Simultaneous Discordant B-Lymphoblastic Lymphoma and Follicular Lymphoma.

American journal of clinical pathology 2021 Feb 04

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We report a rare case of B-lymphoblastic lymphoma (B-LBL) and low-grade follicular lymphoma (FL) identified concurrently in biopsies from different sites at the initial diagnosis in a 39-year-old man. The clonal relationship between the 2 histologic subtypes was investigated. A diagnosis of FL grade 1/2 (low grade) was made by bone marrow (BM) biopsy. B-LBL was identified in biopsies from the testis and pancreas. Cytogenetic and molecular analyses were performed to investigate their clonal relationship. Interphase fluorescence in situ hybridization analyses and G-banding karyotype analyses identified the BCL2-IGH and MYC-IGH translocation in tumor cells from both the BM and testis. The tumor cells from the BM and testis shared the same IGH VDJ usage and a high degree of somatic mutations. These findings suggest that acquisition of MYC gene rearrangement is a critical event for lymphoblastic transformation of FL. Of note, the presence of intraclonal diversity in the B-LBL sample further suggests an earlier or concurrent event of MYC translocation than the somatic IGH mutation in the germinal center and the dedifferentiation of lymphoma cells to a precursor stage of B-cell development. B-lymphoblastic transformation of FL can occur with MYC gene rearrangement. © American Society for Clinical Pathology, 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Citation

Ayumi Fujimoto, Fumiyoshi Ikejiri, Fumiko Arakawa, Shunsuke Ito, Yusuke Okada, Fumimasa Takahashi, Shinichiro Matsuda, Takahiro Okada, Masaya Inoue, Tsutomu Takahashi, Takaaki Miyake, Riruke Maruyama, Koichi Ohshima, Junji Suzumiya, Ritsuro Suzuki. Simultaneous Discordant B-Lymphoblastic Lymphoma and Follicular Lymphoma. American journal of clinical pathology. 2021 Feb 04;155(2):308-317