Transformation of follicular lymphoma to precursor B-cell lymphoblastic lymphoma with c-myc gene rearrangement as a critical event.
Progression of follicular lymphoma (FL) to a higher-grade lymphoma occurs in 25% to 60% of cases and frequently indicates a poor prognosis. The transformation is accompanied by alteration in morphologic features and clinical behaviors. Herein, we report a case of FL occurring in a 59-year-old woman with the development of a precursor B-cell lymphoblastic lymphoma (PBC-LBL) during a 6-month period. Both lymphomas had identical bcl-2 and immunoglobulin heavy-chain gene breakpoints as assessed by polymerase chain reaction amplification and direct sequencing, indicating that the 2 tumors originated from a common precursor B-cell clone or the PBC-LBL arose from clonal evolution of its preceding FL and "dedifferentiated" into a lymphoblastic stage. Immunohistochemical studies revealed that both lymphomas displayed typical phenotypic characteristics. A c-myc gene translocation was observed in the PBC-LBL but not the FL by fluorescence in situ hybridization. The c-myc translocation is also reported in similar cases in the literature and likely is crucial in the pathogenesis of the PBC-LBL.
Young
Ken H
KH
Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison WI 53792-2472, USA.
Xie
Qingmei
Q
Zhou
Guimei
G
Eickhoff
Jens C
JC
Sanger
Warren G
WG
Aoun
Patricia
P
Chan
Wing C
WC
D002471:Cell Transformation, Neoplastic / Q000235:genetics*; D019457:Chromosome Breakage; D002999:Clone Cells; D004273:DNA, Neoplasm / Q000032:analysis; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D015321:Gene Rearrangement; D019254:Genes, bcl-2; D016259:Genes, myc; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D017404:In Situ Hybridization, Fluorescence; D016393:Lymphoma, B-Cell / Q000235:genetics* / Q000473:pathology; D008224:Lymphoma, Follicular / Q000235:genetics* / Q000473:pathology; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics* / Q000473:pathology; D017422:Sequence Analysis, DNA; D014178:Translocation, Genetic
D004273:DNA, Neoplasm; D007143:Immunoglobulin Heavy Chains