Burkitt-like lymphoma in a pediatric patient with familial adenomatous polyposis

Cytogenomic and clinicopathological comparison of MYC-positive and MYC-negative High-grade B-cell lymphoma with 11q aberration in the context of other aggressive lymphomas with MYC rearrangement

According to the 2022 WHO classification, High-grade B-cell lymphoma with 11q aberration (HGBCL-11q) is a MYC-negative lymphoma with 11q duplication and terminal deletion as specific chromosomal aberrations for this neoplasm. However, there are a growing number of reports defying this definition describing cases with the co-occurrence of 11q aberration and MYC rearrangement (HGBCL-11q,MYCR). This research has two aims. First, to compare the unique HGBCL-11q,MYCR group of 9 cases with 26 HGBCL-11q cases on chromosomal, mutational and clinicopathological level. The second objective is to investigate the association of the new HGBCL-11q,MYCR group with HGBCL-11q and two other closely related MYC-positive aggressive lymphoma subtypes: Burkitt lymphoma (BL) (n=17) and High-grade B-cell lymphoma, not otherwise specified with MYC rearrangement (n=10). Genetic results were obtained by classical cytogenetics, fluorescence in situ hybridization, microarrays, and whole exome sequencing. In parallel histopathological/ immunohistochemical analyses (HP/IHC) with flow cytometry(FCM), in conjunction with clinical presentation and treatment outcomes are presented. Our findings reveal that HGBCL-11q,MYCR, exists as an independent nosological entity, distinct from BL and HGBCL-11q at the cytogenetic, molecular, and clinicopathological levels, although it contains common features of both lymphoma subtypes. Common features with BL include: MYC rearrangement with the immunoglobulin genes, patterns of secondary chromosomal aberrations like dup(1q), del(17p), high number of MYC and CCND3 mutations. Other BL features are: frequent extranodal abdominal presentation, morphology, GCB cell of origin determined by IHC and FCM, immunophenotypical features such as MYC(+)/LMO2(-) detected by flow cytometric features: CD45(+)weaker, more cases with CD43(+) and CD44(-) expression, only expression of IgD and IgM heavy chain and CD38(+)higher overexpression, which correlates with MYC rearrangement assessed by FCM. Similarity to HGBCL-11q includes the existence of 11q aberration, presence of DDX3X, ETS1, GNA13, NFRKB, KMT2D, and the lack of TCF3 and ID3 mutations. Additionally, frequent nodal and tonsillar presentation, morphology, GCB cell of origin, immunophenotypical features with flow cytometry measured CD56(+) expression, associated with NCAM duplication/amplification on 11q, and pathogenesis not associated with Epstein-Barr virus infection. The distinctive chromosomal change of HGBCL-11q,MYCR was the gain or amplification of 3q29. Our cohort of patients with HGBCL-11q,MYCR had similar relapse-free survival to that of patients with HGBCL-11q and BL, if treated with BL-directed regimens.

A Puzzling Case of Pouch Pathology

A 36-year-old man with familial adenomatous polyposis secondary to an adenomatous polyposis coli mutation status post proctocolectomy with ileal pouch-anal anastomosis presented with hematochezia. Pouchoscopy revealed a 4-cm indurated mass in the distal ileal pouch just 17 months after a normal pouchoscopy. Histopathology was diagnostic for Burkitt lymphoma, and the patient achieved complete remission with subsequent chemotherapy. Although there are reports of Burkitt lymphoma in patients with ileal pouch-anal anastomosis, to date, this is the first report in a patient with familial adenomatous polyposis. This case highlights the presentation of a rapidly enlarging tumor not commonly seen in the adult gastroenterology population.

Burkitt-like lymphoma with 11q aberration in a patient with AIDS and a patient without AIDS: Two cases reports and literature review

Objective

The aim of this study is to evaluate the clinicopathological features and the treatment of the Burkitt-like lymphoma with 11q aberration.

Methods

We reported two patients with Burkitt-like lymphoma with 11q aberration: a 56-year-old man with AIDS (case 1) and a 37-year-old woman (case 2) without AIDS. The biopsy of cervical lymph nodes showed Burkitt-like morphologic and immunophenotypic features. But both of them lack MYC rearrangement and carry an 11q-arm aberration with proximal gains and/or telomeric losses. The diagnosis was confirmed by pathological morphology, immunohistochemistry, and fluorescence in situ hybridization.

Result

After a cycle of R-CTOEP (rituximab, cyclophosphamide, pirarubicin, vincristine, and prednisone) chemotherapy, case 1 refused to chemotherapy and radiotherapy and was followed up for 34 months without recurrence and new focus. Case 2 received R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) for two cycles and achieved PR (partial response). Then, the patient in case 2 received EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin) for three cycles, and the right cervical mass disappeared. She achieved complete response and was followed up for 16 months without recurrence and new focus.

Conclusion

Burkitt-like lymphoma with 11q abnormalities resembles Burkitt lymphoma morphologically but lacks MYC rearrangement and may have a better prognosis.

Burkitt-Like Lymphoma with 11q Aberration: A Case Report and Review of a Rare Entity

Burkitt-like lymphoma with 11q aberration is a rare diagnostic entity commonly occurring in children and young adults with a nodal presentation. This entity shares many similar morphologic and immunophenotypic features with conventional Burkitt lymphoma and other aggressive B-cell lymphomas, making its recognition challenging. However, the presence of its characteristic 11q gain/loss pattern is helpful in the diagnosis. We report a case of Burkitt-like lymphoma presenting as a right neck mass in a 17-year-old female patient that demonstrated no improvement with antibiotic therapy. The neoplasm displayed a diffuse proliferation of intermediate-sized atypical lymphoid cells with prominent nucleoli in a background of apoptotic debris, morphologically raising concern for conventional Burkitt lymphoma. Subsequent immunohistochemical and cytogenetic studies established the most likely diagnosis of Burkitt-like lymphoma with 11q aberration. Though rare, Burkitt-like lymphoma exhibits significant morphologic overlap with other high-grade B-cell lymphomas, making it an important entity to consider on the differential diagnosis of these lesions.