title: Combination of t(14;18) and a Burkitt's type translocation in B-cell malignancies.
abstract: The combination of chromosomal translocations associated with bcl-2 rearrangement [t(14;18)] and c-myc rearrangement [t(8;14), t(8;22), or t(2;8)] has infrequently been detected in lymphoproliferative disorders. We have recently identified four cases of a B-cell malignancy exhibiting this dual translocation. In addition to t(14;18), one case had t(8;14) and three had the t(8;22). One case presented as de novo acute lymphoblastic leukemia (ALL-L2), two as de novo high grade lymphomas and the fourth evolved to a "blastic" phase from a previously documented follicular lymphoma. Immunophenotyping and molecular analysis was performed on three of the cases: all were negative for terminal deoxynucleotidyl transferase (TdT) but were CD10 positive. Two of the three cases with t(8;22) were negative for surface immunoglobulin (SIg) and positive for HLA-DR. Rearrangement of the oncogene bcl-2 was identified in a single case by polymerase chain reaction (PCR) only. Similar to cases reported in the literature, all patients had a poor clinical outcome despite aggressive therapy. Dual translocation lymphoid malignancy has a relatively characteristic morphology and the diagnosis should be considered when there is a history of an antecedent low grade lymphoma or when there is discordance between the "blastic" morphology and the immunophenotype (TdT- and/or SIg+). Confirmation requires demonstration of the characteristic translocations. Recognition of this entity has significant clinical implications that may require consideration of alternate treatment strategies.
authors.affiliation: Department of Pathology, Vancouver General Hospital, British Columbia, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Karsan
authors.forename: R D
authors.initials: RD
authors.lastname: Gascoyne
authors.forename: R W
authors.initials: RW
authors.lastname: Coupland
authors.forename: J D
authors.initials: JD
authors.lastname: Shepherd
authors.forename: G L
authors.initials: GL
authors.lastname: Phillips
authors.forename: D E
authors.initials: DE
authors.lastname: Horsman
mesh_terms: D000328:Adult; D001483:Base Sequence; D002051:Burkitt Lymphoma / Q000235:genetics / Q000276:immunology / Q000473:pathology; D002883:Chromosomes, Human, Pair 14; D002887:Chromosomes, Human, Pair 18; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D015322:Gene Rearrangement, B-Lymphocyte; D016259:Genes, myc; D006801:Humans; D016130:Immunophenotyping; D007621:Karyotyping; D016393:Lymphoma, B-Cell / Q000235:genetics* / Q000276:immunology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D014178:Translocation, Genetic
chemical_list: D004273:DNA, Neoplasm