Dear Editor, Although the identification of mutations as an initial event is very difficult, the use of next-generation sequencing and high coverage in sequencing data have made it possible to distinguish early mutations from late events, based on the allelic frequency of the mutations. Since recurrently observed among certain subtypes of B cell malignancies, L256P mutation in MYD88 is regarded as one of the initial molecular events [1]. Ten years before death, the patient, a 68-year-old Japanese man, had a gradually growing mass in the left side of the neck. Pathological analysis of an excisional biopsy of the mass led to the diagnosis of primary malignant lymphoma in the parotid gland (the pathological diagnosis at that time was high-grade mucosa-associated lymphoid tissue (MALT) lymphoma that was retrospectively diagnosed as diffuse large B cell lymphoma (DLBCL) according to the 2011 WHO classification: CD10 negative, Bcl-6 positive, MUM1 negative, and 5 % of Ki67 labeling index; Fig. 1a–d). The patient received three courses of chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP)) combined with radiotherapy. Although the combined therapy was effective at first, the patient suffered from exacerbation of preexisting chronic hepatitis B during the last course of chemotherapy. Anti-hepatitis B viral therapy with lamivudine was administered for 6 months. After being clinically recurrence-free of malignant lymphoma for 8 years, the patient again developed a mass in the left side of the neck. Biopsy revealed the presence of the non-germinal center B (GCB) subtype of DLBCL (CD10 (−), Bcl-6 (−), MUM1 (+)). From the clinical record, we confirmed that except for BCL2 amplification at the relapsed phase, neither translocations nor breaks were evident in BCL6, IgH, and MYC genes. Three courses of chemotherapy (rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP)) were ineffective, however, and the patient died of multiple organ failure. Autopsy revealed aggressive DLBCL infiltrating virtually all the organs, especially the liver (Fig. 1e–h) and the spleen. B cell monoclonality of DLBCL at the parotid K. Fujiishi :R. Kitazawa :Y. Nagai : T. Watanabe :R. Haraguchi : S. Kitazawa (*) Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon City, Ehime 791-0295, Japan e-mail: kitazawa@m.ehime-u.ac.jp