Disseminated Double-Hit Lymphoma in a Young Adult
DOI:
https://doi.org/10.21141/PJP.2021.07Keywords:
lymphoma, B-cell lymphoma, molecular diagnostic techniqueAbstract
High-grade B-cell lymphoma with MYC and BCL2 and-or BCL6 rearrangements, also called double-hit lymphoma, is an aggressive mature B-cell lymphoma that carries both MYC and BCL2 and/or BCL6 translocations. This can present as a diagnostic challenge since clinical characteristics, morphology and immunophenotype are not accurate indicators of underlying genetic aberrations in this type of lymphoma. We report a case of a 25-year-old male who presented with a one-year history of cough, gradually increasing abdominal girth and jaundice. Definitive diagnosis was made post-mortem with additional ancillary studies using immunohistochemistry staining and fluorescent in-situ hybridization studies.
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References
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169621. https://doi.org/10.3343/alm.2020.40.5.361.
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14. Di Napoli A, Remotti D, Agostinelli C, et al. A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era: selecting cases, matching clinical benefit. Virchows Archiv. 2019;475(4):513–8. https://pubmed.ncbi.nlm.nih.gov/31388760.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312021. https://doi.org/10.3324/haematol.2018.195958.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905641. https://doi.org/10.7573/dic.2019-8-1.
2. Smith SM. Aggressive B-cell lymphoma: the double-hit and double-expresser phenotypes. Clin Adv Hematol Oncol. 2017;15(1):40-2. https://pubmed.ncbi.nlm.nih.gov/28212368.
3. Stephens DM, Smith SM. Diffuse large B-cell lymphoma- who should we FISH? Ann Lymphoma. 2018; 2:1-10. https://doi.org/10.21037/aol.2018.11.01.
4. Aukema SM, Siebert R, Schuuring E, et al. Double-hit-B-cell lymphoma. Blood. 2011; 117(8):2319-31. https://pubmed.ncbi.nlm.nih.gov/21119107. https://doi.org/10.1182/blood-2010-09-297879.
5. Msimang MZ, Ramdial PK, Kuppusamy JB, Nargan K, Sheik-Gafoor MH. AIDS-associated pediatric high-grade B-cell lymphoma with MYC and BCL2 translocations. J AIDS Clin Res. 2018;8(11):742. https://doi.org/10.4172/2155-6113.1000742.
6. Niitsu N, Okamoto M, Miura I. et al. Clinical features and prognosis of de novo diffuse large B-cell lymphoma with t(14;18) and 8q24/c-MYC translocations. Leukemia. 2009;23(4):777–83. https://pubmed.ncbi.nlm.nih.gov/19151788. https://doi.org/10.1038/leu.2008.344.
7. López-Guillermo A, Colomo L, Jímenez M, et al. Diffuse large B-cell lymphoma: clinical and biological characterization and outcome according to the nodal or extranodal primary origin. J Clin Oncol. 2016; 23(12):2797-804. https://pubmed.ncbi.nlm.nih.gov/15728226. https://doi.org/10.1200/JCO.2005.07.155.
8. Oliveira CC, Maciel-Guerra H, Kucko L, et al. Double-hit lymphomas: clinical, morphological, immunohistochemical and cytogenetic study in a series of Brazilian patients with high-grade non-Hodgkin lymphoma. Diagn Pathol. 2017;12(1):3. https://pubmed.ncbi.nlm.nih.gov/28061782.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5219810. https://doi.org/10.1186/s13000-016-0593-0.
9. Friedberg, JW. How I treat double hit lymphoma. Blood. 2017;130(5): 590-6. https://pubmed.ncbi.nlm.nih.gov/28600333. https://doi.org/10.1182/blood-2017-04-737320.
10. Liu Y, Barta SK. Diffuse large B-cell lymphoma: 2019 update on diagnosis, risk stratification, and treatment. Am J Hematol. 2019;95(5):604-16. https://pubmed.ncbi.nlm.nih.gov/30859597. https://doi.org/10.1002/ajh.25460.
11. Kim H, Kim HJ, Kim SH. Diagnostic approach for double-hit and triple-hit lymphoma based on immunophenotypic and cytogenetic characteristics of bone marrow specimens. Ann Lab Med. 2020;40(5):361-9. https://pubmed.ncbi.nlm.nih.gov/32311849.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169621. https://doi.org/10.3343/alm.2020.40.5.361.
12. Friedberg JW. Double hit diffuse large B-cell lymphomas: diagnostic and therapeutic challenges. Chin Clin Oncol. 2015; 4(1):9. https://pubmed.ncbi.nlm.nih.gov/25841716. https://doi.org/10.3978/j.issn.2304-3865.2015.03.02.
13. Davies, A. Double-hit lymphoma: so what? Hematol Oncol. 2019; 37(Suppl 1):19-23. https://pubmed.ncbi.nlm.nih.gov/31187528. https://doi.org/10.1002/hon.2581.
14. Di Napoli A, Remotti D, Agostinelli C, et al. A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era: selecting cases, matching clinical benefit. Virchows Archiv. 2019;475(4):513–8. https://pubmed.ncbi.nlm.nih.gov/31388760.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6828632. https://doi.org/10.1007/s00428-019-02637-2.
15. Ambrosio MR, Lazzi S, Lo Bello G, et al. MYC protein expression scoring and its impact on the prognosis of aggressive B-cell lymphoma patients. Haematologica. 2019;104(1):e25-8. https://pubmed.ncbi.nlm.nih.gov/29954940.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312021. https://doi.org/10.3324/haematol.2018.195958.
16. Phuoc V, Sus J, Chavez JC. Drug therapy for double-hit lymphoma. Drugs Context. 2019;8:2019-8-1. https://pubmed.ncbi.nlm.nih.gov/31844420.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6905641. https://doi.org/10.7573/dic.2019-8-1.
Published
06/29/2021
How to Cite
Damian, K., & Cancio, J. E. . (2021). Disseminated Double-Hit Lymphoma in a Young Adult. PJP, 6(1), 56–61. https://doi.org/10.21141/PJP.2021.07
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Section
Autopsy Vault
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The Philippine Journal of Pathology is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Based on works made open access at http://philippinejournalofpathology.org
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