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Open AccessCase Report

High-grade B-cell Lymphoma with MYC and BCL2 Rearrangement Arising from Follicular Lymphoma: Presentation as a Large Peripancreatic Mass

1
Department of Pathology, University of California, Irvine, CA 92868, USA
2
Department of Radiological Sciences, University of California, Irvine, CA 92868, USA
*
Author to whom correspondence should be addressed.
Diagnostics 2020, 10(3), 157; https://doi.org/10.3390/diagnostics10030157
Received: 17 January 2020 / Revised: 7 March 2020 / Accepted: 9 March 2020 / Published: 14 March 2020
(This article belongs to the Section Pathology and Molecular Diagnostics)
Follicular lymphoma, the second most common non-Hodgkin lymphoma (NHL), primarily affects adults and shows an indolent clinical course. Rare cases of follicular lymphoma transform to a high-grade B-cell lymphoma with MYC and BCL2 rearrangements or “double-hit lymphoma”. Transformation to a “double-hit lymphoma” portends a worse prognosis and requires aggressive treatment. We report a comprehensive clinical, pathologic and radiographic review of a patient with previously undiagnosed low-grade follicular lymphoma that transformed into a “double-hit lymphoma”. The patient presented with a large heterogeneous mass 16 x 19 cm involving pancreatic head and neck and a mildly enlarged inguinal lymph node. Positron emission tomography (PET) study demonstrated Fluorodeoxyglucose (18F) (FDG)-avid peripancreatic mass. Tissue biopsy demonstrated a high-grade B-cell lymphoma with rearrangements t(14;18) and MYC, leading to the diagnosis of high-grade B-cell lymphoma with MYC and BCL2 rearrangements. Excisional biopsy of an inguinal lymph node demonstrated low-grade follicular lymphoma. Clonality studies demonstrated the same immunoglobulin clone V7-4 in inguinal lymph node and peripancreatic mass. Therefore, diagnosis of a high-grade B-cell lymphoma with MYC and BCL2 rearrangements that transformed from a low-grade follicular lymphoma was rendered. It is ultimately important to establish a tissue-based diagnosis at the different sites that are involved with lymphoma. Patient proceeded with the aggressive treatment with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin and rituximab (EPOCH-R) treatment. View Full-Text
Keywords: double-hit lymphoma 1; follicular lymphoma 2; CT scan 3 double-hit lymphoma 1; follicular lymphoma 2; CT scan 3
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Shestakova, A.; Rezk, S.; Ghasemizadeh, D.; Nael, A.; Zhao, X. High-grade B-cell Lymphoma with MYC and BCL2 Rearrangement Arising from Follicular Lymphoma: Presentation as a Large Peripancreatic Mass. Diagnostics 2020, 10, 157.

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