High-grade B-cell lymphoma with MYC and BCL2 rearrangements arising in a composite lymphoma

• Published in: Diagnostic pathology Vol. 13; no. 1; p. 34
• Main Authors: Moore, Alison M, Moshkin, Olga, Swain, Gordon J, Crocker, Susan, LeBrun, David P
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 24.05.2018; BioMed Central; BMC
• Subjects: B-cell lymphoma; Biopsy; Biopsy, Needle; Case Report; Chemotherapy; Chronic lymphocytic leukemia; Cloning; Composite lymphoma; CT imaging; Cytogenetics; Diagnosis; Diffuse large B-cell lymphoma; Double-hit lymphoma; Fluorescence; Fluorescence in situ hybridization; Follicular lymphoma; Genetic transformation; Heavy chains; High-grade B-cell lymphoma; Immunoglobulins; Leukemia; Lymphatic leukemia; Lymphocytes B; Lymphocytic leukemia; Lymphoma; Molecular chains; Morphology; Myc protein; Neck; Translocation; Canada; Chronic lymphocytic leukemia; Composite lymphoma; Small lymphocytic lymphoma; MYC; BCL2; Cytogenetics; Follicular lymphoma; High-grade B-cell lymphoma; Double-hit lymphoma; Diffuse large B-cell lymphoma
• ISSN: 1746-1596; 1746-1596
• DOI: 10.1186/s13000-018-0714-z

We report the first case of composite lymphoma consisting of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), follicular lymphoma (FL) and high-grade B-cell lymphoma with MYC and BCL2 rearrangements within the same needle biopsy in which a clonal relationship between the FL and high-grade B-cell lymphoma components was demonstrated by molecular cytogenetics. An 85-year-old man presented with masses in his neck and right groin. Cutting needle biopsy of the inguinal mass revealed the three lymphoma types which were morphologically, immunophenotypically and topographically distinct. Fluorescence in situ hybridization (FISH) identified an IGH-BCL2 rearrangement in both the FL and high-grade B-cell components while a MYC rearrangement was detected in the high-grade B-cell component alone. Our findings suggest that the high-grade lymphoma with MYC and BCL2 translocations evolved through transformation of the FL by a process that entailed acquisition of the MYC translocation. No clonal relationship between the FL and CLL/SLL components was evident since the IGH-BCL2 rearrangement was present in in the former but not the latter. This unique case of co-localized FL, CLL/SLL, and high-grade B-cell lymphoma contributes to our understanding of the clonal relationships that may exist between the components of composite lymphomas.