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Leukemic presentation of high-grade B cell lymphoma with MYC and BCL2 rearrangement—a series of two cases and review of literature

  • Mohammad ShahidEmail author
  • Robert Seifert
  • Peng Li
  • Ying Li
Case Report

Abstract

High-grade B cell lymphoma (HGBL) is a recently introduced category of aggressive mature B cell lymphoma which is clinically and biologically distinct from diffuse large B cell lymphoma (DLBCL), NOS, and Burkitt Lymphoma. HGBL consists of two categories; the first category includes HGBL with MYC and BCL2 and/or BCL6 rearrangement which is so-called double or triple hit lymphoma. The second category includes HGBL, NOS which lacks genetic double or triple hit; however, its morphology is intermediate between DLBCL and Burkitt lymphoma or appear blastoid. Clinically, patients present with advanced disease, bone marrow involvement, elevated lactate dehydrogenase (LDH), extranodal disease which includes CNS involvement and a high international prognostic index (IPI). Leukemic presentation has been described in various types of B and T cell non-Hodgkin lymphoma; however, peripheral blood involvement as an initial presentation is seldom described in the literature for HGBL with MYC and BCL2 rearrangement. Here, we report two cases of HGBL whose initial presentation was leukocytosis with peripheral blood involvement mimicking acute leukemia.

Keywords

High-grade B cell lymphoma Leukemic presentation MYC and BCL2 rearrangement 

Notes

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (2017) WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues (Revised 4th edn). IARC, Lyon, FranceGoogle Scholar
  2. 2.
    Sarkozy C, Traverse-Glehen A, Coiffier B (2015) Double-hit and double-protein-expression lymphomas: aggressive and refractory lymphomas. Lancet Oncol 16(15):e555–e567CrossRefGoogle Scholar
  3. 3.
    Arora K, Zhang L, Xie W, Baker KR, Zu Y, Hao S (2016) Overt leukemic phase: an unusual presentation of angioimmunoblastic lymphoma. J Hematop 9(3):139–142CrossRefGoogle Scholar
  4. 4.
    Sesques P and Johnson NA (2016) Approach to the diagnosis and treatment of high-grade B cell lymphomas with MYC and BCL2 and/or BCL6 rearrangements. Blood: p. blood-2016–02-636316Google Scholar
  5. 5.
    Schniederjan SD, Li S, Saxe DF, Lechowicz MJ, Lee KL, Terry PD, Mann KP (2010) A novel flow cytometric antibody panel for distinguishing Burkitt lymphoma from CD10+ diffuse large B-cell lymphoma. Am J Clin Pathol 133(5):718–726CrossRefGoogle Scholar
  6. 6.
    Aukema SM, Siebert R, Schuuring E, van Imhoff GW, Kluin-Nelemans HC, Boerma EJ, Kluin PM (2011) Double-hit B-cell lymphomas. Blood 117(8):2319–2331CrossRefGoogle Scholar
  7. 7.
    Matutes E, Parry-Jones N, Brito-Babapulle V, Wotherspoon A, Morilla R, Atkinson S, Elnenaei MO, Jain P, Giustolisi GM, A’hern R, Catovsky D (2004) The leukemic presentation of mantle-cell lymphoma: disease features and prognostic factors in 58 patients. Leuk Lymphoma 45(10):2007–2015CrossRefGoogle Scholar
  8. 8.
    Sarkozy C et al (2014) Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor prognosis. Br J Haematol 164(5):659–667Google Scholar
  9. 9.
    Crane GM, Perkins AS (2017) Leukemic presentation of diffuse large B-cell lymphoma: an unusual pattern associated with splenic involvement. Blood 130(20):2233–2233CrossRefGoogle Scholar
  10. 10.
    Pires PP, Kanegae MY, Ray J, Catania M, Lima FR, Noronha TR, Abdo ANR, Pereira J (2016) Diffuse large B-cell lymphoma presenting in the leukemic phase. Autops Case Rep 6(1):41–45CrossRefGoogle Scholar
  11. 11.
    Nguyen JT, Condron MR, Nguyen ND, de J, Medeiros LJ, Padula A (2009) Anaplastic large cell lymphoma in leukemic phase: extraordinarily high white blood cell count. Pathol Int 59(5):345–353CrossRefGoogle Scholar
  12. 12.
    Nelson BP, Variakojis D, Peterson LC (2002) Leukemic phase of B-cell lymphomas mimicking chronic lymphocytic leukemia and variants at presentation. Mod Pathol 15(11):1111–1120CrossRefGoogle Scholar
  13. 13.
    Chen D, Ketterling RP (2014) A leukemic presentation of a “triple-hit” lymphoma. Blood 123(8):1126CrossRefGoogle Scholar
  14. 14.
    Beltran BE, Quiñones P, Morales D, Alva JC, Miranda RN, Lu G, Shah BD, Sotomayor EM, Castillo JJ (2013) Follicular lymphoma with leukemic phase at diagnosis: a series of seven cases and review of the literature. Leuk Res 37(9):1116–1119CrossRefGoogle Scholar
  15. 15.
    Bischin AM, Dorer R, Aboulafia DM (2017) Transformation of follicular lymphoma to a high-grade b-cell lymphoma with MYC and BCL2 translocations and overlapping features of Burkitt lymphoma and acute lymphoblastic leukemia: a case report and literature review. Clinical Medicine Insights: Blood Disorders 10:1179545X17692544Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Hematopathology, Department of Pathology and Laboratory Medicine, College of MedicineUniversity of FloridaGainesvilleUSA
  2. 2.Department of PathologyUniversity of Florida College of Medicine- JacksonvilleJacksonvilleUSA

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