Abstract
Amongst follicular lymphoma that transforms into a high-grade lymphoma, majority are diffuse large B cell lymphoma. Here we reported a rare atypical Burkitt's lymphoma transformation from an asymptomatic follicular lymphoma. Lymph node biopsy showed a composite lymphoma with infiltration of the inter-follicular areas by high grade small non-cleaved lymphoma cells amongst neoplastic follicles. Moreover, FISH and molecular genetic study confirmed concomitant MYC translocations and t(14;18) in the high-grade component, thereby suggesting the transformation of atypical Burkitt's lymphoma from an undiagnosed antecedent follicular lymphoma. The disease followed an aggressive clinical course, terminating in refractory disease 13 months after diagnosis. This is followed by a comprehensive review of the literature on lymphoma transformations from underlying follicular lymphoma after acquisition of MYC translocation, using Burkitt's lymphoma, follicular lymphoma, transformation and MYC translocations as keywords.
Highlights
Amongst follicular lymphoma that transforms into a high-grade lymphoma, majority are diffuse large B cell lymphoma
The lymphoma arises from germinal centre lymphocytes with three histological grades based on the number of centroblasts in the neoplastic follicles
The pathogenesis of disease is due to the overexpression of the anti-apoptotic Bcl-2 associated with t(14;18), which juxtaposes BCL-2 gene on chromosome 18 to the enhancer of the immunoglobulin heavy chain gene (IgH) locus on chromosome 14
Summary
Amongst follicular lymphoma that transforms into a high-grade lymphoma, majority are diffuse large B cell lymphoma. In patients presenting with atypical Burkitt’s lymphoma, about 25% were transformations from an antecedent FL [5]. Acquisition of MYC translocation was reported in some high grade transformation of FL.
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