Utility of immunohistochemistry with an antibody against MYC at the initial diagnosis of follicular lymphoma, grade 3A, for predicting a more aggressive clinical course: a case report and review of the literature.
Follicular lymphoma (FL) is the most common indolent lymphoma, and associated with the chromosomal translocation t(14;18)(q32;q21). While, FL harboring both BCL2 and MYC translocation at diagnosis is very rare. The evaluation of MYC expression in typical FL at presentation using southern blot, G-banded karyotyping or fluorescence in situ hybridization (FISH) analyses has been described so far. However, there are no reports about the use of immunohistochemistry (IHC) to evaluate MYC protein expression in FL at presentation. Here, we present a FL patient who transformed to a B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt's lymphoma, accompanied by concurrent BCL2, BCL6, and MYC translocations; i.e., triple-hit lymphoma. Paraffin-embedded tissue section-FISH analysis demonstrated that the FL was negative for MYC, but MYC protein expression was subsequently detected in the lymph node specimen obtained at the initial diagnosis using IHC. This case revealed aggressive clinical course and central nervous system involvement. In the literature concerning MYC positive FL five out of 8 patients were dead within 24 months. The detection of MYC protein expression in FL using IHC might be useful to predict more aggressive clinical course.
Department of Internal Medicine, Division of Hematology, Juntendo University School of Medicine Tokyo, Japan ; Department of Hematology, Juntendo University Urayasu Hospital Chiba, Japan.
Kunimoto
K
Ichikawa
Department of Hematology, Juntendo University Nerima Hospital Tokyo, Japan.
Nanae
N
Aritaka
Department of Diagnostic Pathology, Juntendo University Nerima Hospital Tokyo, Japan.
Kanako
K
Ogura
Department of Pathology, Nippon Medical School Tama-Nagayama Hospital Tokyo, Japan.
Masaru
M
Hosone
Department of Pathology, Institute of Medical Science, The University of Tokyo Tokyo, Japan.
Yasunori
Y
Ota
Department of Hematology, Juntendo University Nerima Hospital Tokyo, Japan.
Eriko
E
Sato
Department of Internal Medicine, Division of Hematology, Juntendo University School of Medicine Tokyo, Japan.
Norio
N
Komatsu
Department of Hematology, Juntendo University Nerima Hospital Tokyo, Japan.
Takao
T
Hirano
D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000235:genetics; D004268:DNA-Binding Proteins / Q000235:genetics; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D020022:Genetic Predisposition to Disease; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D016393:Lymphoma, B-Cell / Q000737:chemistry* / Q000235:genetics / Q000473:pathology; D008224:Lymphoma, Follicular / Q000737:chemistry* / Q000235:genetics / Q000473:pathology; D060787:Neoplasm Grading; D010641:Phenotype; D011237:Predictive Value of Tests; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000235:genetics; D051560:Proto-Oncogene Proteins c-bcl-6; D016271:Proto-Oncogene Proteins c-myc / Q000032:analysis* / Q000235:genetics; D013997:Time Factors; D014178:Translocation, Genetic
C000595707:BCL2 protein, human; C084103:BCL6 protein, human; D014408:Biomarkers, Tumor; D004268:DNA-Binding Proteins; C489427:MYC protein, human; D019253:Proto-Oncogene Proteins c-bcl-2; D051560:Proto-Oncogene Proteins c-bcl-6; D016271:Proto-Oncogene Proteins c-myc
BCL2; BCL6; MYC; follicular lymphoma; transformation; triple-hit lymphoma