript. Acknowledgements The authors are thankful for the participation of the patients, their families, clinicians in this study. Data Availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Devi P, Pattanayak L, Samantaray S (2011) Synchronous adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the colon. 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Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 14(8), 811-817. https://doi.org/10.1038/modpathol.3880395 Lee DY, Hong SW, Chang YG, Lee WY, Lee B, Kang YK (2012) Synchronous T-cell lymphoma in patient with colon cancer: a case report. Journal of the Korean Surgical Society, 83(1), 60-64. https://doi.org/10.4174/jkss.2012.83.1.60 McGuire S (2016) World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Advances in nutrition (Bethesda, Md.), 7(2), 418–419. https://doi.org/10.3945/an.116.012211 Mir-Madjlessi SH, Vafai M, Khademi J, Kamalian N (1984) Coexisting primary malignant lymphoma and adenocarcinoma of the large intestine in an IgA-deficient boy. Diseases of the colon and rectum, 27(12), 822-824. https://doi.org/10.1007/BF02553947 MOERTEL C. G, DOCKERTY M. B, BAGGENSTOSS A. H (1961) Multiple primary malignant neoplasms. II. Tumors of different tissues or organs. Cancer, 14, 231-237. https://doi.org/10.1002/1097-0142(196103/04)14:23.0.co;2-2 Moriya Y, Koyama Y, Minato K, Shimoyama M, Hirota T, Itabashi M (1985) [Coexisting malignant lymphoma and advanced adenocarcinoma of the colon--a case report]. Gan no rinsho. Japan journal of cancer clinics, 31(7), 894-899. Nishino H, Hatano E, Seo S, Shibuya S, Anazawa T, Iida T, Masui T, Taura K, Haga H, Uemoto S (2016) Histological features of mixed neuroendocrine carcinoma and hepatocellular carcinoma in the liver: a case report and literature review. Clinical journal of gastroenterology, 9(4), 272-279. https://doi.org/10.1007/s12328-016-0669-0 O'Rourke M. A, Feussner J. R, Feigl P, Laszlo J (1987) Age trends of lung cancer stage at diagnosis. Implications for lung cancer screening in the elderly. JAMA, 258(7), 921–926. Padmanabhan V, Trainer TD (2003) Synchronous adenocarcinoma and mantle cell lymphoma of the colon. Archives of pathology & laboratory medicine, 127(2), E64-E66. https://doi.org/10.5858/2003-127-e64-SAAMCL Siegel R, Naishadham D, & Jemal A (2013) Cancer statistics, 2013. CA: a cancer journal for clinicians, 63(1), 11-30. https://doi.org/10.3322/caac.21166 Silvestris N, Zito FA, Fiore MG, Simone G, Tommasi S, Izzi G, Guarini A, Colucci G (2011) Synchronous presentation of B-cell chronic lymphocytic leukemia/small-cell lymphoma and colon adenocarcinoma within the same mesenteric lymph nodes and a single liver metastasis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 29(1), e11-e13. https://doi.org/10.1200/JCO.2010.31.1001 Sztarkier I, Levy I, Walfisch S, Delgado J, Benharroch D (2009) Mantle cell lymphoma in a tubular adenoma: unusual presentation with synchronous colonic carcinoma. Annals of diagnostic pathology, 13(1), 47-49. https://doi.org/10.1016/j.anndiagpath.2007.05.017 Tihan T, Filippa DA (1996) Coexistence of renal cell carcinoma and malignant lymphoma. A causal relationship or coincidental occurrence?. Cancer, 77(11), 2325-2331. https://doi.org/10.1002/(SICI)1097-0142(19960601)77:113.0.CO;2-Y Tseng CE, Shu TW, Lin CW, Liao KS (2013) Synchronous adenocarcinoma and extranodal natural killer/T-cell lymphoma of the colon: a case report and literature review. World journal of gastroenterology, 19(11), 1850-1854. https://doi.org/10.3748/wjg.v19.i11.1850 Ueno M, Fujiyama J, Yamazaki I, Uchiyama T, Ishikawa Y, Satoh Y (1998). Cytology of primary pulmonary meningioma. Report of the first multiple case. Acta cytologica, 42(6), 1424-1430. https://doi.org/10.1159/000332179 Wagle SD, Mohandas KM, Vazifdar KF, Dhir V, Swaroop VS, Jagannath P, Desouza LJ (1997) Synchronous adenocarcinoma and lymphoma of the colon. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 16(1), 28–29. Warren S (1932) Multiple primary malignant tumors: a survey of the literature and a statistical study. Gastroenterology, 93(4), 779. https://doi.org/10.1016/0016-5085(87)90440-9 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7718956","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":551171368,"identity":"04ed14d7-0307-4f4a-bf26-e71f007043d9","order_by":0,"name":"Huichao Zhang","email":"","orcid":"","institution":"The Fourth Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Huichao","middleName":"","lastName":"Zhang","suffix":""},{"id":551171377,"identity":"727f1c8f-2442-4f6d-af61-9af2cdb2f094","order_by":1,"name":"Dongmei Yuan","email":"","orcid":"","institution":"Chongqing Medical 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14:00:54","extension":"png","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":263870,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7718956/v1/4dce7d6b576c901bd562c81b.png"},{"id":97261133,"identity":"5373c65d-a5ea-4c51-806c-2d6999f94f8d","added_by":"auto","created_at":"2025-12-02 14:00:54","extension":"xml","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70406,"visible":true,"origin":"","legend":"","description":"","filename":"99912caf99ff4f77a7aa5e34f63b9a661structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7718956/v1/fd2ac22e18545a25fa5caca3.xml"},{"id":97261138,"identity":"a17ad6e7-0646-4941-8d44-026cdcc37558","added_by":"auto","created_at":"2025-12-02 14:00:54","extension":"html","order_by":15,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77443,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7718956/v1/a45491a515c5a42cd0531eca.html"},{"id":97261121,"identity":"f675a754-377d-4ca8-abef-6f85785435a4","added_by":"auto","created_at":"2025-12-02 14:00:54","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":185007,"visible":true,"origin":"","legend":"\u003cp\u003eChest CT and superficial lymph node ultrasound in the neck. \u003cstrong\u003eA\u003c/strong\u003e Right upper lobe space occupying lesions and mediastinal lymph nodes；\u003cstrong\u003eB\u003c/strong\u003e Mediastinal lymph nodes；\u003cstrong\u003eC\u003c/strong\u003e Multiple lung nodules；\u003cstrong\u003eD\u003c/strong\u003e Superficial ultrasound of the neck shows multiple enlarged lymph nodes.\u003c/p\u003e","description":"","filename":"Figure1.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7718956/v1/6c8f0570e72cb93716832ad8.jpg"},{"id":97367197,"identity":"da537f8d-0c5e-48f4-9214-72b5eccb2f65","added_by":"auto","created_at":"2025-12-03 16:17:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":754731,"visible":true,"origin":"","legend":"\u003cp\u003ePathological and immunohistochemical staining of cervical lymph nodes. \u003cstrong\u003eA\u003c/strong\u003e shows the disappearance of lymph node normal structure. Instead, they are infiltrated with large amount of atypical lymphoid cells and focal infiltration of atypical glands (20×). The immunohistochemical staining showed positive CD20 (\u003cstrong\u003eB\u003c/strong\u003e) (20×), BCL-6 positive (20×), ki-67 (\u003cstrong\u003eC\u003c/strong\u003e) positive cells over 50% (20×), MUM-1 (\u003cstrong\u003eD\u003c/strong\u003e) positive (20×). Moreover, other positive elements include CK-H (\u003cstrong\u003eE\u003c/strong\u003e), CK7 (\u003cstrong\u003eF\u003c/strong\u003e), CK-L, TTF-1 (\u003cstrong\u003eG\u003c/strong\u003e) and Napsin A (\u003cstrong\u003eH\u003c/strong\u003e) (20×).\u003c/p\u003e","description":"","filename":"Figure2.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7718956/v1/1b8e243ec2e38f9cec60b3a2.jpg"},{"id":97960830,"identity":"a5dee8d7-45e0-404f-b23b-bc790febe324","added_by":"auto","created_at":"2025-12-11 08:41:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1406443,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7718956/v1/621bedb1-d487-49a2-bee8-b33a1318a9f2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Coexistence of diffuse large B cell lymphoma and lung adenocarcinoma in one lymph node: a case report and literature review","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDiffuse large B-cell lymphoma (DLBCL) represents the most prevalent histological subtype of non-Hodgkin lymphoma (NHL), accounting for approximately 30\u0026ndash;40% of NHL cases worldwide (Siegel, Rebecca et al. 2013). The disease demonstrates a male predominance and is typically diagnosed at a median age of 60 years. Lung adenocarcinoma, constituting approximately 40% of all lung carcinomas(McGuire, Shelley. 2016), is commonly diagnosed in older patients with a median age at presentation of 70 years(O'Rourke, M A et al. 1987). Advances in diagnostic imaging and histopathological techniques have increased the detection of multiple primary malignancies(Nishino, Hiroto et al. 2016). Nevertheless, synchronous occurrence of DLBCL and lung adenocarcinoma within the same anatomical site remains exceptionally rare. We report the first documented case of primary DLBCL with concurrent metastatic lung adenocarcinoma components in a cervical lymph node, confirmed through comprehensive histopathological evaluation.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA 70-year-old Chinese man had coughed with white sputum more than one year, but without any other symptom. The patient visited our hospital because of his consistent cough, shortness of breath and tightness, and nodules in his right neck. The patient never smoked and had no relatives with cancer. Chest and neck computed tomography(CT) scan imaging demonstrated bilateral lung nodules with a suspicion of lung cancer. The nodules in right neck were hard, movable, and painless (2 cm*3 cm and 1 cm*2 cm). There were multiple lung nodules and pulmonary metastasis. Enlarged mediastinal lymph nodes were considered metastasis. The CT imaging also showed bilateral pleural effusion. Superficial lymph node ultrasonic double probe found multiple hypoechoic nodules of varying sizes in the necks, two largest 1.4 cm*0.5 cm and 2.4 cm*0.6 cm at left and right side, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eA-D).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe neck nodules were resected as biopsy of cervical lymph node. Microscope examination showed that a great amount of atypical lymphoid cells that was large, or medium-sized with oval nuclear. The cells contained rough chromatin, visible nucleoli, mitoses, and focal infiltration of atypical glands (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eA). The Histological result indicated adenocarcinoma accompanying with lymphoma. After consultation with other hospitals, the diagnosis of lymph node DLBCL (non-GCB) with lung adenocarcinoma metastasis in lymphoma was confirmed. Immunohistochemical staining showed expression of cluster of differentiation(CD) 20 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eB)in the large cells, as well as B-cell lymphoma(BCL)-2, ki-67positive cells accounted for over 50%(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eC), BCL-6and multiple myeloma oncogene 1(MUM-1) were positive(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eD);CD10 negative,The cells showed positive in CK-L, CK-H (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eE), CK7(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eF), hyroid transcription factor-1(TTF-1) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eG) and Napsin A (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eH).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMultiple primary malignant neoplasms, also named MPMNs, was first reported by Warren and Gateshas more than 80 years ago (Warren S. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e1932\u003c/span\u003e). A patient with MPMNs has two or more simultaneous or successive primary cancers that are not related to each other. They may grow in the same organ, different parts of the same system, different organs, or different systems. The diagnostic criteria include malignancy, different positions, unsuccessiveness, and unique pathological morphology, which can rule out the possibility of metastasis (Ueno M. et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1998\u003c/span\u003e). In the systematic analysis conduct by Moertel et al. in 1961, MPMMs are generally divided into two categories: synchronous, when the second primary malignancy arises simultaneously or within 6 months after the detection of the first primary, and metachronous, when the second tumor follows primary detection after 6 months or more (MOERTEL, C G et al. 1961). Metachronous are more frequent than synchronous tumors. The patient described in this study belongs to synchronous MPMNs.\u003c/p\u003e\u003cp\u003eThe pathogenesis for MPMNs was unknown. Available evidence involves host\u0026rsquo;s susceptibility, immune deficiency, environmental factors, side effect of chemoradiotherapy, smoking and unhealthy lifestyle (Grady, William M. 2003). In a retrospective study, Tihan and Filippa evaluated the coexistence of primary malignant neoplasms. The authors suggested that multiple neoplasms may develop due to genetic predisposition to cancer and/or similar immunrelated mechanisms(Tihan T, et al. 1996). Recently, with the improvement of diagnosis and treatment to malignant cancer, patients have longer survival than before, and MPMNs are increasingly common in clinical medicine. It is easier to confirm metaehronous multiple cancers because of the uniqueness presenting of diseases at different time or positions, whereas it is somewhat difficult to diagnose synchronous cancers and to avoid misdiagnose. When primary cancer is found, the doctors should try to take biopsies for pathology diagnoses, just like this case. The comprehensive check and biopsy examination help to confirm synchronous MPMN. Pathological diagnosis is very important to the diagnosis and guides the treatment of MPMNs. The therapeutic schedule should be determined on pathological types and clinical status. There are only 13 reported cases (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), in the literature (Mir-Madjlessi, S H et al.1984, Moriya, Y et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1985\u003c/span\u003e, Hopster, D et al.1995, Wagle, S D et al. 1997, Kanehira, K et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e, Padmanabhan, Vijayalakshmi et al. 2003, Sztarkier, Ignacio et al. 2009, Silvestris, Nicola et al. 2011, Eshra, A et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2010\u003c/span\u003e, Devi, Padmalaya et al. 2011, Lee, Deuk Young et al. 2012, Tseng, Chih-En et al. 2013). All these cases, with the exception of two (14-year-old and 32-year-old) were older than 50 years with a mean age of 63.7 years. Synchronous mantle cell lymphoma and adenocarcinoma (5 cases) were the most frequent diagnoses followed by synchronous extranodal marginal zone lymphoma of mucosa associated lymphoid tissue and adenocarcinoma (3 cases). Synchronous adenocarcinoma and malignant lymphoma is rare. Coexistence of lymphoma and adenocarcinoma in the same lymph node has not yet been reported.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCases of lymphoma and adenocarcinoma\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge (Year)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTumor1/tumor2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003esite\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSurvival time (mo)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMir-Madjlessi, S H et al.1984\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/large cell L immunoblastic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRectosigmoid/cecum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMoriya, Y et al. \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1985\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/ML\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAscending/ascending\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHopster, D et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e1995\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCecum, rectum/ileum,colon, rectum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWagle, S D et al.\u0026nbsp;1997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MALToma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSigmoid/cecum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKanehira, K et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRectum/sigmoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4 mo alive\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKanehira, K et al. \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2001\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAscending/terminal ileum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e6 mo alive\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePadmanabhan V et al. 2003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e85\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCecum/colon\u0026thinsp;+\u0026thinsp;terminal ileum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSztarkier, Ignacio et al. 2009\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSigmoid/pericolic LN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSilvestris, Nicola et al. 2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/SLL/CLL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eR,t colon/mesenteric LN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEshra, A et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2010\u003c/span\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca\u0026thinsp;+\u0026thinsp;MALToma/FL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAscending/terminal ileum\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDevi, Padmalaya et al. 2011\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/MALToma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAscending/ascending\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAlive\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLee, Deuk Young et al. 2012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e79\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/AITL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eCecum/pericolic LN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTseng, Chih-En et al. 2013\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/ENKTL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAscending/sigmoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e4.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHong Li\u003c/b\u003e et al. (the current case)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdenoca/DLBCL\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eLung/superficial lymph node\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5 mo alive\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCurrently, DLBCL is the most common malignant lymphoma in the world. Rituximab and CHOP chemotherapy is used to treat DLBCL currently. For lung cancer, surgical operation should be done firstly, followed by radiotherapy and chemotherapy depending on the pathological types, and tumor location. In this case, DLBCL and adenocarcinoma coexist in the same lymph node, and multiple metastases should not be operated again. Therefore, 4 courses of R-CHOP chemotherapy were performed, and the cervical lymph nodes were significantly reduced. The patients were followed up for 5 months and survived.\u003c/p\u003e"},{"header":"Abbreviation","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eDLBCL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eDiffuse large B cell lymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eNHL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eNon-Hodgkin\u0026rsquo;s lymphoma\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eComputed tomography\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eMPMNs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eMultiple primary malignant neoplasms\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eBCL-6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eB-cell lymphoma\u0026ensp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eBCL-2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eB-cell lymphoma\u0026ensp;2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eCD20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCluster of differentiation 20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eCD10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eCluster of differentiation 10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 33px;\"\u003e\n \u003cp\u003eTTF-1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eThyroid transcription factor-1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\u003cp\u003eThe study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was granted by the Ethics Committee of the Fourth Hospital of Hebei Medical University (Approval No.: [2025KS110]). Written informed consent was obtained from the patient.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003e The patient consented to the publication of this case report and all relevant imaging data.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eConflict of interest\u003c/h2\u003e\u003cp\u003eThe authors state no conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNot available.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eHuichao Zhang and Hong Li and Jing Shang for conception and design of the study; Jianguang Ji and Wenfeng Ning for acquisition and analysis of data; Hongfang Yang and Xiao Wang and Jianguang Ji for drafting the manuscript or figures. Dongmei Yuan help emendation manuscript and edit figures. All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eThe authors are thankful for the participation of the patients, their families, clinicians in this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003cp\u003eDevi P, Pattanayak L, Samantaray S (2011) Synchronous adenocarcinoma and mucosa-associated lymphoid tissue lymphoma of the colon. Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association, 17(1), 69-71. https://doi.org/10.4103/1319-3767.74455\u003c/p\u003e\n\u003cp\u003eEshra A, Al-Hendal A, Al EM, Al-Mishaan M, Abo DW (2010) One patient, two lymphomas, three primaries. The Gulf journal of oncology, (8), 39-43.\u003c/p\u003e\n\u003cp\u003eGrady W. M (2003) Genetic testing for high-risk colon cancer patients. Gastroenterology, 124(6), 1574-1594. https://doi.org/10.1016/s0016-5085(03)00376-7\u003c/p\u003e\n\u003cp\u003eHopster D, Smith PA, Nash JR, Elders K, Poston GJ (1995) Synchronous multiple lymphomatous polyposis and adenocarcinomata in the large bowel. Postgraduate medical journal, 71(837), 443. https://doi.org/10.1136/pgmj.71.837.443\u003c/p\u003e\n\u003cp\u003eKanehira K, Braylan RC, Lauwers GY (2001) Early phase of intestinal mantle cell lymphoma: a report of two cases associated with advanced colonic adenocarcinoma. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc, 14(8), 811-817. https://doi.org/10.1038/modpathol.3880395\u003c/p\u003e\n\u003cp\u003eLee DY, Hong SW, Chang YG, Lee WY, Lee B, Kang YK (2012) Synchronous T-cell lymphoma in patient with colon cancer: a case report. Journal of the Korean Surgical Society, 83(1), 60-64. https://doi.org/10.4174/jkss.2012.83.1.60\u003c/p\u003e\n\u003cp\u003eMcGuire S (2016) World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Advances in nutrition (Bethesda, Md.), 7(2), 418\u0026ndash;419. https://doi.org/10.3945/an.116.012211\u003c/p\u003e\n\u003cp\u003eMir-Madjlessi SH, Vafai M, Khademi J, Kamalian N (1984) Coexisting primary malignant lymphoma and adenocarcinoma of the large intestine in an IgA-deficient boy. Diseases of the colon and rectum, 27(12), 822-824. https://doi.org/10.1007/BF02553947\u003c/p\u003e\n\u003cp\u003eMOERTEL C. G, DOCKERTY M. B, BAGGENSTOSS A. H (1961) Multiple primary malignant neoplasms. II. Tumors of different tissues or organs. Cancer, 14, 231-237. https://doi.org/10.1002/1097-0142(196103/04)14:2\u0026lt;231::aid-cncr2820140203\u0026gt;3.0.co;2-2\u003c/p\u003e\n\u003cp\u003eMoriya Y, Koyama Y, Minato K, Shimoyama M, Hirota T, Itabashi M (1985) [Coexisting malignant lymphoma and advanced adenocarcinoma of the colon--a case report]. Gan no rinsho. Japan journal of cancer clinics, 31(7), 894-899.\u003c/p\u003e\n\u003cp\u003eNishino H, Hatano E, Seo S, Shibuya S, Anazawa T, Iida T, Masui T, Taura K, Haga H, Uemoto S (2016) Histological features of mixed neuroendocrine carcinoma and hepatocellular carcinoma in the liver: a case report and literature review. Clinical journal of gastroenterology, 9(4), 272-279. https://doi.org/10.1007/s12328-016-0669-0\u003c/p\u003e\n\u003cp\u003eO\u0026apos;Rourke M. A, Feussner J. R, Feigl P, Laszlo J (1987) Age trends of lung cancer stage at diagnosis. Implications for lung cancer screening in the elderly. JAMA, 258(7), 921\u0026ndash;926.\u003c/p\u003e\n\u003cp\u003ePadmanabhan V, Trainer TD (2003) Synchronous adenocarcinoma and mantle cell lymphoma of the colon. Archives of pathology \u0026amp; laboratory medicine, 127(2), E64-E66. https://doi.org/10.5858/2003-127-e64-SAAMCL\u003c/p\u003e\n\u003cp\u003eSiegel R, Naishadham D, \u0026amp; Jemal A (2013) Cancer statistics, 2013. CA: a cancer journal for clinicians, 63(1), 11-30. https://doi.org/10.3322/caac.21166\u003c/p\u003e\n\u003cp\u003eSilvestris N, Zito FA, Fiore MG, Simone G, Tommasi S, Izzi G, Guarini A, Colucci G (2011) Synchronous presentation of B-cell chronic lymphocytic leukemia/small-cell lymphoma and colon adenocarcinoma within the same mesenteric lymph nodes and a single liver metastasis. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 29(1), e11-e13. https://doi.org/10.1200/JCO.2010.31.1001\u003c/p\u003e\n\u003cp\u003eSztarkier I, Levy I, Walfisch S, Delgado J, Benharroch D (2009) Mantle cell lymphoma in a tubular adenoma: unusual presentation with synchronous colonic carcinoma. Annals of diagnostic pathology, 13(1), 47-49. https://doi.org/10.1016/j.anndiagpath.2007.05.017\u003c/p\u003e\n\u003cp\u003eTihan T, Filippa DA (1996) Coexistence of renal cell carcinoma and malignant lymphoma. A causal relationship or coincidental occurrence?. Cancer, 77(11), 2325-2331. https://doi.org/10.1002/(SICI)1097-0142(19960601)77:11\u0026lt;2325::AID-CNCR22\u0026gt;3.0.CO;2-Y\u003c/p\u003e\n\u003cp\u003eTseng CE, Shu TW, Lin CW, Liao KS (2013) Synchronous adenocarcinoma and extranodal natural killer/T-cell lymphoma of the colon: a case report and literature review. World journal of gastroenterology, 19(11), 1850-1854. https://doi.org/10.3748/wjg.v19.i11.1850\u003c/p\u003e\n\u003cp\u003eUeno M, Fujiyama J, Yamazaki I, Uchiyama T, Ishikawa Y, Satoh Y (1998). Cytology of primary pulmonary meningioma. Report of the first multiple case. Acta cytologica, 42(6), 1424-1430. https://doi.org/10.1159/000332179\u003c/p\u003e\n\u003cp\u003eWagle SD, Mohandas KM, Vazifdar KF, Dhir V, Swaroop VS, Jagannath P, Desouza LJ (1997) Synchronous adenocarcinoma and lymphoma of the colon. Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology, 16(1), 28\u0026ndash;29.\u003c/p\u003e\n\u003cp\u003eWarren S (1932) Multiple primary malignant tumors: a survey of the literature and a statistical study. Gastroenterology, 93(4), 779. https://doi.org/10.1016/0016-5085(87)90440-9\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adenocarcinoma, Diffuse large B cell lymphoma, Multiple primary malignant neoplasms","lastPublishedDoi":"10.21203/rs.3.rs-7718956/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7718956/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOlder males demonstrate heightened susceptibility to both diffuse large B-cell lymphoma (DLBCL) and lung adenocarcinoma. Nevertheless, synchronous presentation of DLBCL and adenocarcinoma within the same lymph node remains exceptionally rare. We report a case of a 70-year-old male patient in whom histopathological examination of a lymph node revealed co-existing DLBCL (non-germinal center B-cell subtype) and metastatic lung adenocarcinoma components. The patient received four cycles of R-CHOP immunochemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone), achieving disease stabilization with no progression observed at five-month follow-up. This unusual coexistence of DLBCL and metastatic carcinoma poses a significant diagnostic challenge, underscoring the critical need for precise early histopathological evaluation to guide optimal therapeutic intervention.\u003c/p\u003e","manuscriptTitle":"Coexistence of diffuse large B cell lymphoma and lung adenocarcinoma in one lymph node: a case report and literature review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 14:00:49","doi":"10.21203/rs.3.rs-7718956/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7726dc3-0d4a-4938-ac78-0e3a75f7ca2e","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-11T08:40:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-02 14:00:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7718956","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7718956","identity":"rs-7718956","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}