Transformation of follicular lymphoma to high-grade Burkitt?s like lymphoma and acute lymphoblastic leukemia-L3 type
CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2013; 34(02): 136-137
DOI: DOI: 10.4103/0971-5851.116223
Article published online:
20 July 2021
© 2013. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
A 38-year-old lady who presented at our institute in February 2012 with generalized lymphadenopathy was diagnosed as follicular lymphoma (FL) (grade-III, stage-IV) [Figure 1a]. Immuno–histochemically (IHC), the tumor cells showed positivity to BCL 2 [Figure 1b], MIB 60-70% [Figure 1c], CD20 [Figure 1d], CD79α, CD10 and BCL6. Bone marrow biopsy showed marrow involvement. Follow-up computed tomography after 4 cycles of CHOP (Cyclophosphamide, Hydroxydaunorubicin, Oncovin, Prednisolone) showed residual lymphadenopathy and hepato-splenomegaly. Total white blood cell count (TWBC) was 4.8 × 106/L, with 62% lymphoid cells, no blasts. Subsequent lymph node biopsy showed features of high grade diffuse large B cell lymphpma (DLBCL, Burkitt's like) [Figure 2a]. IHC showed positivity to CD20, CD79α, BCl2 [Figure 2b], MIB 80% [Figure 2c], CD10 [Figure 2d] and BCL6, and negative to terminal deoxynucleotidyl transferase, CD99 and Cyclin-D1. Bone marrow showed residual disease with few blasts. Assessment after 2 more cycles (August 2012) showed persistent lymphadenopathy, TWBC: 7 × 106/L with 10% L3 type blasts [Figure 3d], bone marrow aspiration: 80% L3 type blasts [Figure 3b], bone marrow biopsy showed sheets of blasts [Figure [Figure3a3a and andc].c]. Flow-cytometry: Positive for CD5, CD20, CD21, CD33, FMC7, Kappa. CD23 was negative. The patient showed transformation of FL to high-grade DLBCL and acute lymphoblastic leukemia of L3 type.