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Zhang F, Chen Y, Cui Q, Ge Y, Liu Y. Case report: Mutation evolution in a patient with TdT positive high grade B cell lymphoma with MYC and BCL2 rearrangements following the treatment of concurrent follicular lymphoma and diffuse large B-cell lymphoma. Discov Oncol 2024; 15:129. [PMID: 38662249 PMCID: PMC11045710 DOI: 10.1007/s12672-024-00991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Concurrent follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL)was reported in some studies, while the diagnosis of TdT (terminal deoxynucleotydil transferase) positive high grade B cell lymphoma (HGBL) with MYC and BCL2 rearrangements ("double hit") transformed from FL/DLBCL has been rarely reported. Herein, we described the clinical features and mutation profiles of a case diagnosed with TdT positive "double hit" HGBL following the treatment of FL/DLBCL. CASE PRESENTATION This is a 43-year-old Chinese man who was diagnosed with low grade FL (account for 80%) combined with DLBCL (20%) at a stage of IVB. The patient presented with BCL2/IGH translocation without MYC rearrangement, as well as the expressions of CD20, CD19, CD10 and BCL2 at the initial diagnosis of FL/DLBCL. MYC rearrangement and TdT expression occurred after the treatment. The targeted sequencing revealed mutations in KMT2D, FOXO1, CREBBP, ATM, STAT6, BCL7A, DDX3X, MUC4, FGFR3, ARID5B, DDX11 and PRKCSH genes were the co-mutations shared by the FL/DLBCL and TdT positive "double hit" HGBL, while CCND3, BIRC6, ROBO1 and CHEK2 mutations specifically occurred after the treatment. The overall survival time was 37.8 and 17.8 months after the initial diagnosis of FL/DLBCL and TdT positive "double hit" HGBL, respectively. CONCLUSION This study reports a rare case of TdT positive "double hit" HGBL following the treatment of concurrent FL/DLBCL and highlights the mutation characteristics. Collectively, this study will help enrich the knowledge of TdT positive "double hit" HGBL transformed from FL/DLBCL.
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Affiliation(s)
- Fen Zhang
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106, 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Yu Chen
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106, 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Qian Cui
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106, 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Yan Ge
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106, 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Yanhui Liu
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106, 2nd Zhongshan Road, Guangzhou, 510080, China.
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Rodriguez-Pinilla SM, Dojcinov S, Dotlic S, Gibson SE, Hartmann S, Klimkowska M, Sabattini E, Tousseyn TA, de Jong D, Hsi ED. Aggressive B-cell non-Hodgkin lymphomas: a report of the lymphoma workshop of the 20th meeting of the European Association for Haematopathology. Virchows Arch 2024; 484:15-29. [PMID: 37530792 PMCID: PMC10791773 DOI: 10.1007/s00428-023-03579-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 08/03/2023]
Abstract
Aggressive B-cell non-Hodgkin lymphomas are a heterogeneous group of diseases and our concepts are evolving as we learn more about their clinical, pathologic, molecular genetic features. Session IV of the 2020 EAHP Workshop covered aggressive, predominantly high-grade B-cell lymphomas, many that were difficult to classify. In this manuscript, we summarize the features of the submitted cases and highlight differential diagnostic difficulties. We specifically review issues related to high-grade B-cell lymphomas (HGBCLs) with MYC and BCL2 and/or BCL6 rearrangements including TdT expression in these cases, HGBCL, not otherwise specified, large B-cell lymphomas with IRF4 rearrangement, high-grade/large B-cell lymphomas with 11q aberration, Burkitt lymphoma, and pleomorphic mantle cell lymphoma. Since the workshop, the 5th edition of the WHO Classification for Haematolymphoid Tumours (WHO-HAEM5) and International Consensus Classification (ICC) 2022 were published. We endeavor to use the updated terminology.
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Affiliation(s)
| | - Stefan Dojcinov
- Department of Pathology, Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Snjezana Dotlic
- Department of Pathology and Cytology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Sarah E Gibson
- Division of Hematopathology, Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, AZ, USA
| | - Sylvia Hartmann
- Dr. Senckenberg Institute of Pathology, Goethe University Frankfurt Am Main, Frankfurt Am Main, Germany
| | - Monika Klimkowska
- Department of Clinical Pathology and Cancer Diagnostics, Karolinska University Hospital, Stockholm, Sweden
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Thomas A Tousseyn
- Department of Imaging and Pathology, Translational Cell and Tissue Research Lab, KU Leuven, Leuven, Belgium
| | - Daphne de Jong
- Department of Pathology, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
| | - Eric D Hsi
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Parry EM, Roulland S, Okosun J. DLBCL arising from indolent lymphomas: How are they different? Semin Hematol 2023; 60:277-284. [PMID: 38072721 DOI: 10.1053/j.seminhematol.2023.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/10/2023] [Accepted: 11/16/2023] [Indexed: 03/12/2024]
Abstract
Transformation to diffuse large B-cell lymphoma (DLBCL) is a recognized, but unpredictable, clinical inflection point in the natural history of indolent lymphomas. Large retrospective studies highlight a wide variability in the incidence of transformation across the indolent lymphomas and the adverse outcomes associated with transformed lymphomas. Opportunities to dissect the biology of transformed indolent lymphomas have arisen with evolving technologies and unique tissue collections enabling a growing appreciation, particularly, of their genetic basis, how they relate to the preceding indolent lymphomas and the comparative biology with de novo DLBCL. This review summarizes our current understanding of both the clinical and biological aspects of transformed lymphomas and the outstanding questions that remain.
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Affiliation(s)
- Erin M Parry
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA
| | - Sandrine Roulland
- Aix-Marseille University, CNRS, INSERM, Centre d'Immunologie de Marseille-Luminy, Marseille, France
| | - Jessica Okosun
- Centre for Haemato-Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK; Department of Haemato-Oncology, St Bartholomew's Hospital, London, UK.
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4
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Zhou KI, Lin C, Neff JL, Galal A. Dasatinib-associated follicular lymphoma in a patient with B-cell acute lymphoblastic leukaemia. BMJ Case Rep 2023; 16:e252739. [PMID: 37197831 PMCID: PMC10193045 DOI: 10.1136/bcr-2022-252739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
The tyrosine kinase inhibitor dasatinib is approved for the treatment of chronic myeloid leukaemia and Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukaemia (ALL). Patients on dasatinib can rarely develop a form of benign reversible reactive lymphadenopathy termed follicular lymphoid hyperplasia (FLH). Here, we describe a patient with Ph+ ALL who developed follicular lymphoma (FL) after prolonged treatment with dasatinib and who had complete remission of FL after discontinuation of dasatinib. This case suggests that dasatinib-associated FLH could be a premalignant condition that can transform into FL. Moreover, withdrawal of dasatinib may be sufficient for remission of dasatinib-associated FL.
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Affiliation(s)
- Katherine Ismei Zhou
- Division of Medical Oncology, Duke University Health System, Durham, North Carolina, USA
| | - Chenyu Lin
- Division of Hematologic Malignancies & Cellular Therapy, Duke University Health System, Durham, North Carolina, USA
| | - Jadee Lee Neff
- Department of Pathology, Duke University Health System, Durham, North Carolina, USA
| | - Ahmed Galal
- Division of Hematologic Malignancies & Cellular Therapy, Duke University Health System, Durham, North Carolina, USA
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5
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Duffield AS, Dogan A, Amador C, Cook JR, Czader M, Goodlad JR, Nejati R, Xiao W, Happ L, Parker C, Thacker E, Thakkar D, Dave SS, Wasik MA, Ott G. Progression of follicular lymphoma and related entities: Report from the 2021 SH/EAHP Workshop. Am J Clin Pathol 2023; 159:aqad042. [PMID: 37167543 PMCID: PMC10233403 DOI: 10.1093/ajcp/aqad042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/21/2023] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES The 2021 Society for Hematopathology and European Association for Haematopathology Workshop addressed the molecular and cytogenetic underpinnings of transformation and transdifferentiation in lymphoid neoplasms. METHODS Session 4, "Transformations of Follicular Lymphoma," and session 5, "Transformations of Other B-Cell Lymphomas," included 45 cases. Gene alteration analysis and expression profiling were performed on cases with submitted formalin-fixed, paraffin embedded tissue. RESULTS The findings from session 4 suggest that "diffuse large B-cell lymphoma/high-grade B-cell lymphoma with rearrangements of MYC and BCL2" is a distinct category arising from the constraints of a preexisting BCL2 translocation. TdT expression in aggressive B-cell lymphomas is associated with MYC rearrangements, immunophenotypic immaturity, and a dismal prognosis but must be differentiated from lymphoblastic -lymphoma. Cases in session 5 illustrated unusual morphologic and immunophenotypic patterns of transformation. Additionally, the findings support the role of cytogenetic abnormalities-specifically, MYC and NOTCH1 rearrangements-as well as single gene alterations, including TP53, in transformation. CONCLUSIONS Together, these unique cases and their accompanying molecular and cytogenetic data suggest potential mechanisms for and unusual patterns of transformation in B-cell lymphomas and indicate numerous opportunities for further study.
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Affiliation(s)
- Amy S Duffield
- Department of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | - Catalina Amador
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| | - James R Cook
- Department of Laboratory Medicine, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, US
| | - Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, US
| | - John R Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Reza Nejati
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Hematopathology Service, Memorial Sloan Kettering Cancer Center, New York, NY, US
| | | | | | | | - Devang Thakkar
- Center for Genomic and Computational Biology and Department of Medicine, Duke University, Durham, NC, US
| | - Sandeep S Dave
- Center for Genomic and Computational Biology and Department of Medicine, Duke University, Durham, NC, US
| | - Mariusz A Wasik
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
| | - German Ott
- Abteilung für Klinische Pathologie, Robert-Bosch-Krankenhaus, and Dr Margarete Fischer-Bosch Institut für Klinische Pharmakologie, Stuttgart, Germany
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6
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Kurz KS, Ott M, Kalmbach S, Steinlein S, Kalla C, Horn H, Ott G, Staiger AM. Large B-Cell Lymphomas in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Concepts. Cancers (Basel) 2023; 15:cancers15082285. [PMID: 37190213 DOI: 10.3390/cancers15082285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
The family/class of the large B-cell lymphomas (LBCL) in the 5th edition of the World Health Organization (WHO) classification of haematolymphoid tumors (WHO-HAEM5) features only a few major changes as compared to the 4th edition. In most entities, there are only subtle changes, many of them only representing some minor modifications in diagnostic terms. Major changes have been made in the diffuse large B-cell lymphomas (DLBCL)/high-grade B-cell lymphomas (HGBL) associated with MYC and BCL2 and/or BCL6 rearrangements. This category now consists of MYC and BCL2 rearranged cases exclusively, while the MYC/BCL6 double hit lymphomas now constitute genetic subtypes of DLBCL, not otherwise specified (NOS) or of HGBL, NOS. Other major changes are the conceptual merger of lymphomas arising in immune-privileged sites and the description of LBCL arising in the setting of immune dysregulation/deficiency. In addition, novel findings concerning underlying biological mechanisms in the pathogenesis of the different entities are provided.
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Affiliation(s)
- Katrin S Kurz
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Michaela Ott
- Department of Pathology, Marienhospital, 70199 Stuttgart, Germany
| | - Sabrina Kalmbach
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Sophia Steinlein
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Claudia Kalla
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - Heike Horn
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
| | - Annette M Staiger
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, 70376 Stuttgart, Germany
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology, 70376 Stuttgart, Germany
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7
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Takata K. Highlights: Follicular lymphoma. J Clin Exp Hematop 2023; 63:212-213. [PMID: 38148010 PMCID: PMC10861372 DOI: 10.3960/jslrt.23051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/28/2023] Open
Affiliation(s)
- Katsuyoshi Takata
- Department of Molecular and Cellular Pathology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
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8
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Duffield AS, Mullighan CG, Borowitz MJ. International Consensus Classification of acute lymphoblastic leukemia/lymphoma. Virchows Arch 2023; 482:11-26. [PMID: 36422706 PMCID: PMC10646822 DOI: 10.1007/s00428-022-03448-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/21/2022] [Accepted: 10/27/2022] [Indexed: 11/27/2022]
Abstract
The updated International Consensus Classification (ICC) of B-acute lymphoblastic leukemia (B-ALL) and T-acute lymphoblastic leukemia (T-ALL) includes both revisions to subtypes previously outlined in the 2016 WHO classification and several newly described entities. The ICC classification incorporates recent clinical, cytogenetic, and molecular data, with a particular emphasis on whole transcriptome analysis and gene expression (GEX) clustering studies. B-ALL classification is modified to further subclassify BCR::ABL1-positive B-ALL and hypodiploid B-ALL. Additionally, nine new categories of B-ALL are defined, including seven that contain distinguishing gene rearrangements, as well as two new categories that are characterized by a specific single gene mutation. Four provisional entities are also included in the updated B-ALL classification, although definitive identification of these subtypes requires GEX studies. T-ALL classification is also updated to incorporate BCL11B-activating rearrangements into early T-precursor (ETP) ALL taxonomy. Additionally, eight new provisional entities are added to the T-ALL subclassification. The clinical implications of the new entities are discussed, as are practical approaches to the use of different technologies in diagnosis. The enhanced specificity of the new classification will allow for improved risk stratification and optimized treatment plans for patients with ALL.
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Affiliation(s)
- Amy S. Duffield
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Charles G. Mullighan
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA
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9
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Blastoid high-grade B-cell lymphoma initially presenting in bone marrow: a diagnostic challenge. Mod Pathol 2022; 35:419-426. [PMID: 34608246 DOI: 10.1038/s41379-021-00909-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022]
Abstract
The 2016 WHO classification introduced the category of high-grade B-cell lymphoma (HGBL), which includes one poorly understood subset, blastoid-HGBL. Establishing the diagnosis and distinguishing blastoid-HGBL from B-acute lymphoblastic leukemia (B-ALL) in bone marrow can be challenging. We assessed 31 cases of blastoid-HGBL diagnosed initially in bone marrow and compared this group to 36 cases of B-ALL using immunophenotyping, fluorescence in situ hybridization, and targeted next generation sequencing analysis. The 31 blastoid-HGBL cases included 14 HGBL with MYC and BCL2 and/or BCL6 rearrangements (double hit lymphoma, DHL), 13 HGBL, not otherwise specified (NOS), and four cases with TdT expression that were difficult to classify. Compared with B-ALL, blastoid-HGBL cases more often showed increased intensity/bright expression of CD20, CD38, CD45, BCL-6, and MYC, and less frequent bright expression of CD10 and TdT. Cases of blastoid-HGBL also more frequently had MYC rearrangement, a complex karyotype and TP53 mutation (p < 0.01). With the exception of CD34, no other single factor, including TdT, was sensitive or adequately specific to distinguish blastoid-HGBL from B-ALL. We developed a scoring system using six distinctive features between 16 cases of unequivocal blastoid HGBL and 22 cases of CD34-positive B-ALL, with a score of ≥3 defining blastoid-HGBL. The system was further validated by using 15 cases of surface light chain negative, and/or CD45 dim to negative blastoid-HGBL and 14 cases of CD34-negative B-ALL. The sensitivity, specificity, positive, and negative predictive value of this scoring system were 100%, 94%, 94%, and 100%, respectively. Using this system, the four cases with TdT expression were all classified as blastoid-HGBL: three were DHL and one was HGBL-NOS. In conclusion, blastoid-HGBL shows distinctive immunophenotypic, cytogenetic, and molecular features as compared with B-ALL. The proposed scoring system can be helpful for the classification of diagnostically challenging blastoid lymphoid tumors presenting initially in the bone marrow.
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10
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Bhavsar S, Liu YC, Gibson SE, Moore EM, Swerdlow SH. Mutational Landscape of TdT+ Large B-cell Lymphomas Supports Their Distinction From B-lymphoblastic Neoplasms: A Multiparameter Study of a Rare and Aggressive Entity. Am J Surg Pathol 2021; 46:71-82. [PMID: 34392269 DOI: 10.1097/pas.0000000000001750] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the current World Health Organization classification, terminal deoxynucleotidyl transferase (TdT) expression in a high grade/large cell B-cell lymphoma (LBCL) indicates a B-lymphoblastic lymphoma/leukemia (B-LBL), although TdT expression in what appear to be mature LBCL or following mature B-cell neoplasms is reported. The frequency of TdT+ LBCL, how to best categorize these cases, and their clinicopathologic features, molecular landscape, and relationship to classic B-LBL remain to be better defined. TdT expression was therefore assessed in 258 LBCL and the results correlated with the cytologic, phenotypic, and cytogenetic findings. Targeted mutational analysis, review of prior biopsies, and assessment of clinical associations was performed in the 6 cases with >10% TdT+ cells. All 6 TdT+ LBCL were blastoid-appearing, CD34-, MYC+, BCL2+, and had MYC rearrangements (R) (5/6 with BCL2 and/or BCL6-R). 5/6 had a prior TdT- LBCL and/or follicular lymphoma and all had an aggressive course. Fifteen nonsynonymous variants in 11 genes were seen in the 4/5 tested cases with mutations. TdT+ and TdT- areas in 1 case showed identical mutations. The mutational profiles were more like those reported in germinal center B-cell type-diffuse LBCL rather than B-LBL. Evolution from preceding TdT- lymphomas was nondivergent in 1/3 tested cases and partially divergent in 2. The clinicopathologic and cytogenetic features of these 6 cases were similar to those found in a meta-analysis that included additional cases of TdT+ LBCL or B-LBL following follicular lymphoma. Thus, TdT+, CD34- large B-cell neoplasms with MYC rearrangements and often a "double hit" are rare, frequently a transformational event and aggressive but are distinct from classic B-LBL.
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Affiliation(s)
- Shweta Bhavsar
- Department of Pathology, UPMC Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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11
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Genomic landscape of cutaneous follicular lymphomas reveals 2 subgroups with clinically predictive molecular features. Blood Adv 2021; 5:649-661. [PMID: 33560380 DOI: 10.1182/bloodadvances.2020002469] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/20/2020] [Indexed: 01/14/2023] Open
Abstract
Primary cutaneous follicle center lymphomas (PCFCLs) are indolent B-cell lymphomas that predominantly remain skin restricted and manageable with skin-directed therapy. Conversely, secondary cutaneous involvement by usual systemic follicular lymphoma (secondary cutaneous follicular lymphoma [SCFL]) has a worse prognosis and often necessitates systemic therapy. Unfortunately, no histopathologic or genetic features reliably differentiate PCFCL from SCFL at diagnosis. Imaging may miss low-burden internal disease in some cases of SCFLs, leading to misclassification as PCFCL. Whereas usual systemic FL is well characterized genetically, the genomic landscapes of PCFCL and SCFL are unknown. Herein, we analyzed clinicopathologic and immunophenotypic data from 30 cases of PCFCL and 10 of SCFL and performed whole-exome sequencing on 18 specimens of PCFCL and 6 of SCFL. During a median follow-up of 7 years, 26 (87%) of the PCFCLs remained skin restricted. In the remaining 4 cases, systemic disease developed within 3 years of diagnosis. Although the SCFLs universally expressed BCL2 and had BCL2 rearrangements, 73% of the PCFCLs lacked BCL2 expression, and only 8% of skin-restricted PCFCLs had BCL2 rearrangements. SCFLs showed low proliferation fractions, whereas 75% of PCFCLs had proliferation fractions >30%. Of the SCFLs, 67% had characteristic loss-of-function CREBBP or KMT2D mutations vs none in skin-restricted PCFCL. Both SCFL and skin-restricted PCFCL showed frequent TNFRSF14 loss-of-function mutations and copy number loss at chromosome 1p36. These data together establish PCFCL as a unique entity with biological features distinct from usual systemic FL and SCFL. We propose 3 criteria based on BCL2 rearrangement, chromatin-modifying gene mutations (CREBBP, KMT2D, EZH2, and EP300), and proliferation index to classify cutaneous FL specimens based on the likelihood of concurrent or future systemic spread.
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12
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Chaudhary S, Brown N, Song JY, Yang L, Skrabek P, Nasr MR, Wong JT, Bedell V, Murata-Collins J, Kochan L, Li J, Zhang W, Chan WC, Weisenburger DD, Perry AM. Relative frequency and clinicopathologic characteristics of MYC-rearranged follicular lymphoma. Hum Pathol 2021; 114:19-27. [PMID: 33964277 DOI: 10.1016/j.humpath.2021.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 12/12/2022]
Abstract
MYC rearrangement is a relatively rare genetic abnormality in follicular lymphoma (FL). In this study, we evaluated the relative frequency of MYC rearrangement in 522 cases of FL and studied their clinicopathologic, cytogenetic, and molecular characteristics. Fluorescence in situ hybridization studies for MYC (break-apart probe), MYC/IGH, IGH/BCL2, and BCL6 rearrangements were performed on tissue microarrays. Immunohistochemical stains for CD10, BCL2, BCL6, and MYC were performed and scored on MYC-rearranged cases. On 4 FL cases, a custom targeted panel of 356 genes was used for mutation analysis. Ten cases (1.9%) were positive for MYC rearrangement. Histologically, 6 of 10 cases were grade 1-2, and 4 cases were grade 3A. By immunohistochemistry, 9 of 9 tested cases were CD10+, all cases were BCL6+, and 9/10 cases were BCL2+. MYC protein staining was low in all cases tested. IGH/BCL2 rearrangement was detected in 5 of 9 cases, whereas BCL6 rearrangement was detected in 3 of 7 tested cases and 4 of 10 cases showed MYC/IGH rearrangement. The most commonly detected mutations in the MYC-positive cases included HLA-B, TNFRSF14, and KMT2D. MYC and/or B2M abnormalities were detected in 2 cases. In conclusion, MYC rearrangement is uncommon in FL and these cases do not appear to have specific histologic characteristics. Molecular analysis showed abnormalities in genes associated with transformation, namely MYC and B2M. Larger studies are needed to evaluate if MYC-rearrangement in FL has prognostic significance.
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Affiliation(s)
- Shweta Chaudhary
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Noah Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Joo Y Song
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Lin Yang
- Section of Hematology/Oncology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W2, Canada; Cancer Care Manitoba, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Pamela Skrabek
- Section of Hematology/Oncology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W2, Canada; Cancer Care Manitoba, Winnipeg, Manitoba, R3E 0V9, Canada
| | - Michel R Nasr
- Department of Pathology, SUNY Upstate Medical University, Syracuse, NY, 13210, USA
| | - Jerry T Wong
- Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, 14203, USA
| | - Victoria Bedell
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Joyce Murata-Collins
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Lindsay Kochan
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Jie Li
- Department of Pathology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 0W2, Canada; Shared Health Manitoba, Winnipeg, Manitoba, R3C 3H8, Canada
| | - Weiwei Zhang
- Department of Pathology and Microbiology, University of Nebraska, Omaha, NE 68198, USA
| | - Wing C Chan
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Dennis D Weisenburger
- Department of Pathology, City of Hope National Medical Center, Duarte, CA, 91010, USA
| | - Anamarija M Perry
- Department of Pathology, University of Michigan, Ann Arbor, MI, 48109, USA.
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13
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Łukasik P, Załuski M, Gutowska I. Cyclin-Dependent Kinases (CDK) and Their Role in Diseases Development-Review. Int J Mol Sci 2021; 22:ijms22062935. [PMID: 33805800 PMCID: PMC7998717 DOI: 10.3390/ijms22062935] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/13/2022] Open
Abstract
Cyclin-dependent kinases (CDKs) are involved in many crucial processes, such as cell cycle and transcription, as well as communication, metabolism, and apoptosis. The kinases are organized in a pathway to ensure that, during cell division, each cell accurately replicates its DNA, and ensure its segregation equally between the two daughter cells. Deregulation of any of the stages of the cell cycle or transcription leads to apoptosis but, if uncorrected, can result in a series of diseases, such as cancer, neurodegenerative diseases (Alzheimer’s or Parkinson’s disease), and stroke. This review presents the current state of knowledge about the characteristics of cyclin-dependent kinases as potential pharmacological targets.
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Affiliation(s)
- Paweł Łukasik
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp. 72 Av., 70-111 Szczecin, Poland;
| | - Michał Załuski
- Department of Pharmaceutical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp. 72 Av., 70-111 Szczecin, Poland;
| | - Izabela Gutowska
- Department of Medical Chemistry, Pomeranian Medical University in Szczecin, Powstancow Wlkp. 72 Av., 70-111 Szczecin, Poland;
- Correspondence:
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14
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Chiu BCH, Chen C, You Q, Chiu R, Venkataraman G, Zeng C, Zhang Z, Cui X, Smith SM, He C, Zhang W. Alterations of 5-hydroxymethylation in circulating cell-free DNA reflect molecular distinctions of subtypes of non-Hodgkin lymphoma. NPJ Genom Med 2021; 6:11. [PMID: 33574286 PMCID: PMC7878492 DOI: 10.1038/s41525-021-00179-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/12/2021] [Indexed: 01/30/2023] Open
Abstract
The 5-methylcytosines (5mC) have been implicated in the pathogenesis of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL). However, the role of 5-hydroxymethylcytosines (5hmC) that are generated from 5mC through active demethylation, in lymphomagenesis is unknown. We profiled genome-wide 5hmC in circulating cell-free DNA (cfDNA) from 73 newly diagnosed patients with DLBCL and FL. We identified 294 differentially modified genes between DLBCL and FL. The differential 5hmC in the DLBCL/FL-differentiating genes co-localized with enhancer marks H3K4me1 and H3K27ac. A four-gene panel (CNN2, HMG20B, ACRBP, IZUMO1) robustly represented the overall 5hmC modification pattern that distinguished FL from DLBCL with an area under curve of 88.5% in the testing set. The median 5hmC modification levels in signature genes showed potential for separating patients for risk of all-cause mortality. This study provides evidence that genome-wide 5hmC profiles in cfDNA differ between DLBCL and FL and could be exploited as a non-invasive approach.
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Affiliation(s)
- Brian C-H Chiu
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA.
| | - Chang Chen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Qiancheng You
- Department of Chemistry, The University of Chicago, Chicago, IL, USA
| | - Rudyard Chiu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Chang Zeng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Zhou Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Xiaolong Cui
- Department of Chemistry, The University of Chicago, Chicago, IL, USA
| | - Sonali M Smith
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Chuan He
- Department of Chemistry, The University of Chicago, Chicago, IL, USA
- Department of Biochemistry and Molecular Biology; Institute for Biophysical Dynamics; and Howard Hughes Medical Institute, The University of Chicago, Chicago, IL, USA
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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15
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Fujimoto A, Ikejiri F, Arakawa F, Ito S, Okada Y, Takahashi F, Matsuda S, Okada T, Inoue M, Takahashi T, Miyake T, Maruyama R, Ohshima K, Suzumiya J, Suzuki R. Simultaneous Discordant B-Lymphoblastic Lymphoma and Follicular Lymphoma. Am J Clin Pathol 2021; 155:308-317. [PMID: 32915189 DOI: 10.1093/ajcp/aqaa126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We report a rare case of B-lymphoblastic lymphoma (B-LBL) and low-grade follicular lymphoma (FL) identified concurrently in biopsies from different sites at the initial diagnosis in a 39-year-old man. The clonal relationship between the 2 histologic subtypes was investigated. METHODS A diagnosis of FL grade 1/2 (low grade) was made by bone marrow (BM) biopsy. B-LBL was identified in biopsies from the testis and pancreas. Cytogenetic and molecular analyses were performed to investigate their clonal relationship. RESULTS Interphase fluorescence in situ hybridization analyses and G-banding karyotype analyses identified the BCL2-IGH and MYC-IGH translocation in tumor cells from both the BM and testis. The tumor cells from the BM and testis shared the same IGH VDJ usage and a high degree of somatic mutations. These findings suggest that acquisition of MYC gene rearrangement is a critical event for lymphoblastic transformation of FL. Of note, the presence of intraclonal diversity in the B-LBL sample further suggests an earlier or concurrent event of MYC translocation than the somatic IGH mutation in the germinal center and the dedifferentiation of lymphoma cells to a precursor stage of B-cell development. CONCLUSIONS B-lymphoblastic transformation of FL can occur with MYC gene rearrangement.
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Affiliation(s)
- Ayumi Fujimoto
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Fumiyoshi Ikejiri
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Fumiko Arakawa
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Shunsuke Ito
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Yusuke Okada
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Fumimasa Takahashi
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Shinichiro Matsuda
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Takahiro Okada
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Masaya Inoue
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Tsutomu Takahashi
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Takaaki Miyake
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Riruke Maruyama
- Department of Pathology, Shimane University Hospital, Izumo, Japan
| | - Koichi Ohshima
- Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Junji Suzumiya
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
| | - Ritsuro Suzuki
- Department of Oncology and Hematology, Shimane University Hospital, Izumo, Japan
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16
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CCND1 Genomic Rearrangement as a Secondary Event in High Grade B-Cell Lymphoma. Hemasphere 2020; 5:e505. [PMID: 33324951 PMCID: PMC7732336 DOI: 10.1097/hs9.0000000000000505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
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17
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Ronchi A, Zito Marino F, Vitiello P, Caccavale S, Argenziano G, Crisci S, Franco R, Sica A. A case of primary cutaneous B-cell lymphoma with immature features in an old man. Diffuse large B-cell lymphoma with immature features or B-cell lymphoblastic lymphoma? J Cutan Pathol 2020; 48:535-540. [PMID: 32623764 DOI: 10.1111/cup.13795] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
Primary cutaneous B-cell lymphomas are a heterogeneous group of lymphoid neoplasms primarily occurring in the skin. Although most cases are represented by primary cutaneous follicle center cell lymphoma, primary cutaneous marginal zone lymphoma and leg-type diffuse large B-cell lymphoma, other diffuse large B-cell lymphomas and B-cell lymphoblastic lymphoma may rarely present primarily in the skin. In this setting, the presence of histopathologic and immunohistochemical features of cellular immaturity is exceedingly rare and may represent a diagnostic challenge. We present the first case of a primary cutaneous diffuse large B-cell lymphoma characterized by diminished expression of CD45, expression of TdT and rearrangement of MYC gene. The differential diagnosis mainly included B-cell lymphoblastic lymphoma, and required the genetic analysis of heavy chain (IGH) gene rearrangements.
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Affiliation(s)
- Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paola Vitiello
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefano Caccavale
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Argenziano
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Stefania Crisci
- Hematology-Oncology and Stem Cell Transplantation Unit, Istituto Nazionale Tumori, Fondazione "G. Pascale" IRCCS, Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello Sica
- Oncology and Hematology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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18
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Nie K, Redmond D, Eng KW, Zhang T, Cheng S, Mathew S, Elemento O, Tam W. Mutation landscape, clonal evolution pattern, and potential pathogenic pathways in B-lymphoblastic transformation of follicular lymphoma. Leukemia 2020; 35:1203-1208. [PMID: 32788647 DOI: 10.1038/s41375-020-01014-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/24/2020] [Accepted: 07/30/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Kui Nie
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - David Redmond
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth W Eng
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Taotao Zhang
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shuhua Cheng
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Susan Mathew
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Institute for Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
| | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
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19
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Bouroumeau A, Kaphan E, Legrand C, Raskovalova T, Szymanski G, Vettier C, Lefebvre C, Jacob MC, McLeer A, Peuchmaur M, Gressin R, Sartelet H. Transformation of a low-grade follicular lymphoma into a composite lymphoma combining a high-grade B-cell lymphoma and a lymphoblastic neoplasm expressing Terminal deoxynucleotidyl Transferase: a case report. J Med Case Rep 2020; 14:117. [PMID: 32713346 PMCID: PMC7384216 DOI: 10.1186/s13256-020-02433-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
Background High-grade B-cell lymphoma with rearrangements of MYC and BCL2 and/or BCL6 is an aggressive mature B-cell neoplasm, whereas B-lymphoblastic lymphoma is immature cell proliferation, with a frequent positivity for terminal deoxynucleotidyl transferase. The transformation of a low-grade follicular lymphoma into a lymphoblastic neoplasm expressing terminal deoxynucleotidyl transferase is a very rare event. Case presentation A 55-year-old Caucasian man was followed for a grade 1–2 follicular lymphoma carrying a t(14;18) IGH/BCL2+ and was initially treated with R-CHOP. The follicular lymphoma presented two relapses. In the third relapse, the patient had multiple lymphadenopathy and ascites, which motivated a retroperitoneal biopsy and an ascitic tap. These samples were analyzed by histological, cytological, flow cytometric, cytogenetic, and molecular assessments. The patient died of a multiple organ dysfunction syndrome 2 weeks after his third relapse. The biopsy revealed a diffuse proliferation made up of two types of tumor cells: centroblasts (Bcl-6-positive) and immature cells (terminal deoxynucleotidyl transferase-positive). Flow cytometric analysis confirmed the immature phenotype, with an expression of terminal deoxynucleotidyl transferase, combined with a loss of membrane immunoglobulins. The cytogenetic analysis performed on the ascites revealed a clonal evolution characterized by a t(8;22)(q24;q11) MYC+ translocation not previously detected in follicular lymphoma. Fluorescence in situ hybridization confirmed the double rearrangement of the BCL2 and MYC genes. Polymerase chain reactions and sequencing were used to study the clonal relationship between follicular lymphoma and the secondary tumors. The IGVH gene rearrangement revealed a unique clonal rearrangement involving an IGVH4–59 subset in all three specimens. Conclusion These findings suggest a clonal relationship between the two types of lymphoma cells. Furthermore, they support the transformation of an acute follicular lymphoma into a composite lymphoma combining a high-grade B-cell lymphoma and a lymphoblastic neoplasm expressing terminal deoxynucleotidyl transferase. This case report highlights the possible transformation of follicular lymphoma into a highly aggressive and immature proliferation.
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Affiliation(s)
| | | | - Clémentine Legrand
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Tatiana Raskovalova
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Gautier Szymanski
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Claire Vettier
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | - Christine Lefebvre
- Laboratory of Hematology and Oncohematology, CHU de Grenoble, Grenoble, France
| | | | - Anne McLeer
- Department of Pathology, CHU de Grenoble, Grenoble, France
| | | | - Rémy Gressin
- Department of Hematology, CHU de Grenoble, Grenoble, France
| | - Hervé Sartelet
- Department of Pathology, CHU de Grenoble, Grenoble, France.
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20
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Scientific Advances and the Evolution of Diagnosis, Subclassification and Treatment of Lymphoma. Arch Med Res 2020; 51:749-764. [PMID: 32553461 DOI: 10.1016/j.arcmed.2020.05.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
The diagnosis of lymphoma has evolved tremendously over time. Initially, diagnosis of lymphoma was largely based on morphology alone. Over time, immunophenotyping using flow cytometry and immunohistochemistry, and then in situ hybridization, have contributed dramatically to the pathologist's ability to recognize, diagnose and subclassify lymphomas more precisely. In recent years, cytogenetic and molecular genetic techniques have developed that allow evaluation of abnormalities in lymphomas, leading to an understanding of their pathogenesis and opening the door to targeted therapies that will lead to better outcomes for lymphoma patients.
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21
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Maeshima AM, Taniguchi H, Ida H, Hosoba R, Fujino T, Saito Y, Yuda S, Makita S, Fukuhara S, Munakata W, Suzuki T, Maruyama D, Izutsu K. Non-diffuse large B-cell lymphoma transformation from follicular lymphoma: a single-institution study of 19 cases. Hum Pathol 2020; 102:33-43. [PMID: 32540222 DOI: 10.1016/j.humpath.2020.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/09/2020] [Accepted: 06/05/2020] [Indexed: 11/19/2022]
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common histological transformation (HT) of follicular lymphoma (FL). Other types of HT are very rare, and their incidence, histopathology, and patient outcomes have not been sufficiently described. Here, we assessed the clinicopathological characteristics of 19 cases of non-DLBCL HT of FL in a single institution in Japan to advance the understanding of the disease. Among 889 consecutive patients diagnosed with FL between 2000 and 2018, 191 suffered HT (21%). The median follow-up period was 94 months (range = 3-225). A total of 172 patients (90%) had DLBCL transformation, whereas the remaining 19 patients (10%) exhibited non-DLBCL transformation. In the latter cases, the following diagnoses were made based on morphology, immunohistochemistry, flow cytometry, and fluorescence in situ hybridization analyses: classic Hodgkin lymphoma (7 patients; 4%); high-grade B-cell lymphoma (HGBL) with MYC and BCL2 rearrangements (4 patients; 2%); HGBL, not otherwise specified (4 patients; 2%); B-cell lymphoblastic leukemia/lymphoma (2 patients; 1%); anaplastic large-cell lymphoma-like lymphoma (1 patient; 0.5%); and plasmablastic lymphoma (1 patient; 0.5%). Epstein-Barr virus-encoded RNA-1 did not associate with HT in any of the cases tested (n = 8). Patients with non-DLBCL transformation showed poor outcomes, with a median overall survival of 13 months (range = 2 days-107 months); 10 of the patients (53%) died of HT. In conclusions, non-DLBCL transformation was observed in 10% of patients with HT from FL. Our data show that timely, accurate, and comprehensive histopathological diagnosis is needed to ensure optimal treatment and improve the outcome of these patients.
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Affiliation(s)
| | - Hirokazu Taniguchi
- Departments of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hanae Ida
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Rika Hosoba
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Takahiro Fujino
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yo Saito
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Sayako Yuda
- Departments of Pathology, National Cancer Center Hospital, Tokyo 104-0045, Japan; Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shinichi Makita
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Suguru Fukuhara
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Wataru Munakata
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tatsuya Suzuki
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Dai Maruyama
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Koji Izutsu
- Departments of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan
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22
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Transformation of de novo high-grade B cell lymphoma with MYC and BCL2 rearrangements to double-hit B lymphoblastic leukemia/lymphoma: a case report and review of literature. J Hematop 2020. [DOI: 10.1007/s12308-020-00400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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23
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Fratoni S, Zanelli M, Zizzo M, Sanguedolce F, Aimola V, Cerrone G, Ricci L, Filosa A, Martino G, Fara AM, Annessi V, Soriano A, Ascani S. The broad landscape of follicular lymphoma: Part II. Pathologica 2020; 112:79-92. [PMID: 32202535 PMCID: PMC7931560 DOI: 10.32074/1591-951x-6-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/16/2020] [Indexed: 12/15/2022] Open
Abstract
Follicular lymphoma is a neoplasm derived from follicle center B cells, typically both centrocytes and centroblasts, in variable proportions according to the lymphoma grading. The pattern of growth may be entirely follicular, follicular and diffuse and rarely completely diffuse. It represents the second most common non-Hodgkin lymphoma, after diffuse large B-cell lymphoma and it is the most common low-grade mature B-cell lymphoma in Western countries. In the majority of cases, follicular lymphoma is a nodal tumor, occurring in adults and is frequently associated with the translocation t(14;18)(q32;q21)/IGH-BCL2. However, in recent years the spectrum of follicular lymphoma has expanded and small subsets of follicular lymphoma, which differ from common follicular lymphoma, have been identified and included in the current 2017 WHO classification. The aim of our review is to describe the broad spectrum of follicular lymphoma, pointing out that the identification of distinct clinicopathological variants of follicular lymphoma is relevant for the patient outcomes and treatment.
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Affiliation(s)
- Stefano Fratoni
- Department of Anatomic Pathology, St. Eugenio Hospital of Rome, Rome, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, Foggia, Italy
| | | | | | - Linda Ricci
- Pathology Unit, University of Siena, Siena, Italy
| | | | - Giovanni Martino
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Perugia, Italy
| | - Antonella Maria Fara
- Pathology Unit, Department of Medical, Surgical and Experimental Surgery, University of Sassari, Italy
| | - Valerio Annessi
- General Surgery Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Guastalla, Reggio Emilia, Italy
| | - Alessandra Soriano
- Gastroenterology Unit, Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria Terni, University of Perugia, Terni, Italy
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24
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High-grade B-cell lymphoma: a term re-purposed in the revised WHO classification. Pathology 2020; 52:68-77. [DOI: 10.1016/j.pathol.2019.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 12/24/2022]
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25
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Double hit B cell precursor leukemia/lymphoma in a patient with a prior diagnosis of follicular lymphoma: a diagnostic and therapeutic dilemma. Ann Hematol 2019; 99:391-393. [PMID: 31858188 DOI: 10.1007/s00277-019-03897-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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26
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Belman JP, Meng W, Wang HY, Li J, Strauser HT, Rosenfeld AM, Zhang Q, Prak ETL, Wasik M. Dramatic increase in gene mutational burden after transformation of follicular lymphoma into TdT + B-lymphoblastic leukemia/lymphoma. Cold Spring Harb Mol Case Stud 2019; 6:mcs.a004614. [PMID: 31776129 PMCID: PMC6996523 DOI: 10.1101/mcs.a004614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 12/17/2022] Open
Abstract
Transformation of follicular lymphoma (FL) into B-lymphoblastic leukemia/lymphoma (B-ALL/LBL) is rare and results in greatly increased aggressiveness of clinical course. Here we present extensive molecular analysis of this unusual transformation, including immunoglobulin (Ig) gene rearrangement studies, cytogenetic analysis, and whole-exome sequencing (WES) of the patient's FL, B-ALL/LBL, and normal cells. Although FL showed marked somatic hypermutation (SHM) of the Ig genes, SHM appeared to be even more extensive in B-ALL/LBL. Cytogenetically, at least three translocations were identified in the B-ALL/LBL involving the BCL2, BCL6, and MYC genes; two of these, the BCL6 and BCL2 gene rearrangements, were already seen at the FL stage. WES identified 751 single-nucleotide variants with high allelic burden in the patient's cells, with the vast majority (575) present exclusively at the B-ALL/LBL stage. Of note, a TAF3 gene mutation was shared by normal, FL, and B-ALL/LBL tissue. A KMT2D nonsense mutation was identified in both FL and B-ALL/LBL and therefore may have contributed directly to lymphomagenesis. Mutations in KDM6A, SMARCA4, CBX1, and JMY were specific to the B-ALL/LBL stage, possibly contributing to the B-ALL/LBL transformation. Functionally, these identified mutations may lead to dysregulation of DNA repair, transcription, and cell differentiation. Thus, these genetic changes, together with the identified chromosomal translocations, may have contributed to lymphoma development and progression. Our findings may improve the mechanistic understanding of the FL-B-ALL/LBL transformation and may have therapeutic implications for this aggressive disease.
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Affiliation(s)
- Jonathan P Belman
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Wenzhao Meng
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Hong Yi Wang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Jie Li
- Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA
| | - Honore T Strauser
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Aaron M Rosenfeld
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Qian Zhang
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Eline T Luning Prak
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Mariusz Wasik
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Double hit B cell precursor leukemia/lymphoma in a patient with a prior diagnosis of follicular lymphoma: a diagnostic and therapeutic dilemma. Ann Hematol 2019; 98:2837-2839. [PMID: 31712881 DOI: 10.1007/s00277-019-03829-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
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28
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Mai B, Wang W, Medeiros LJ, Ma HY, Hu Z. TdT-positive high grade B-cell lymphoma transformed from grade 3B follicular lymphoma in an HIV-positive patient. Pathology 2019; 51:764-768. [PMID: 31666176 DOI: 10.1016/j.pathol.2019.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/29/2019] [Accepted: 08/07/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Brenda Mai
- Department of Pathology, The University of Texas Health Center at Houston, Houston, TX, United States
| | - Wei Wang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hilary Y Ma
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, TX, United States
| | - Zhihong Hu
- Department of Pathology, The University of Texas Health Center at Houston, Houston, TX, United States.
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29
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Geyer JT, Yigit N, Miyaguchi A, Cheng S, Casano J, Mathew S, Desai P, Gergis U, Tam W. Histiocytic Sarcoma Following B-Lymphoblastic Leukemia/Lymphoma. Am J Clin Pathol 2019; 152:486-494. [PMID: 31172191 DOI: 10.1093/ajcp/aqz056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Rare cases of clonally related histiocytic sarcoma (HS) following B-lymphoblastic leukemia/lymphoma (B-ALL/LBL) have been reported to date. METHODS We present a patient with HS, which appeared as a breast mass 12 months after the initial diagnosis of B-ALL. RESULTS Both HS and the B-ALL shared IGH-MYC and IGK gene rearrangements. Next-generation sequencing and whole-exome sequencing (WES) studies detected 35 common mutations, as well as mutations unique to B-ALL (16) and HS (15), including BRAF D594G. The patient achieved complete remission of B-ALL, but HS failed to respond to many cycles of intensive chemotherapy regimens. A partial response was achieved with sorafenib, a BRAF-targeted therapy. CONCLUSIONS To our knowledge, this is the first study to demonstrate by WES that clonally related B-ALL and HS arise through divergent evolution from a common precursor. We present our findings together with a discussion of the previously reported cases of HS in patients with B-ALL.
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Affiliation(s)
- Julia T Geyer
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Nuri Yigit
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Ayako Miyaguchi
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Shuhua Cheng
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Joseph Casano
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Susan Mathew
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Pinkal Desai
- Departments of Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Usama Gergis
- Departments of Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, NY
| | - Wayne Tam
- Departments of Pathology and Laboratory Medicine/NewYork-Presbyterian Hospital, New York, NY
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30
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Lim MS, Bailey NG, King RL, Piris M. Molecular Genetics in the Diagnosis and Biology of Lymphoid Neoplasms. Am J Clin Pathol 2019; 152:277-301. [PMID: 31278738 DOI: 10.1093/ajcp/aqz078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The 2017 Workshop of the Society for Hematopathology/European Association for Haematopathology reviewed the role of molecular genetics in the diagnosis and biology of lymphoid neoplasms. METHODS The Workshop Panel reviewed 82 cases. RESULTS Molecular genetic testing reveals alterations that expand the spectrum of diseases such as DUSP22 rearrangement in ALK-negative anaplastic large cell lymphoma, large B-cell lymphoma with IRF4 rearrangement, MYD88 mutations in B-cell lymphomas, Burkitt-like lymphoma with 11q aberrations, and diagnostic criteria for high-grade B-cell lymphomas. Therapeutic agents and natural tumor progression may be associated with transcriptional reprogramming that lead to transdifferentiation and lineage switch. CONCLUSIONS Application of emerging technical advances has revealed the complexity of genetic events in lymphomagenesis, progression, and acquired resistance to therapies. They also contribute to enhanced understanding of the biology of indolent vs aggressive behavior, clonal evolution, tumor progression, and transcriptional reprogramming associated with transdifferentiation events that may occur subsequent to therapy.
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Affiliation(s)
- Megan S Lim
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | | | - Miguel Piris
- Department of Pathology, Centro de Investigación Biomédica en Red de Oncología, Hospital Universitario Fundación Jimenez Diaz, Madrid, Spain
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31
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Vaddepally RK, Hejab A, Dabak V, Menon M. A rare case of follicular lymphoma transformed to a high-grade B-cell lymphoma in orbit. Clin Case Rep 2019; 7:1053-1056. [PMID: 31110744 PMCID: PMC6509924 DOI: 10.1002/ccr3.2153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 03/13/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022] Open
Abstract
Transformation of lymphoma is an infrequent phenomenon, and involvement of the eye as such is even uncommon. Histological transformation in patients with follicular lymphoma who were previously treated with immune-chemotherapy carry a poor outcome. Here, we illustrate such a case with aggressive histological transformation from a low-grade lymphoma.
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Affiliation(s)
| | - Amal Hejab
- Internal MedicineHenry Ford Health SystemDetroitMichigan
| | - Vrushali Dabak
- Hematology/OncologyHenry Ford Health SystemDetroitMichigan
| | - Madhu Menon
- HematopathoogyHenry Ford Health SystemDetroitMichigan
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32
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Double-hit pancreatic B-lymphoblastic lymphoma with a variant translocation t(2;18)(p11;q21). Int J Hematol 2019; 110:107-114. [PMID: 30963474 DOI: 10.1007/s12185-019-02646-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
Double-hit lymphoma is typically categorized as "high-grade B-cell lymphoma, with MYC and BCL2 and/or BCL6 rearrangements", but in infrequent cases in which terminal deoxynucleotidyl transferase (TdT) expression is positive, it is categorized as B-lymphoblastic lymphoma (B-LBL). BCL2 rearrangements are usually caused by t(14;18)(q32;q21); variant translocations are very rare. Here, we describe an unusual case of double-hit pancreatic B-LBL with a variant translocation t(2;18)(p11;q21). A 69-year-old man was admitted because of an abdominal mass. Computed tomography scans demonstrated a diffusely enlarged pancreas and massive ascites. Cell block preparations of ascites cells revealed marked proliferation of blastic lymphoid cells positive for CD19, CD10, CD79a, PAX5, and TdT, indicating a diagnosis of B-LBL. G-banding and spectral karyotyping showed 45,XY,+X,t(2;18)(p11;q21),-4,der(5)t(1;5)(q12;p15),der(6)t(6;21)(q21;q?),t(8;14)(q24;q32),-15. Fluorescence in situ hybridization detected split BCL2 and IGH/MYC fusion signals. Almost all ascites cells were diffusely and strongly positive for MYC and BCL2. The patient died of progressive disease 20 days after admission. To our knowledge, this is the first reported case of MYC and BCL2 double-hit B-LBL with t(2;18)(p11;q21). High coexpression of MYC by t(8;14) and BCL2 by t(2;18) may be implicated in the development of B-LBL. Furthermore, double-hit B-LBL may be associated with a less favorable outcome compared with typical B-LBL.
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33
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B Lymphoblastic Leukemia/Lymphoma With Burkitt-like Morphology and IGH/MYC Rearrangement: Report of 3 Cases in Adult Patients. Am J Surg Pathol 2019; 42:269-276. [PMID: 29112016 DOI: 10.1097/pas.0000000000000982] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Isolated MYC rearrangement without other recurrent genetic abnormalities is rare in B lymphoblastic leukemia/lymphoma (B-ALL/LBL), with most cases reported in pediatric patients. We report 3 adult cases with lymphoblasts showing a precursor B cell immunophenotype, and isolated MYC/IGH translocation. All 3 cases occurred in male patients with initial presentation of diffuse lymphadenopathy. Cases 1 and 2 had B-ALL with significantly increased lymphoblasts in peripheral blood and bone marrow. Case 3, a patient with human immunodeficiency virus infection, had the diagnosis of B-LBL made on a retroperitoneal lymph node biopsy and had no peripheral blood or bone marrow involvement. The leukemic and lymphoma cells in all 3 cases demonstrated Burkitt lymphoma-like morphology with deeply basophilic cytoplasm and numerous cytoplasmic vacuoles. However, all 3 had immature immunophenotypes including expression of terminal deoxynucleotidyl transferase (TdT), absence of BCL6, and dim-to-negative CD45. CD20 was largely negative in 2 of 3 cases. All 3 had confirmed MYC/IGH translocation, but lacked rearrangements of BCL2 or BCL6. EBV was negative by Epstein-Barr virus encoded small RNA in situ hybridization. Treatment protocols varied, including both high-risk ALL-type (protocol 8707) and high-grade lymphoma regimens (hyper-CVAD [cyclophosphamide, vincristine, adriamycin, and dexamethasone]), but no patient achieved continuous complete remission. These cases seem to represent a distinct biological phenomenon, in which a MYC translocation may be acquired at an immature stage of differentiation, thus manifesting features of both B-ALL/LBL and Burkitt lymphoma.
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34
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Ok CY, Medeiros LJ, Thakral B, Tang G, Jain N, Jabbour E, Pierce SA, Konoplev S. High-grade B-cell lymphomas with TdT expression: a diagnostic and classification dilemma. Mod Pathol 2019; 32:48-58. [PMID: 30181564 DOI: 10.1038/s41379-018-0112-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/09/2022]
Abstract
Mature B-cell neoplasms and immature or precursor B-cell neoplasms need to be distinguished because these patients usually require different therapeutic approaches. B-cell neoplasms that express TdT without unequivocal other features of immaturity may therefore present a diagnostic challenge. We describe 13 patients with TdT-positive aggressive B-cell lymphoma. The clinicopathologic features of these patients were highly heterogeneous, but for the purpose of this study we grouped these cases as follows: (1) de novo high-grade B-cell lymphoma with MYC, BCL2, and/or BCL6 rearrangements (double-hit or triple-hit lymphoma) with TdT expression. In this group we included two cases of de novo composite lymphoma in which there were components of diffuse large B-cell lymphoma and TdT-positive blastic B-cell lymphoma; (2) TdT-positive aggressive B-cell lymphoma arising in patients who previously had follicular lymphoma; (3) initial relapse of TdT-negative aggressive B-cell lymphoma in patients who previously had follicular lymphoma, followed by relapses in which the neoplasm acquired TdT expression; and (4) mature B-cell lymphomas that acquired TdT expression at relapse. This group included one case of EBV-positive diffuse large B-cell lymphoma and one case of pleomorphic variant mantle cell lymphoma. All patients in this study had an aggressive clinical course and a dismal outcome despite appropriate therapy. Rather than "squeezing" these cases into current World Health Organization classification categories, we suggest the use of a descriptive term such as high-grade B-cell lymphoma with TdT expression. In these tumors, the cytogenetic findings and poor prognosis of this patient subgroup suggest that these neoplasms need to be distinguished from B-lymphoblastic leukemia/lymphoma. Segregation of these neoplasms also may foster additional research on these neoplasms.
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Affiliation(s)
- Chi Young Ok
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beenu Thakral
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guilin Tang
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nitin Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sherry A Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sergej Konoplev
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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35
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Choi SM, Betz BL, Perry AM. Follicular Lymphoma Diagnostic Caveats and Updates. Arch Pathol Lab Med 2018; 142:1330-1340. [PMID: 30221980 DOI: 10.5858/arpa.2018-0217-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Follicular lymphoma is a common small B-cell lymphoma, likely to be encountered by any practicing pathologist, regardless of specialty. Although the features of typical follicular lymphoma are well known and in most instances easily identifiable, there are lesser-appreciated morphologic appearances that can raise alternative diagnostic possibilities. The limited tissue available in core needle biopsies can make it additionally challenging to thoroughly evaluate those features in the context of architecture. Furthermore, ancillary testing including immunohistochemistry and molecular/genetic analysis do not always show classic findings and may pose additional challenges to interpretation. OBJECTIVES.— To review the morphologic features of follicular lymphoma with a discussion of morphologic variants and mimics; to discuss pitfalls of ancillary testing and provide the practicing pathologist with an appropriate context for interpretation of immunohistochemical and molecular/genetic studies when follicular lymphoma is part of the differential diagnosis; and to propose diagnostic strategies when there is limited tissue for evaluation. DATA SOURCES.— We used examples of follicular lymphoma from our institution as well as a review of the literature, with a focus on the diagnostic aspects that are broadly relevant to a general pathology practice. CONCLUSIONS.— Follicular lymphoma can occasionally present with atypical morphologic, immunohistochemical, or molecular/genetic features. In particular, those findings can be difficult to interpret in the setting of a limited tissue sample. Awareness of those possibilities will help guide the pathologist to a more accurate and precise diagnosis.
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Affiliation(s)
- Sarah M Choi
- From the Department of Pathology, University of Michigan, Ann Arbor
| | - Bryan L Betz
- From the Department of Pathology, University of Michigan, Ann Arbor
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36
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Minhas H, Abdelmalek C, Khan M, O'Donnell JE, Gotlieb V, Wang JC. Double-Hit Lymphoma (MYC and BCL6) with Involvement of Skull and Adnexal Lesions: A Case Report and a Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1035-1041. [PMID: 30158513 PMCID: PMC6128191 DOI: 10.12659/ajcr.909400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Double-hit lymphomas (DHL) belong to a category of very aggressive lymphomas characterized by MYC translocation and either BCL2, or less commonly, BCL6 translocations. Those with BCL6 translocations have a predilection for rare extranodal sites such as the gastrointestinal tract, nasopharynx, and tonsils. Involvement of the skull and adnexal structures is rare. Here we report a case of a young female with both skull and adnexal involvement. CASE REPORT A 20-year-old female who presented with hypercalcemia was found to have adnexal, skull, and jaw masses. Workup revealed a stage IV high grade B-cell lymphoma (HGBL) with MYC and BCL6 rearrangements. She was subsequently treated with R-EPOCH and attained complete remission 9 months after her initial presentation. To the best of our knowledge, our patient represents the first reported case of skull and adnexal involvement in HGBL with MYC and BCL6 rearrangement. CONCLUSIONS Rare extranodal presentations of HGBL with MYC and BCL6 rearrangement should be considered in the differential diagnosis of masses found in unusual sites such as the skull and adnexa. Due to their aggressive nature, early and prompt recognition of these lymphomas is essential for timely administration of appropriate therapy.
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Affiliation(s)
- Hamza Minhas
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Cherif Abdelmalek
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Marium Khan
- Department of Internal Medicine, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - James E O'Donnell
- Department of Pathology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Vladimir Gotlieb
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
| | - Jen Chin Wang
- Division of Hematology/Oncology, Brookdale Hospital Medical Center, Brooklyn, NY, USA
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37
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Lui GYL, Grandori C, Kemp CJ. CDK12: an emerging therapeutic target for cancer. J Clin Pathol 2018; 71:957-962. [PMID: 30104286 DOI: 10.1136/jclinpath-2018-205356] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 12/20/2022]
Abstract
Cyclin-dependent kinase 12 (CDK12) belongs to the cyclin-dependent kinase (CDK) family of serine/threonine protein kinases that regulate transcriptional and post-transcriptional processes, thereby modulating multiple cellular functions. Early studies characterised CDK12 as a transcriptional CDK that complexes with cyclin K to mediate gene transcription by phosphorylating RNA polymerase II. CDK12 has been demonstrated to specifically upregulate the expression of genes involved in response to DNA damage, stress and heat shock. More recent studies have implicated CDK12 in regulating mRNA splicing, 3' end processing, pre-replication complex assembly and genomic stability during embryonic development. Genomic alterations in CDK12 have been detected in oesophageal, stomach, breast, endometrial, uterine, ovarian, bladder, colorectal and pancreatic cancers, ranging from 5% to 15% of sequenced cases. An increasing number of studies point to CDK12 inhibition as an effective strategy to inhibit tumour growth, and synthetic lethal interactions have been described with MYC, EWS/FLI and PARP/CHK1 inhibition. Herein, we discuss the present literature on CDK12 in cell function and human cancer, highlighting important roles for CDK12 as a clinical biomarker for treatment response and potential as an effective therapeutic target.
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Affiliation(s)
- Goldie Y L Lui
- Fred Hutchinson Cancer Research Center, Human Biology Division, Seattle, Washington, USA
| | | | - Christopher J Kemp
- Fred Hutchinson Cancer Research Center, Human Biology Division, Seattle, Washington, USA
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38
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Jaffe ES. Diagnosis and classification of lymphoma: Impact of technical advances. Semin Hematol 2018; 56:30-36. [PMID: 30573042 DOI: 10.1053/j.seminhematol.2018.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/08/2018] [Indexed: 01/19/2023]
Abstract
Our current understanding of the normal lymphoid system informs the modern classification of lymphomas. B-cell, T-cell, and natural killer-cell neoplasms often recapitulate normal stages of lymphoid cell differentiation and function. Moreover, the clinical manifestations of lymphomas often reflect the normal function of lymphoid cells in vivo. The multiparameter approach to classification adopted by the Revised European and American Lymphoma and subsequent WHO classifications facilitates the interpretation of clinical and translational studies, and provides a framework for the discovery of molecular alterations that drive these tumors. An accurate and precise classification of disease entities facilitates the discovery of the molecular basis of lymphoid neoplasms in the basic science laboratory, and leads to new diagnostic tools that play a role in clinical diagnosis.
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Affiliation(s)
- Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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39
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Jaffe ES, Barr PM, Smith SM. Understanding the New WHO Classification of Lymphoid Malignancies: Why It's Important and How It Will Affect Practice. AMERICAN SOCIETY OF CLINICAL ONCOLOGY EDUCATIONAL BOOK. AMERICAN SOCIETY OF CLINICAL ONCOLOGY. ANNUAL MEETING 2017. [PMID: 28561690 DOI: 10.14694/edbk_175437] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Improved delineation of lymphoid malignancy biology has prompted refinement of the 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tumors with a new framework introduced in 2016. This knowledge has provided valuable insights regarding management. Early clonal proliferations have been set apart given their limited potential for malignant dissemination. Increasing knowledge of molecular drivers of aggressive lymphomas has allowed subclassification and opportunity for clinical investigations to personalize therapy. New insights into T-cell pathophysiology has allowed grouping based on shared molecular and cellular features. This article will summarize the key changes in terms of diagnosis and histopathologic definitions, the impact of these changes on clinical management, and the challenges of future research in this field.
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Affiliation(s)
- Elaine S Jaffe
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Paul M Barr
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Sonali M Smith
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
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40
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Kurant D, Fisher S, Tang W, Aguilera N. B-lymphoblastic leukemia/lymphoma arising in treated plasma cell myeloma: A rare second malignancy. HUMAN PATHOLOGY: CASE REPORTS 2017. [DOI: 10.1016/j.ehpc.2017.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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41
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Chen HR, Juan HC, Wong YH, Tsai JW, Fann MJ. Cdk12 Regulates Neurogenesis and Late-Arising Neuronal Migration in the Developing Cerebral Cortex. Cereb Cortex 2017; 27:2289-2302. [PMID: 27073218 DOI: 10.1093/cercor/bhw081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
DNA damage response (DDR) pathways are critical for ensuring that replication stress and various types of DNA lesion do not perturb production of neural cells during development. Cdk12 maintains genomic stability by regulating expression of DDR genes. Mutant mice in which Cdk12 is conditionally deleted in neural progenitor cells (NPCs) die after birth and exhibit microcephaly with a thinner cortical plate and an aberrant corpus callosum. We show that NPCs of mutant mice accumulate at G2 and M phase, and have lower expression of DDR genes, more DNA double-strand breaks and increased apoptosis. In addition to there being fewer neurons, there is misalignment of layers IV-II neurons and the presence of abnormal axonal tracts of these neurons, suggesting that Cdk12 is also required for the migration of late-arising cortical neurons. Using in utero electroporation, we demonstrate that the migrating mutant cells remain within the intermediate zone and fail to adopt a bipolar morphology. Overexpression of Cdk5 brings about a partially restoration of the neurons reaching layers IV-II in the mutant mice. Thus, Cdk12 is crucial to the repair of DNA damage during the proliferation of NPCs and is also central to the proper migration of late-arising neurons.
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Affiliation(s)
- Hong-Ru Chen
- Department of Life Sciences and Institute of Genome Sciences.,Brain Research Center
| | - Hsien-Chia Juan
- Department of Life Sciences and Institute of Genome Sciences
| | | | - Jin-Wu Tsai
- Brain Research Center.,Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan 11221, Republic of China
| | - Ming-Ji Fann
- Department of Life Sciences and Institute of Genome Sciences.,Brain Research Center
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42
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Jaffe ES, Barr PM, Smith SM. Understanding the New WHO Classification of Lymphoid Malignancies: Why It's Important and How It Will Affect Practice. Am Soc Clin Oncol Educ Book 2017; 37:535-546. [PMID: 28561690 PMCID: PMC6324533 DOI: 10.1200/edbk_175437] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Improved delineation of lymphoid malignancy biology has prompted refinement of the 2008 World Health Organization (WHO) classification of hematopoietic and lymphoid tumors with a new framework introduced in 2016. This knowledge has provided valuable insights regarding management. Early clonal proliferations have been set apart given their limited potential for malignant dissemination. Increasing knowledge of molecular drivers of aggressive lymphomas has allowed subclassification and opportunity for clinical investigations to personalize therapy. New insights into T-cell pathophysiology has allowed grouping based on shared molecular and cellular features. This article will summarize the key changes in terms of diagnosis and histopathologic definitions, the impact of these changes on clinical management, and the challenges of future research in this field.
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Affiliation(s)
- Elaine S Jaffe
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Paul M Barr
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
| | - Sonali M Smith
- From the Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD; Wilmot Cancer Institute, University of Rochester, Rochester, NY; Section of Hematology/Oncology, The University of Chicago, Chicago, IL
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43
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Abstract
Low-grade B-cell leukemias/lymphomas are a diverse group of indolent lymphoproliferative disorders that are typically characterized by good patient outcomes and long life expectancies. A subset of cases, however, undergo histologic transformation to a higher-grade neoplasm, a transition associated with a more aggressive clinical course and poor survival. Transformation of follicular lymphoma to diffuse large B-cell lymphoma and Richter transformation of chronic lymphocytic leukemia/small lymphocytic lymphoma are best characterized in the literature. This article reviews clinical and pathologic characteristics of these most common forms of transformation, with an emphasis on salient histologic, immunophenotypic, and genetic features.
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Affiliation(s)
- Nathan D Montgomery
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, CB #7525, Chapel Hill, NC 27599-7525, USA
| | - Stephanie P Mathews
- Division of Hematopathology, Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, CB #7525, Chapel Hill, NC 27599-7525, USA.
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Hiemcke-Jiwa LS, Leguit RJ, van der Veken LT, Buijs A, Leeuwis JW, de Boer M, Jiwa NM, Bloem AC, Petersen EJ, de Weger RA, Huibers MMH. Lymphoblastic lymphoma with a triple-hit profile: a rare but distinct and relevant entity. Hum Pathol 2016; 63:171-176. [PMID: 27867103 DOI: 10.1016/j.humpath.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 11/24/2022]
Abstract
Follicular lymphoma with progression to a high-grade lymphoma bears a poor prognosis. We describe a case of a 60-year-old man who presented in 2012 with an epidural mass, diagnosed as a diffuse large B-cell lymphoma (DLBCL) with concurrent low-grade follicular lymphoma. Three years later, the patient presented with a cervical mass, diagnosed as a lymphoblastic lymphoma (LBL). Both the DLBCL and LBL contained a "triple hit" with BCL2, BCL6, and cMYC translocations demonstrated by fluorescence in situ hybridization analysis and a complex karyotype by single-nucleotide polymorphism array analysis. Furthermore, the 2 lymphomas were shown to be clonally related by clonality analysis and single-nucleotide polymorphism array analysis. This case report presents a highly unusual case of an LBL with a triple hit, originating from a DLBCL, which has rarely been described in the literature and deserves further exploration.
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Affiliation(s)
- Laura S Hiemcke-Jiwa
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
| | - Roos J Leguit
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Lars T van der Veken
- Department of Genetics, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Arjan Buijs
- Department of Genetics, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Jan Willem Leeuwis
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Mirthe de Boer
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - N Mehdi Jiwa
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Andries C Bloem
- Department of Immunology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Eefke J Petersen
- Department of Hematology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Roel A de Weger
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
| | - Manon M H Huibers
- Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands
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45
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Slot LM, Hoogeboom R, Smit LA, Wormhoudt TAM, Biemond BJ, Oud MECM, Schilder-Tol EJM, Mulder AB, Jongejan A, van Kampen AHC, Kluin PM, Guikema JEJ, Bende RJ, van Noesel CJM. B-Lymphoblastic Lymphomas Evolving from Follicular Lymphomas Co-Express Surrogate Light Chains and Mutated Gamma Heavy Chains. THE AMERICAN JOURNAL OF PATHOLOGY 2016; 186:3273-3284. [PMID: 27750045 DOI: 10.1016/j.ajpath.2016.07.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/30/2016] [Accepted: 07/28/2016] [Indexed: 01/19/2023]
Abstract
Follicular lymphoma (FL) is an indolent B-cell non-Hodgkin lymphoma able to transform into germinal center-type diffuse large B-cell lymphoma. We describe four extraordinary cases of FL, which progressed to TdT+CD20- precursor B-lymphoblastic lymphoma (B-LBL). Fluorescence in situ hybridization analysis showed that all four B-LBLs had acquired a MYC translocation on transformation. Comparative genomic hybridization analysis of one case demonstrated that in addition to 26 numerical aberrations that were shared between the FL and B-LBL, deletion of CDKN2A/B and 17q11, 14q32 amplification, and copy-neutral loss of heterozygosity of 9p were gained in the B-LBL cells. Whole-exome sequencing revealed mutations in FMN2, NEB, and SYNE1 and a nonsense mutation in KMT2D, all shared by the FL and B-LBL, and TNFRSF14, SMARCA2, CCND3 mutations uniquely present in the B-LBL. Remarkably, all four FL-B-LBL pairs expressed IgG. In two B-LBLs, evidence was obtained for ongoing rearrangement of IG light chain variable genes and expression of the surrogate light chain. IGHV mutation analysis showed that all FL-B-LBL pairs harbored identical or near-identical somatic mutations. From the somatic gene alterations found in the IG and non-IG genes, we conclude that the FLs and B-LBLs did not develop in parallel from early t(14;18)-positive IG-unmutated precursors, but that the B-LBLs developed from preexistent FL subclones that accumulated additional genetic damage.
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Affiliation(s)
- Linda M Slot
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, the Netherlands
| | - Robbert Hoogeboom
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, the Netherlands
| | - Laura A Smit
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Thera A M Wormhoudt
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, the Netherlands
| | - Bart J Biemond
- Department of Haematology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Monique E C M Oud
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - André B Mulder
- Department of Laboratory Medicine, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Aldo Jongejan
- Bioinformatics Laboratory, Klinische Epidemiologie, Biostatistiek en Bio-informatica (KEBB), Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - Antoine H C van Kampen
- Bioinformatics Laboratory, Klinische Epidemiologie, Biostatistiek en Bio-informatica (KEBB), Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Biosystems Data Analysis, Swammerdam Institute for Life Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Philip M Kluin
- Department of Pathology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Jeroen E J Guikema
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, the Netherlands
| | - Richard J Bende
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, the Netherlands
| | - Carel J M van Noesel
- Department of Pathology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands; Lymphoma and Myeloma Center Amsterdam (LYMMCARE), Amsterdam, the Netherlands.
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46
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Chilà R, Guffanti F, Damia G. Role and therapeutic potential of CDK12 in human cancers. Cancer Treat Rev 2016; 50:83-88. [PMID: 27662623 DOI: 10.1016/j.ctrv.2016.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022]
Abstract
Phosphorylation of the RNA polymerase II C-terminal domain by cyclin-dependent kinases (CDKs) is important for productive transcription. Deregulated transcription-CDKs have been reported in different human cancers. Until recently CDK9 was the only transcription-CDK with a causative role in cancer, but evidence is cumulating of the importance of CDK12. This review summarizes the role of CDK12 in transcription and RNA processing, in maintaining genomic stability/integrity and in tumorigenesis. CDK12 mutations have been reported in many cancers and have been suggested as a cause of defective DNA repair in ovarian carcinoma. CDK12 may have a role as a new therapeutic target in oncology.
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Affiliation(s)
- Rosaria Chilà
- Laboratory of Molecular Pharmacology, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Federica Guffanti
- Laboratory of Molecular Pharmacology, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Giovanna Damia
- Laboratory of Molecular Pharmacology, Oncology Department, IRCCS - Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
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47
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High-grade Transformation of Low-grade B-cell Lymphoma: Pathology and Molecular Pathogenesis. Am J Surg Pathol 2016; 40:e1-16. [PMID: 26658667 DOI: 10.1097/pas.0000000000000561] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patients with low-grade (clinically indolent) lymphomas are at risk to undergo transformation to high-grade (clinically aggressive) lymphoma, although transformation only occurs in a subset of patients. When transformation occurs it is a critical event that determines the course of disease and is associated with unfavorable patient outcomes. Accurate detection of transformation, predictive biomarkers, and identification of specific molecular pathways implicated in the pathobiology of transformation will facilitate personalized therapeutic approaches and underpin advances in clinical outcomes. In this article, we present an update of the clinical and pathologic diagnostic criteria for low-grade B-cell lymphoma transformation and discuss the molecular alterations involved in the pathogenesis of this biological phenomenon.
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48
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Moench L, Sachs Z, Aasen G, Dolan M, Dayton V, Courville EL. Double- and triple-hit lymphomas can present with features suggestive of immaturity, including TdT expression, and create diagnostic challenges. Leuk Lymphoma 2016; 57:2626-35. [PMID: 26892631 DOI: 10.3109/10428194.2016.1143939] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Double- and triple-hit lymphomas (DHL/THL) are aggressive B-cell neoplasms characterized by translocation of MYC with concurrent BCL2 and/or BCL6 translocation. In this retrospective study from one institution, we report clinicopathologic features of 13 cases (9 DHL/4 THL). The median age was 59 years (range 30-74) and patients included eight females and five males. Presentation included enlarging lymphadenopathy/masses (11 patients) and abnormal peripheral blood findings (2 patients). Features which raised the differential of an immature neoplasm included terminal deoxynucleotidyl transferase positivity (four cases, two THL/two DHL); dim CD45 expression (seven cases), lack of CD20 (two cases), or lack of surface immunoglobulin light chain (three cases) by flow cytometry; and blastoid morphology (two cases). We conclude that expression of TdT in a B-cell lymphoma with mature features or expression of surface light chain in a case otherwise suggestive of B-lymphoblastic leukemia/lymphoma should prompt an expedited evaluation for DHL/THL.
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Affiliation(s)
- Laura Moench
- a Department of Laboratory Medicine and Pathology , University of Minnesota , Minneapolis , MN , USA
| | - Zohar Sachs
- b Department of Medicine, Division of Hematology, Oncology, and Transplantation , University of Minnesota , Minneapolis , MN , USA
| | - Garth Aasen
- a Department of Laboratory Medicine and Pathology , University of Minnesota , Minneapolis , MN , USA
| | - Michelle Dolan
- a Department of Laboratory Medicine and Pathology , University of Minnesota , Minneapolis , MN , USA
| | - Vanessa Dayton
- a Department of Laboratory Medicine and Pathology , University of Minnesota , Minneapolis , MN , USA
| | - Elizabeth L Courville
- a Department of Laboratory Medicine and Pathology , University of Minnesota , Minneapolis , MN , USA
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49
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Xerri L, Dirnhofer S, Quintanilla-Martinez L, Sander B, Chan JKC, Campo E, Swerdlow SH, Ott G. The heterogeneity of follicular lymphomas: from early development to transformation. Virchows Arch 2015; 468:127-39. [PMID: 26481245 DOI: 10.1007/s00428-015-1864-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 09/10/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022]
Abstract
Follicular lymphoma (FL) is a lymphoma composed of germinal center B cells, i.e., centroblasts and centrocytes, that almost always show at least a focal follicular growth pattern. Most cases have a characteristic CD5-, CD10+, BCL6+, and BCL2+ immunophenotype, and 85 % of cases exhibit the hallmark translocation t(14;18)(q32;q21) involving BCL2 and IGH. Although the typical clinicopathological findings of FL are well recognized, cases with unusual clinical, morphologic, immunophenotypic, and genetic features may pose problems in diagnosis and nomenclature. In the slide workshop organized by the European Association for Haematopathology (EAHP) and the Society for Hematopathology (SH) held in Istanbul, Turkey, unusual variants of FL were discussed based on the submitted cases, including early lesions, localized extranodal presentation, uncommon immunophenotype, rare genetic alterations, diffuse variant, and marginal zone differentiation. Interesting features such as blastoid morphology and unusual progression forms were presented, aiming to understand the genetic basis of transformation. In this report, novel findings and diagnostic challenges emerging from the submitted cases will be highlighted, and new terminologies for some of these lesions are proposed.
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Affiliation(s)
- Luc Xerri
- Department of Bio-Pathology, Institut Paoli-Calmettes, Aix-Marseille University, Marseille, France.
| | - Stephan Dirnhofer
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Leticia Quintanilla-Martinez
- Institute of Pathology and Neuropathology, Eberhard Karls University of Tübingen and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Birgitta Sander
- Department of Laboratory Medicine, Division of Pathology, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | - Elias Campo
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Steven H Swerdlow
- Division of Hematopathology, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Hospital and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
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50
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Gascoyne RD. XIV. The pathology of transformation of indolent B cell lymphomas. Hematol Oncol 2015; 33 Suppl 1:75-9. [PMID: 26062060 DOI: 10.1002/hon.2222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Randy D Gascoyne
- Hematopathologist, British Columbia Cancer Agency and the Centre for Lymphoid Cancer, Vancouver, BC, Canada
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