High-Grade B-Cell Neoplasm with Surface Light Chain Restriction and Tdt Coexpression Evolved in a MYC-Rearranged Diffuse Large B-Cell Lymphoma: A Dilemma in Classification
Autor: | Mohamed A. Yassin, Abdulrazzaq Haider, Feryal Ibrahim, Sarah Elkourashy, Susanna Akiki, Ruba Y. Taha, Zafar Nawaz, Ahmad Al-Sabbagh, Dina Sameh Soliman |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2017 |
Předmět: |
CD20
medicine.medical_specialty education.field_of_study Pathology biology lcsh:RC633-647.5 Population Cytogenetics Germinal center Case Report lcsh:Diseases of the blood and blood-forming organs General Medicine CD79B medicine.disease CD19 Lymphoma 03 medical and health sciences stomatognathic diseases 0302 clinical medicine 030220 oncology & carcinogenesis medicine biology.protein education Diffuse large B-cell lymphoma 030215 immunology |
Zdroj: | Case Reports in Hematology Case Reports in Hematology, Vol 2017 (2017) |
ISSN: | 2090-6579 2090-6560 |
Popis: | According to World Health Organization (WHO) classification (2008), B-cell neoplasms are classified into precursor B-cell or a mature B-cell phenotype and this classification was also kept in the latest WHO revision (2016). We are reporting a male patient in his fifties, with tonsillar swelling diagnosed as diffuse large B-cell lymphoma (DLBCL), germinal center. He received 6 cycles of RCHOP and showed complete metabolic response. Two months later, he presented with severe CNS symptoms. Flow cytometry on bone marrow (BM) showed infiltration by CD10-positive Kappa-restricted B-cells with loss of CD20 and CD19, and downregulation of CD79b. Moreover, the malignant population showed Tdt expression. BM Cytogenetics revealed t(8;14)(q24;q32) within a complex karyotype. Retrospectively, MYC and Tdt immunostains performed on original diagnostic tissue and came negative for Tdt and positive for MYC. It has been rarely reported that mature B-cell neoplasms present with features of immaturity; however the significance of Tdt acquisition during disease course was not addressed before. What is unique in this case is that the emerging disease has acquired an immaturity marker while retaining some features of the original mature clone. No definitive WHO category would adopt high-grade neoplasms that exhibit significant overlapping features between mature and immature phenotypes. |
Databáze: | OpenAIRE |
Externí odkaz: |