Abstract
BackgroundWe report the first case of composite lymphoma consisting of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), follicular lymphoma (FL) and high-grade B-cell lymphoma with MYC and BCL2 rearrangements within the same needle biopsy in which a clonal relationship between the FL and high-grade B-cell lymphoma components was demonstrated by molecular cytogenetics.Case presentationAn 85-year-old man presented with masses in his neck and right groin. Cutting needle biopsy of the inguinal mass revealed the three lymphoma types which were morphologically, immunophenotypically and topographically distinct. Fluorescence in situ hybridization (FISH) identified an IGH-BCL2 rearrangement in both the FL and high-grade B-cell components while a MYC rearrangement was detected in the high-grade B-cell component alone.ConclusionsOur findings suggest that the high-grade lymphoma with MYC and BCL2 translocations evolved through transformation of the FL by a process that entailed acquisition of the MYC translocation. No clonal relationship between the FL and CLL/SLL components was evident since the IGH-BCL2 rearrangement was present in in the former but not the latter. This unique case of co-localized FL, CLL/SLL, and high-grade B-cell lymphoma contributes to our understanding of the clonal relationships that may exist between the components of composite lymphomas.
Highlights
We report the first case of composite lymphoma consisting of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), follicular lymphoma (FL) and high-grade B-cell lymphoma with MYC and BCL2 rearrangements within the same needle biopsy in which a clonal relationship between the FL and high-grade B-cell lymphoma components was demonstrated by molecular cytogenetics.Case presentation: An 85-year-old man presented with masses in his neck and right groin
Our findings suggest that the high-grade lymphoma with MYC and BCL2 translocations evolved through transformation of the FL by a process that entailed acquisition of the MYC translocation
No clonal relationship between the FL and CLL/SLL components was evident since the IGH-BCL2 rearrangement was present in in the former but not the latter
Summary
The findings from our unique case of composite lymphoma in which FL, SLL and high-grade B-cell lymphoma with rearrangement of MYC and BCL2 co-existed within a single, small tissue fragment suggest that the FL and SLL/CLL processes represent distinct neoplastic clones and that the high-grade B-cell component emerged through direct clonal evolution from the FL in a process that entailed acquisition of an IGH-MYC rearrangement. Abbreviations CLL/SLL: Chronic lymphocytic leukemia / small lymphocytic lymphoma; CT: Computed tomography; DLBCL: Diffuse large B-cell lymphoma; EPOCH-R: Etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab; FISH: Fluorescence in situ hybridization; FL: Follicular lymphoma; IHC: Immunohistochemistry; PCR: Polymerase chain reaction; R-CHOP: Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone
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