title: Transformation of follicular lymphoma to plasmablastic lymphoma with c-myc gene rearrangement.
abstract: Follicular lymphoma (FL) is an indolent lymphoma that transforms to high-grade lymphoma, mostly diffuse large B-cell lymphoma, in about a third of patients. We present the first report of a case of FL that transformed to plasmablastic lymphoma (PBL). Clonal transformation of the FL to PBL was evidenced by identical IGH/BCL2 gene rearrangements and VDJ gene usage in rearranged IGH genes. IGH/ BCL2 translocation was retained in the PBL, which also acquired c-myc gene rearrangement. Genealogic analysis based on somatic hypermutation of the rearranged IGH genes of both FL and PBL suggests that transformation of the FL to PBL occurred most likely by divergent evolution from a common progenitor cell rather than direct evolution from the FL clone. Our study of this unusual case expands the histologic spectrum of FL transformation and increases our understanding of the pathogenetic mechanisms of transformation of indolent lymphomas to aggressive lymphomas.
authors.affiliation: Division of Hematopathology, Weill Cornell Medical Center-New York Presbyterian Hospital, New York, NY,USA.
authors.forename: Ihsane
authors.initials: I
authors.lastname: Ouansafi
authors.forename: Bing
authors.initials: B
authors.lastname: He
authors.forename: Cory
authors.initials: C
authors.lastname: Fraser
authors.forename: Kui
authors.initials: K
authors.lastname: Nie
authors.forename: Susan
authors.initials: S
authors.lastname: Mathew
authors.forename: Rumina
authors.initials: R
authors.lastname: Bhanji
authors.forename: Rana
authors.initials: R
authors.lastname: Hoda
authors.forename: Melissa
authors.initials: M
authors.lastname: Arabadjief
authors.forename: Daniel
authors.initials: D
authors.lastname: Knowles
authors.forename: Andrea
authors.initials: A
authors.lastname: Cerutti
authors.forename: Attilio
authors.initials: A
authors.lastname: Orazi
authors.forename: Wayne
authors.initials: W
authors.lastname: Tam
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001854:Bone Marrow Cells / Q000473:pathology; D002471:Cell Transformation, Neoplastic / Q000235:genetics* / Q000473:pathology; D004252:DNA Mutational Analysis; D004273:DNA, Neoplasm / Q000235:genetics; D017809:Fatal Outcome; D015321:Gene Rearrangement; D005803:Genes, Immunoglobulin; D016259:Genes, myc; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000235:genetics; D017404:In Situ Hybridization, Fluorescence; D008224:Lymphoma, Follicular / Q000188:drug therapy / Q000235:genetics*; D016400:Lymphoma, Large-Cell, Immunoblastic / Q000235:genetics*; D008297:Male; D010950:Plasma Cells / Q000473:pathology*; D016133:Polymerase Chain Reaction
chemical_list: D004273:DNA, Neoplasm; D007143:Immunoglobulin Heavy Chains