High-grade B-cell lymphoma with MYC and BCL2 rearrangements arising in a composite lymphoma
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CASE REPORT
Open Access
High-grade B-cell lymphoma with MYC and BCL2 rearrangements arising in a composite lymphoma Alison M. Moore1, Olga Moshkin2, Gordon J. Swain2, Susan Crocker1 and David P. LeBrun1*
Abstract Background: 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. Case presentation: 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. Conclusions: 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. Keywords: Composite lymphoma, Double-hit lymphoma, High-grade B-cell lymphoma, Diffuse large B-cell lymphoma, Follicular lymphoma, Chronic lymphocytic leukemia, Small lymphocytic lymphoma, Cytogenetics, MYC, BCL2
Background “Composite lymphoma” refers to the co-occurrence of two or more distinct lymphoma types at a single anatomical site [1]. Composite lymphomas are relatively rare, accounting for only 1–4% of lymphomas. Instances of histological transformation from an indolent non-Hodgkin lymphoma to more aggressive disease, typically diffuse large B-cell lymphoma (DLBCL), are often excluded from the composite lymphoma category even when the two components are present in the same sample. We describe a case of composite lymphoma consisting of chronic lymphocytic leukemia/ small lymphocytic lymphoma (CLL/SLL), follicular lymphoma (FL) and high-grade lymphoma with MYC and BCL2 rearrangements (formerly and more colloquially denoted * Correspondence: [email protected] 1 Department of Pathology and Molecular Medicine, Queen’s University, Kingston, ON, Canada Full list of author information is available at the end of the article
“double-hit” lymphoma). All of these components were present in a single, small tissue sample obtained by cutting needle biopsy. To the best of our knowledge, the results derived from this case are unique and address important questions pertaining to the clonal interrelationships that exist between the three ly
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