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 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 cnd keep an opal mind 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 grey sns nails for an anti-tumour response, the continuous idiotype modulation and progressive loss of HLA expression on the tumour cells facilitates further immune escape.