Multiple malignancies and Richter's transformation in patient with small lymphocytic B-cell lymphoma – diagnostic and therapeutic dilemmas

A clonal lymphocyte proliferation in patients with NHL interferes with the immune system, disturbing both humoral and cellular immunity. An antileukemic therapy additionally affects the immune system functioning. A higher than expected in general population incidence of infections and other malignancies is the consequence of impaired immunological surveillance. The fate of patients is also influenced by the possibility of low grade NHL transformation in more aggressive large B cell lymphoma, called the Richter's transformation.We present the case of patient with multiple malignancies small lymphocytic B-cell lymphoma (SLL), renal cell carcinoma (RCC), pulmonary adeno-carcinoma and recurrent laryngeal papillomas, that occurred in different stages of lymphoma diagnosis and treatment. He also developed SLL transformation in large B-cell lymphoma 7 years after the initial diagnosis.A clinical course, together with diagnostic and therapeutic difficulties we faced, are discussed in relation to the literature data