Mature B-cell acute lymphoblastic leukemia (ALL) is defined by the expression of light chain-restricted surface immunoglobulin (sIg) and usually has features of the leukemic phase of Burkitt lymphoma including FAB-L3 morphology and MYC rearrangement. Recently, another distinct entity in childhood mature B-cell ALL has been characterized as non-L3 morphology and KMT2A rearrangement. Here we report an unusual case of mature B-cell ALL that presented with RUNX1 rearrangement. A 65-year-old male was admitted to our department for thorough examination of leukocytosis and thrombocytopenia. The patient's bone marrow was hypercellular and infiltrated with 97.8% myeloperoxidase-negative, medium-to-large-sized blasts without cytoplasmic vacuoles. Immunophenotypes were characterized by the presence of light chain-restricted sIg and the lack of immature markers, indicating a diagnosis of mature B-cell ALL with L2 morphology: sIg-κ+, CD19+, CD20+, CD22+, CD79a+, TdT-, and CD34-. G-banding combined with spectral karyotyping showed the following complex karyotype: 45,X,der(Y;10)(p10;q10),del(13)(q?),inv(21)(p13q22.1). Fluorescence in situ hybridization revealed separated signals of RUNX1 at 21q22.1, whereas rearrangements of MYC and KMT2A were not found. To our knowledge, inv(21)(p13q22.1) involving RUNX1 is a novel cytogenetic aberration and this is the first case of mature B-cell ALL that presented with RUNX1 rearrangement. Thus, RUNX1 may be implicated in the pathogenesis of mature B-cell ALL showing non-L3 morphology without MYC rearrangement.
{"title":"RUNX1 rearrangement in mature B-cell acute lymphoblastic leukemia with non-L3 morphology.","authors":"Katsuya Yamamoto, Akihito Kitao, Marika Watanabe, Hiroshi Kanehira, Miki Joyce, Yuri Hirakawa, Sakuya Matsumoto, Kimikazu Yakushijin, Hironobu Minami","doi":"10.3960/jslrt.23028","DOIUrl":"10.3960/jslrt.23028","url":null,"abstract":"<p><p>Mature B-cell acute lymphoblastic leukemia (ALL) is defined by the expression of light chain-restricted surface immunoglobulin (sIg) and usually has features of the leukemic phase of Burkitt lymphoma including FAB-L3 morphology and MYC rearrangement. Recently, another distinct entity in childhood mature B-cell ALL has been characterized as non-L3 morphology and KMT2A rearrangement. Here we report an unusual case of mature B-cell ALL that presented with RUNX1 rearrangement. A 65-year-old male was admitted to our department for thorough examination of leukocytosis and thrombocytopenia. The patient's bone marrow was hypercellular and infiltrated with 97.8% myeloperoxidase-negative, medium-to-large-sized blasts without cytoplasmic vacuoles. Immunophenotypes were characterized by the presence of light chain-restricted sIg and the lack of immature markers, indicating a diagnosis of mature B-cell ALL with L2 morphology: sIg-κ+, CD19+, CD20+, CD22+, CD79a+, TdT-, and CD34-. G-banding combined with spectral karyotyping showed the following complex karyotype: 45,X,der(Y;10)(p10;q10),del(13)(q?),inv(21)(p13q22.1). Fluorescence in situ hybridization revealed separated signals of RUNX1 at 21q22.1, whereas rearrangements of MYC and KMT2A were not found. To our knowledge, inv(21)(p13q22.1) involving RUNX1 is a novel cytogenetic aberration and this is the first case of mature B-cell ALL that presented with RUNX1 rearrangement. Thus, RUNX1 may be implicated in the pathogenesis of mature B-cell ALL showing non-L3 morphology without MYC rearrangement.</p>","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"240-245"},"PeriodicalIF":1.5,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10861373/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71414656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Here we describe our experience with a rare case of methotrexate (MTX)-associated lymphoproliferative disorder (LPD) initially diagnosed as follicular lymphoma (FL) and then in relapse as classic Hodgkin lymphoma (CHL). A 66-year-old man was admitted to the hospital with fever and abdominal and lower back pain after a transient remission of MTX-associated FL (MTX-FL) following MTX withdrawal. Computed tomography (CT) showed para-aortic lymphadenopathy, which was compatible with one of the previous FL lesions. We considered a relapse of FL and started bendamustine and rituximab. Although his initial symptoms and para-aortic lymphadenopathy regressed after the first course, he began to have dorsal pain, and multiple osteolytic lesions were detected on CT. We biopsied a Th4 vertebra osteolytic lesion, and the results indicated MTX-associated CHL (MTX-CHL). We successfully treated advanced MTX-CHL with brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD). This case suggests the importance of repeat biopsy of a new lesion arising after resolution of previously affected sites in MTX-LPD and the effectiveness of A+AVD in treating advanced MTX-CHL.
{"title":"A case of classic Hodgkin lymphoma arising after remission of methotrexate-associated follicular lymphoma.","authors":"Yayoi Ueda, Takehiro Tanaka, Shoji Asakura, Tomofumi Yano","doi":"10.3960/jslrt.23016","DOIUrl":"10.3960/jslrt.23016","url":null,"abstract":"<p><p>Here we describe our experience with a rare case of methotrexate (MTX)-associated lymphoproliferative disorder (LPD) initially diagnosed as follicular lymphoma (FL) and then in relapse as classic Hodgkin lymphoma (CHL). A 66-year-old man was admitted to the hospital with fever and abdominal and lower back pain after a transient remission of MTX-associated FL (MTX-FL) following MTX withdrawal. Computed tomography (CT) showed para-aortic lymphadenopathy, which was compatible with one of the previous FL lesions. We considered a relapse of FL and started bendamustine and rituximab. Although his initial symptoms and para-aortic lymphadenopathy regressed after the first course, he began to have dorsal pain, and multiple osteolytic lesions were detected on CT. We biopsied a Th4 vertebra osteolytic lesion, and the results indicated MTX-associated CHL (MTX-CHL). We successfully treated advanced MTX-CHL with brentuximab vedotin, doxorubicin, vinblastine, and dacarbazine (A+AVD). This case suggests the importance of repeat biopsy of a new lesion arising after resolution of previously affected sites in MTX-LPD and the effectiveness of A+AVD in treating advanced MTX-CHL.</p>","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"177-180"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9899815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
), and PFS were compared between the BR and GB groups. Tumor volume was determined according to the Groupe d’Étude des Lymphomes Folliculaires (GELF) criteria, and response was determined according to the International Workshop to standardize response criteria for NHL, 9 using computed tomography (CT) or 18 F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT). Adverse events including febrile neutropenia, sepsis, pneumonia, herpes zoster, and cytomegalovirus (CMV) infection, were evaluated by CTCAE Ver5.0. Survival was analyzed starting from the date of treatment initiation. PFS was defined as the period from treatment to dis - ease progression, relapse, or death. The cumulative incidence of CMV infection was analyzed using Gray’s test, and the competing events were deaths due to causes other than infection. All statistical analyses were performed with EZR software. 10 This study was approved by the ethics review board of Oita Prefectural Hospital, and by the ethics review board of each collaborating research institution. Patients’ informed consent was obtained in the form of opt-out on a
{"title":"Infections associated with bendamustine and anti-CD20 antibody in untreated follicular lymphoma: a real-world study.","authors":"Masuho Saburi, Kazuki Okuhiro, Natsumi Yoshida, Takami Haruyama, Yui Moroga, Yuka Yanai, Kazuhito Itani, Kuniko Takano, Shuhei Honda, Keiji Ono, Manami Iwanaga, Hitohiro Sasaki, Miyuki Abe, Kazuhiro Kohno, Toshiyuki Nakayama, Eiichi Ohtsuka, Masao Ogata","doi":"10.3960/jslrt.23015","DOIUrl":"10.3960/jslrt.23015","url":null,"abstract":"), and PFS were compared between the BR and GB groups. Tumor volume was determined according to the Groupe d’Étude des Lymphomes Folliculaires (GELF) criteria, and response was determined according to the International Workshop to standardize response criteria for NHL, 9 using computed tomography (CT) or 18 F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT). Adverse events including febrile neutropenia, sepsis, pneumonia, herpes zoster, and cytomegalovirus (CMV) infection, were evaluated by CTCAE Ver5.0. Survival was analyzed starting from the date of treatment initiation. PFS was defined as the period from treatment to dis - ease progression, relapse, or death. The cumulative incidence of CMV infection was analyzed using Gray’s test, and the competing events were deaths due to causes other than infection. All statistical analyses were performed with EZR software. 10 This study was approved by the ethics review board of Oita Prefectural Hospital, and by the ethics review board of each collaborating research institution. Patients’ informed consent was obtained in the form of opt-out on a","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"197-200"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9897794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28Epub Date: 2023-08-28DOI: 10.3960/jslrt.23012
Yoshiaki Abe
Follicular lymphoma (FL) is the most frequent indolent lymphoma and is characterized by the abundant infiltration of tumor microenvironment (TME) cells. The activity of TME cells reportedly plays an important role in the biology of FL. TME cells that reside within neoplastic follicles, such as T-follicular helper cells and follicular dendritic cells, have been shown to aid in FL development and progression through interactions with malignant B cells, whereas regulatory T cells have unexpectedly shown an apparently favorable prognostic impact in FL. Unfortunately, the understanding of the FL TME, particularly regarding minor cell subsets, has been hampered by unknown cell heterogeneity. As with other solid and hematologic cancers, novel single-cell analysis technologies have recently been applied to FL research and have uncovered previously unrecognized heterogeneities, not only in malignant B cells but also in TME cells. These reports have greatly increased the resolution of our understanding of the FL TME and, at the same time, raised questions about newly identified TME cells. This review provides an overview of the unique aspects of FL TME cells with a clinical viewpoint and highlights recent discoveries from single-cell analysis, while also suggesting potential future directions.
{"title":"Follicular lymphoma microenvironment: insights provided by single-cell analysis.","authors":"Yoshiaki Abe","doi":"10.3960/jslrt.23012","DOIUrl":"10.3960/jslrt.23012","url":null,"abstract":"<p><p>Follicular lymphoma (FL) is the most frequent indolent lymphoma and is characterized by the abundant infiltration of tumor microenvironment (TME) cells. The activity of TME cells reportedly plays an important role in the biology of FL. TME cells that reside within neoplastic follicles, such as T-follicular helper cells and follicular dendritic cells, have been shown to aid in FL development and progression through interactions with malignant B cells, whereas regulatory T cells have unexpectedly shown an apparently favorable prognostic impact in FL. Unfortunately, the understanding of the FL TME, particularly regarding minor cell subsets, has been hampered by unknown cell heterogeneity. As with other solid and hematologic cancers, novel single-cell analysis technologies have recently been applied to FL research and have uncovered previously unrecognized heterogeneities, not only in malignant B cells but also in TME cells. These reports have greatly increased the resolution of our understanding of the FL TME and, at the same time, raised questions about newly identified TME cells. This review provides an overview of the unique aspects of FL TME cells with a clinical viewpoint and highlights recent discoveries from single-cell analysis, while also suggesting potential future directions.</p>","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"143-151"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10084431","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28Epub Date: 2023-07-28DOI: 10.3960/jslrt.23014
Joaquim Carreras
Follicular lymphoma is one of the most frequent lymphomas. Histologically, it is characterized by a follicular (nodular) growth pattern of centrocytes and centroblasts; mixed with variable immune microenvironment cells. Clinically, it is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. It is biologically and clinically heterogeneous. In most patients it is indolent, but others have a more aggressive evolution with relapses; and transformation to diffuse large B-cell lymphoma. Tumorigenesis includes an asymptomatic preclinical phase in which premalignant B-lymphocytes with the t(14;18) chromosomal translocation acquire additional genetic alterations in the germinal centers, and clonal evolution occurs, although not all the cells progress to the tumor stage. This manuscript reviews the pathobiology and clinicopathological characteristics of follicular lymphoma. It includes a description of the physiology of the germinal center, the genetic alterations of BCL2 and BCL6, the mutational profile, the immune checkpoint, precision medicine, and highlights in the lymphoma classification. In addition, a comment and review on artificial intelligence and machine (deep) learning are made.
{"title":"The pathobiology of follicular lymphoma.","authors":"Joaquim Carreras","doi":"10.3960/jslrt.23014","DOIUrl":"10.3960/jslrt.23014","url":null,"abstract":"<p><p>Follicular lymphoma is one of the most frequent lymphomas. Histologically, it is characterized by a follicular (nodular) growth pattern of centrocytes and centroblasts; mixed with variable immune microenvironment cells. Clinically, it is characterized by diffuse lymphadenopathy, bone marrow involvement, and splenomegaly. It is biologically and clinically heterogeneous. In most patients it is indolent, but others have a more aggressive evolution with relapses; and transformation to diffuse large B-cell lymphoma. Tumorigenesis includes an asymptomatic preclinical phase in which premalignant B-lymphocytes with the t(14;18) chromosomal translocation acquire additional genetic alterations in the germinal centers, and clonal evolution occurs, although not all the cells progress to the tumor stage. This manuscript reviews the pathobiology and clinicopathological characteristics of follicular lymphoma. It includes a description of the physiology of the germinal center, the genetic alterations of BCL2 and BCL6, the mutational profile, the immune checkpoint, precision medicine, and highlights in the lymphoma classification. In addition, a comment and review on artificial intelligence and machine (deep) learning are made.</p>","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"152-163"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9897795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thrombocytopenia is a frequent complication in chronic lymphocytic leukemia (CLL). Differentiating autoimmune thrombocytopenia from thrombocytopenia due to bone marrow infiltration is necessary for appropriate treatment, but sometimes difficult. Here we report a 60-year-old male patient with CLL who had achieved complete response after treatment with fludarabine, cyclophosphamide, and rituximab two years prior to presentation. He was admitted with severe thrombocytopenia that was unresponsive to intravenous immunoglobulin. Imaging studies revealed systemic enlarged lymph nodes and bone marrow aspiration was hypercellular with > 95% lymphocytes and scant megakaryocytes. Acalabrutinib 200 mg/day was administered for the treatment of CLL exacerbation. A gradual decrease in CLL cells and recovery of megakaryocytes in bone marrow were observed, but platelet counts remained low. Systemic administration of prednisolone 0.5 mg/kg, in addition to acalabrutinib, was started, considering the contribution of autoimmune thrombocytopenia; platelet recovery was rapid and sustained for more than a year. Even if bone marrow examination suggested thrombocytopenia due to direct leukemic infiltration, it is difficult to exclude the possibility of concomitant immunogenic thrombocytopenia. We conclude that for CLL patients with severe thrombocytopenia, repeating bone marrow examination and concurrent immunosuppressive therapies and treatment of the underlying CLL may be beneficial.
{"title":"Acalabrutinib and steroid for autoimmune thrombocytopenia due to relapsed chronic lymphocytic leukemia with severe bone marrow infiltration.","authors":"Takashi Oyama, Megumi Yasunaga, Masahiro Jona, Masako Nishikawa, Yutaka Yatomi, Akira Honda, Hiroaki Maki, Ken Morita, Yosuke Masamoto, Mineo Kurokawa","doi":"10.3960/jslrt.23023","DOIUrl":"10.3960/jslrt.23023","url":null,"abstract":"<p><p>Thrombocytopenia is a frequent complication in chronic lymphocytic leukemia (CLL). Differentiating autoimmune thrombocytopenia from thrombocytopenia due to bone marrow infiltration is necessary for appropriate treatment, but sometimes difficult. Here we report a 60-year-old male patient with CLL who had achieved complete response after treatment with fludarabine, cyclophosphamide, and rituximab two years prior to presentation. He was admitted with severe thrombocytopenia that was unresponsive to intravenous immunoglobulin. Imaging studies revealed systemic enlarged lymph nodes and bone marrow aspiration was hypercellular with > 95% lymphocytes and scant megakaryocytes. Acalabrutinib 200 mg/day was administered for the treatment of CLL exacerbation. A gradual decrease in CLL cells and recovery of megakaryocytes in bone marrow were observed, but platelet counts remained low. Systemic administration of prednisolone 0.5 mg/kg, in addition to acalabrutinib, was started, considering the contribution of autoimmune thrombocytopenia; platelet recovery was rapid and sustained for more than a year. Even if bone marrow examination suggested thrombocytopenia due to direct leukemic infiltration, it is difficult to exclude the possibility of concomitant immunogenic thrombocytopenia. We conclude that for CLL patients with severe thrombocytopenia, repeating bone marrow examination and concurrent immunosuppressive therapies and treatment of the underlying CLL may be beneficial.</p>","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"187-192"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10074960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28Epub Date: 2023-07-28DOI: 10.3960/jslrt.23022
Rin Yamada, Yoshihiro Komohara, Hiroshi Yoshii
not associated with COVID-19, with the exception of three cases showing uncommon complications, including heart involvement, generalized lymphade-nopathies, and multisystem inflammatory syndrome. 7,8,10 All but two cases showed complete resolution of clinical symptoms. In one case, cardiac function remained reduced, although whether the heart involvement was associated with KFD or COVID-19 remained unclear. 7 In another case, the clinical course was not documented. 12 Viral particles have never been identified ultrastructurally in the lymph nodes of patients with KFD. The present case and a previous case also did not demonstrate SARS-CoV-2 immunohistochemically. 5 Differential diagnoses for patients with cervical lymph-adenopathy following COVID-19 should include KFD to avoid unnecessary therapeutic interventions, particularly in patients under 40 years old. Further study regarding the relationship between KFD and COVID-19 is necessary.
{"title":"Kikuchi-Fujimoto disease following COVID-19 in a 32-year-old woman.","authors":"Rin Yamada, Yoshihiro Komohara, Hiroshi Yoshii","doi":"10.3960/jslrt.23022","DOIUrl":"10.3960/jslrt.23022","url":null,"abstract":"not associated with COVID-19, with the exception of three cases showing uncommon complications, including heart involvement, generalized lymphade-nopathies, and multisystem inflammatory syndrome. 7,8,10 All but two cases showed complete resolution of clinical symptoms. In one case, cardiac function remained reduced, although whether the heart involvement was associated with KFD or COVID-19 remained unclear. 7 In another case, the clinical course was not documented. 12 Viral particles have never been identified ultrastructurally in the lymph nodes of patients with KFD. The present case and a previous case also did not demonstrate SARS-CoV-2 immunohistochemically. 5 Differential diagnoses for patients with cervical lymph-adenopathy following COVID-19 should include KFD to avoid unnecessary therapeutic interventions, particularly in patients under 40 years old. Further study regarding the relationship between KFD and COVID-19 is necessary.","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"209-211"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9897791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We report two cases of diffuse large B-cell lymphoma (DLBCL) with composite germinal center B-cell (GCB) and non-GCB types. Case 1 was a 72-year-old woman with inguinal lymph node swelling. Two morphologically different lesions were concurrently observed in needle biopsy specimens. One lesion was DLBCL with centroblastic morphology and a GCB phenotype (CD10+, BCL6+, and MUM1-), according to the Hans algorithm. The other lesion was DLBCL with anaplastic morphology and a non-GCB phenotype (CD10-, BCL6+, and MUM1+). Considering cellular atypia, the GCB-type DLBCL likely progressed to non-GCB-type DLBCL. Case 2 was a 34-year-old man who underwent ileocecal resection, with four lesions observed in the ileum. All four lesions indicated centroblastic morphology. Three lesions showed a GCB phenotype (CD10+, BCL6+, and MUM1+), while the other showed a non-GCB phenotype (CD10-, BCL6+, and MUM1+). These tumors were clonally related. BCL2 expression and MYC rearrangement were not related to changes in the cell of origin (COO) in either case. In conclusion, changes in the COO in DLBCL may not be uncommon. Therefore, investigation of the COO in other sites or at relapse may be needed if new drugs with different indications for each COO are developed.
{"title":"Diffuse large B-cell lymphoma with composite germinal center and non-germinal center types: A report of two cases.","authors":"Ayumi Sugitani, Suguru Fukuhara, Maki Shibata, Ryosuke Ichihara, Haruhi Furukawa, Akiko Miyagi Maeshima","doi":"10.3960/jslrt.23020","DOIUrl":"10.3960/jslrt.23020","url":null,"abstract":"<p><p>We report two cases of diffuse large B-cell lymphoma (DLBCL) with composite germinal center B-cell (GCB) and non-GCB types. Case 1 was a 72-year-old woman with inguinal lymph node swelling. Two morphologically different lesions were concurrently observed in needle biopsy specimens. One lesion was DLBCL with centroblastic morphology and a GCB phenotype (CD10<sup>+</sup>, BCL6<sup>+</sup>, and MUM1<sup>-</sup>), according to the Hans algorithm. The other lesion was DLBCL with anaplastic morphology and a non-GCB phenotype (CD10<sup>-</sup>, BCL6<sup>+</sup>, and MUM1<sup>+</sup>). Considering cellular atypia, the GCB-type DLBCL likely progressed to non-GCB-type DLBCL. Case 2 was a 34-year-old man who underwent ileocecal resection, with four lesions observed in the ileum. All four lesions indicated centroblastic morphology. Three lesions showed a GCB phenotype (CD10<sup>+</sup>, BCL6<sup>+</sup>, and MUM1<sup>+</sup>), while the other showed a non-GCB phenotype (CD10<sup>-</sup>, BCL6<sup>+</sup>, and MUM1<sup>+</sup>). These tumors were clonally related. BCL2 expression and MYC rearrangement were not related to changes in the cell of origin (COO) in either case. In conclusion, changes in the COO in DLBCL may not be uncommon. Therefore, investigation of the COO in other sites or at relapse may be needed if new drugs with different indications for each COO are developed.</p>","PeriodicalId":45936,"journal":{"name":"Journal of Clinical and Experimental Hematopathology","volume":" ","pages":"181-186"},"PeriodicalIF":1.5,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10628827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9899816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}