Simultaneous Discordant B-Lymphoblastic Lymphoma and Follicular Lymphoma

Author:

Fujimoto Ayumi1ORCID,Ikejiri Fumiyoshi1,Arakawa Fumiko2,Ito Shunsuke1,Okada Yusuke1,Takahashi Fumimasa1,Matsuda Shinichiro1,Okada Takahiro1,Inoue Masaya1,Takahashi Tsutomu1,Miyake Takaaki1,Maruyama Riruke3,Ohshima Koichi2,Suzumiya Junji1,Suzuki Ritsuro1ORCID

Affiliation:

1. Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan

2. Department of Pathology, Kurume University School of Medicine, Kurume, Japan

3. Department of Pathology, Shimane University Hospital, Izumo, Japan

Abstract

Abstract Objectives 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. Methods 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. Results 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. Conclusions B-lymphoblastic transformation of FL can occur with MYC gene rearrangement.

Publisher

Oxford University Press (OUP)

Subject

General Medicine

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