Clinical, immunophenotypic, and genetic analysis of adult lymphomas with morphologic features of Burkitt lymphoma.
A prompt distinction of Burkitt lymphoma (BL) versus diffuse large B cell lymphomas (DLBCL) has important clinical implications; however, this distinction can be difficult. We analyzed 74 adult gray zone and 10 reference pediatric BL using immunohistochemistry (Ki-67, CD10, bcl2, bcl6) and fluorescence in situ hybridization (FISH) for MYC, BCL2, and BCL6 breakpoints. Two algorithms for classification were followed: algorithm A used a two-step review by four hemato-pathologists and algorithm B a set of only biologic markers (Ki-67 > or = 90%, CD10+, bcl6+, bcl2-, MYC breakpoint+, BCL2 and BCL6 breakpoint-). Both algorithms categorized all reference cases as BL. In the adult group, algorithm A resulted in 21 adult BL and 52 DLBCL and algorithm B in 23 BL and 51 "non-Burkitt" lymphomas (nBL); 9 cases (12%) contained two different translocations and were categorized as nBL in algorithm B. Fifteen cases (20%) fulfilled the BL criteria of both algorithms. Although not considered as BL according to both algorithms, many other lymphomas showed nonetheless a phenotypic and/or genetic shift to BL. BL according to algorithm B was more homogeneous with respect to clinical presentation (gender and localization) than BL defined by algorithm A. Our data suggest that only a few cases of these gray zone lymphomas represent true de novo BL. Immunohistochemistry for Ki-67, CD10, and bcl2 with analysis of MYC and preferably also BCL2 and BCL6 may be advised as a marker panel for this diagnostic dilemma.
Haralambieva
Eugenia
E
Department of Pathology, University Medical Center Groningen, Groningen, The Netherlands.
Boerma
Evert-Jan
EJ
van Imhoff
Gustaaf W
GW
Rosati
Stefano
S
Schuuring
Ed
E
Müller-Hermelink
Hans Konrad
HK
Kluin
Philip M
PM
Ott
German
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000032:analysis; D002051:Burkitt Lymphoma / Q000175:diagnosis / Q000235:genetics* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004268:DNA-Binding Proteins / Q000032:analysis; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D016130:Immunophenotyping; D019394:Ki-67 Antigen / Q000032:analysis; D008223:Lymphoma / Q000235:genetics* / Q000276:immunology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015260:Neprilysin / Q000032:analysis; D011518:Proto-Oncogene Proteins / Q000032:analysis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis; D051560:Proto-Oncogene Proteins c-bcl-6; D014157:Transcription Factors / Q000032:analysis; D014178:Translocation, Genetic
D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; D019394:Ki-67 Antigen; D011518:Proto-Oncogene Proteins; D019253:Proto-Oncogene Proteins c-bcl-2; D051560:Proto-Oncogene Proteins c-bcl-6; D014157:Transcription Factors; D015260:Neprilysin