Transformation of follicular lymphoma to precursor B-cell lymphoblastic lymphoma with c-myc gene rearrangement as a critical event

Am J Clin Pathol. 2008 Jan;129(1):157-66. doi: 10.1309/NKK3FEX2BE5L7EKB.

Abstract

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.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural

MeSH terms

  • Cell Transformation, Neoplastic / genetics*
  • Chromosome Breakage
  • Clone Cells
  • DNA, Neoplasm / analysis
  • Disease Progression
  • Fatal Outcome
  • Female
  • Gene Rearrangement*
  • Genes, bcl-2
  • Genes, myc*
  • Humans
  • Immunoglobulin Heavy Chains / genetics
  • In Situ Hybridization, Fluorescence
  • Lymphoma, B-Cell / genetics*
  • Lymphoma, B-Cell / pathology
  • Lymphoma, Follicular / genetics*
  • Lymphoma, Follicular / pathology
  • Middle Aged
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / genetics*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / pathology
  • Sequence Analysis, DNA
  • Translocation, Genetic

Substances

  • DNA, Neoplasm
  • Immunoglobulin Heavy Chains