Double Hit Lymphoma Mimicking B Cell Precursor Phenotype Burkitt Lymphoma/Leukemia in an Elderly

Background: The differential diagnosis of Burkitt lymphoma/leukemia (BL) and the double or triple hit lymphomas remains often problematic in terms of immunophenotyping in association with MYC gene analysis. In the past, BL-like B-cell malignancy with B-cell precursor phenotype (BCP-ALL) was described. Case Report: We report here an 84-year-old male with massive ascites without superficial lymphadenopathy. Abdominal paracentesis revealed chylous (non-bloody) ascites consisting of mostly abnormal BL-like blasts showing CD20-negative BCP phenotype. However, molecular study indicated no MYC/IGH, but probable involvements of MYC/IGL and BCL6/IGH translocations, which were confirmed by FISH studies. The patient was diagnosed as double hit lymphoma mimicking BCP-ALL.

Keywords

double hit lymphoma

burkitt lymphoma

ascites

CD20

terminal deoxynucleotidyl transferase

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Fig. 1.

Cytospin smear of the ascites reveals numerous lymphoblasts with abundant cytoplasmic vacuoles (A; Giemsa stain, original magnification $\times{}$ 1000) and bone marrow smear (B; May-Giemsa stain, original magnification $\times{}$ 1000) shows FAB L3 type blasts. In A and B, scale bar indicates 10 $\mathrm{\mu}$ m. Flowcytometry of blast cells in bone marrow shows CD10-positive and CD20-negative (C). FISH on interphase nucleus of bone marrow blasts showed split signals (arrows) of BCL6 (D), MYC (E), and IGH (F). Split signals were each detected in 15%; reference $<$ 2%. In (F), 3 green spots were IGH , 2 red spots were MYC and 2 blue spots were D8Z2, with use of Vysis™ LSI® IGH/MYC, CEP® 8 Tri-color, Dual Fusion Translocation Probe: Abbot Molecular Inc.). These results together with the karyotype indicates probable MYC/IGL and IGH/BCL6 translocations and double-hit lymphoma.

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J. Mol. Clin. Med. Print ISSN 2616-3632 Electronic ISSN 2617-5282