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Composite diffuse large B-cell lymphoma and precursor B lymphoblastic lymphoma presenting as a double-hit lymphoma with MYC and BCL2 translocation
  1. Suparna Nanua1,
  2. Nancy L Bartlett2,
  3. Anjum Hassan1,
  4. Diane Robirds1,
  5. Julie Branson1,
  6. John L Frater1,
  7. TuDung T Nguyen1,
  8. Friederike Kreisel1
  1. 1Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri, USA
  2. 2Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
  1. Correspondence to Friederike Kreisel, Washington University Medical Center, Department of Pathology and Immunology, 660 S. Euclid Avenue, Campus Box 8118, Saint Louis, MO 63110, USA; fkreisel{at}

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Double-hit lymphomas (DHL) with concurrent MYC and BCL2 rearrangements are rare entities with an aggressive clinical course and low overall survival. They usually develop de novo and frequently show a morphologic and immunophenotypic overlap with Burkitt lymphoma (BL) and diffuse large B-cell lymphoma (DLBCL).1 2 The WHO Classification of Tumours of Haematopoietic and Lymphoid Tissue has therefore placed these lymphomas in a provisional category of B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and BL, awaiting further insight into disease course and prognosis.2 We describe the first case of double-hit lymphoma that revealed morphologic and immunophenotypic features of both DLBCL and precursor B-lymphoblastic lymphoma (B-ALL), further highlighting the dilemma in diagnosis and treatment of DHL because of its broad morphologic and immunophenotypic spectrum.

Case report

A 43-year-old male came to medical attention because of a cough, sore throat, dysphagia and a 20-pound weight loss. Endoscopy revealed a friable mass involving the right epiglottic fold and extending into the false cord. Histologic sections revealed a varied morphology with areas consistent with DLBCL composed of sheets of large pleomorphic cells with mature chromatin and a single prominent nucleolus and other areas more reminiscent of precursor lymphoblastic lymphoma or BL showing monotonous medium-sized cells with fine chromatin (figure 1A–C). In some areas …

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  • Competing interests None declared.

  • Ethics approval IRB of Washington University Medical School in St. Louis, MO, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.