From brain to testis: immune escape and clonal selection in a B cell lymphoma with selective out-growth in two immune sanctuariesy

From brain to testis: immune escape and clonal selection in a B cell lymphoma with selective out-growth in two immune sanctuariesy

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We describe a patient with a primary 275/60r15 mickey thompson 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 old fashioned cut rock candy 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.