A Rare Intersection: Case Study on Sickle-Cell Thalassemia and Lymphoma

Abstract

This case study explores the rare and complex coexistence of sickle-cell thalassemia (S-talassemia) and lymphoma in a 37-year-old individual, presenting an exceptional diagnostic and therapeutic challenge. Initially evaluated for non-specific symptoms including abdominal pain, nausea, and vomiting, the patient underwent extensive diagnostic investigations revealing a multifaceted clinical picture. Advanced imaging identified multiple abnormal findings, including hyperdense gallbladder stones, increased reticular density in the mesenteric root, and nodular lesions in the thyroid gland, without the presence of mass lesions in the lung parenchyma. Biopsies confirmed the presence of high-grade B-cell, diffuse large B-cell lymphoma (DLBCL), showcasing an aggressive non-germinal center phenotype. Interestingly, immunohistochemistry results pointed towards a complex interplay of markers, with notable findings such as cMYC 80% positivity and a Ki67 proliferation index of 80% positive. The dual diagnosis of S-talassemia and lymphoma, especially considering the rarity of their co-occurrence, posed a significant challenge in terms of treatment decision-making and highlighted the critical need for patient-centered care, taking into account the ethical and autonomy considerations. This case contributes to the limited literature on the intersection of hemoglobinopathies and lymphoma, offering insights into the diagnostic dilemmas and therapeutic strategies in managing such rare comorbid conditions.