title: Lymphoblastic lymphoma with a triple-hit profile: a rare but distinct and relevant entity.
abstract: Follicular lymphoma with progression to a high-grade lymphoma bears a poor prognosis. We describe a case of a 60-year-old man who presented in 2012 with an epidural mass, diagnosed as a diffuse large B-cell lymphoma (DLBCL) with concurrent low-grade follicular lymphoma. Three years later, the patient presented with a cervical mass, diagnosed as a lymphoblastic lymphoma (LBL). Both the DLBCL and LBL contained a "triple hit" with BCL2, BCL6, and cMYC translocations demonstrated by fluorescence in situ hybridization analysis and a complex karyotype by single-nucleotide polymorphism array analysis. Furthermore, the 2 lymphomas were shown to be clonally related by clonality analysis and single-nucleotide polymorphism array analysis. This case report presents a highly unusual case of an LBL with a triple hit, originating from a DLBCL, which has rarely been described in the literature and deserves further exploration.
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands. Electronic address: ljiwa@umcutrecht.nl.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Hiemcke-Jiwa
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Roos J
authors.initials: RJ
authors.lastname: Leguit
authors.affiliation: Department of Genetics, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Lars T
authors.initials: LT
authors.lastname: van der Veken
authors.affiliation: Department of Genetics, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Arjan
authors.initials: A
authors.lastname: Buijs
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Leeuwis
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Mirthe
authors.initials: M
authors.lastname: de Boer
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: N Mehdi
authors.initials: NM
authors.lastname: Jiwa
authors.affiliation: Department of Immunology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Andries C
authors.initials: AC
authors.lastname: Bloem
authors.affiliation: Department of Hematology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Eefke J
authors.initials: EJ
authors.lastname: Petersen
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Roel A
authors.initials: RA
authors.lastname: de Weger
authors.affiliation: Department of Pathology, University Medical Center Utrecht, 3584, CX, Utrecht, the Netherlands.
authors.forename: Manon M H
authors.initials: MMH
authors.lastname: Huibers
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis / Q000235:genetics*; D005434:Flow Cytometry; D020869:Gene Expression Profiling / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D017404:In Situ Hybridization, Fluorescence; D059785:Karyotype; D007621:Karyotyping; D008224:Lymphoma, Follicular / Q000737:chemistry / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000737:chemistry / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D020411:Oligonucleotide Array Sequence Analysis; D020641:Polymorphism, Single Nucleotide; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000235:genetics* / Q000378:metabolism / Q000473:pathology / Q000628:therapy
chemical_list: D014408:Biomarkers, Tumor
keywords: Complex karyotype; Lymphoblastic lymphoma; SNP array; Transformation; Triple hit