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Follicular lymphoma transformed to “double‐hit” B lymphoblastic lymphoma presenting in the peritoneal fluid
Author(s) -
Kaplan Alesia,
Samad Arbaz,
Dolan Michelle M.,
Cioc Adina M.,
Holman Carol J.,
Schmechel Stephen C.,
Pambuccian Stefan E.
Publication year - 2013
Publication title -
diagnostic cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.417
H-Index - 65
eISSN - 1097-0339
pISSN - 8755-1039
DOI - 10.1002/dc.22871
Subject(s) - pathology , lymphoma , follicular lymphoma , immunophenotyping , medicine , lymphoblastic lymphoma , population , fluorescence in situ hybridization , gene rearrangement , biology , immunology , flow cytometry , t cell , chromosome , biochemistry , immune system , environmental health , gene
Lymphomas showing both MYC/8q24 rearrangement and IGH@BCL2/t(14;18)(q32;q21), also referred to as “double‐hit” or “dual‐hit” lymphomas (DHL) are rare B‐cell malignancies with a germinal center B‐cell immunophenotype and heterogeneous cytologic and histologic features. Such lymphomas may arise de novo or through transformation of follicular lymphomas and are classified either as “B‐cell lymphoma, unclassifiable, with features intermediate between diffuse large B‐cell lymphoma (DLBCL) and Burkitt lymphoma (BL)” (most commonly), DLBCL, or, rarely, as B‐lymphoblastic lymphoma. We report a case of B‐lymphobastic lymphoma arising through transformation of follicular lymphoma diagnosed on peritoneal fluid cytology, flow cytometry, and cytogenetic studies in a 53‐year‐old man who presented with abdominal pain, shortness of breath, night sweats, extensive lymphadenopathy, pleural effusion, and ascites. Cytologic examination of the ascitic fluid showed two distinct populations of neoplastic lymphoid cells, a predominant population of larger cells with fine powdery (“blastic”) chromatin, visible to prominent nucleoli and occasional small cytoplasmic vacuoles and a less numerous population of smaller cells with centrocytic morphology. Flow cytometry also showed two distinct monotypic B‐cell populations, both expressing CD10, and TdT‐positivity was demonstrated immunohistochemically. Fluorescence in situ hybridization (FISH) demonstrated both MYC rearrangement and IGH/BCL2 gene fusion and cytogenetic analysis showed a complex karyotype including both t(14;18)(q32;q21) and t(8;22)(q24.1;q11.2). Since DHL pursue an aggressive clinical course, respond poorly to therapy, and have a poor outcome, it is important to suspect the diagnosis when encountering neoplastic lymphoid cells that are difficult to classify in effusion cytology specimens and to order the appropriate immunophenotyping and cytogenetic studies. Diagn. Cytopathol. 2013;41:986–990. © 2012 Wiley Periodicals, Inc.