BackgroundDouble-hit lymphomas (DHL) are rare high-grade neoplasms characterized by two translocations: one involving the gene MYC and another involving genes BCL2 or BCL6, whose diagnosis depends on cytogenetic examination. This research studied DHL and morphological and/or immunophenotypic factors associated with the detection of these translocations in a group of high-grade non-Hodgkin lymphoma cases.MethodClinical and morphological reviews of 120 cases diagnosed with diffuse large B-cell lymphoma and Burkitt lymphoma were conducted. Immunohistochemistry (CD20, CD79a, PAX5, CD10, Bcl6, Bcl2, MUM1, TDT and Myc) and fluorescence in situ hybridization for detection of MYC, BCL2 and BCL6 gene translocations were performed in a tissue microarray platform.ResultsThree cases of DHL were detected: two with translocations of MYC and BCL2 and one with translocations of MYC and BCL6, all leading to death in less than six months. Among 90 cytogenetically evaluable biopsies, associations were determined between immunohistochemistry and fluorescence in situ hybridization for MYC (p = 0.036) and BCL2 (p = 0.001). However, these showed only regular agreement, indicated by Kappa values of 0.23 [0.0;0.49] and 0.35 [0.13;0.56], respectively. “Starry sky” morphology was strongly associated with MYC positivity (p = 0.01). The detection of three cases of DHL, all resulting in death, confirms the rarity and aggressiveness of this neoplasm.ConclusionsThe “starry sky” morphological pattern and immunohistochemical expression of Myc and Bcl2 represent possible selection factors for additional cytogenetic diagnostic testing.

No abstract

Hypereosinophilic Syndrome (HES) is a condition related to helminthiasis, allergies, vasculitis, adverse reactions to drugs or malignant neoplasms. We report a case of a boy, 7 years old, presenting abdominal pain, vomiting, tachidispnea and leukocytosis with predominance of eosinophils. Bone marrow biopsy revealed intense granulocytic hypercellularity characterized by eosinophilia, as well as immature lymphoid cells in the interstitium, associated with trabecular bone infiltration. The immunohistochemical study revealed positivity for CD79a and TDT. Peripheral blood flow cytometry demonstrated 6.5% of lymphoid blasts. The diagnosis was Lymphoproliferative Disease associated with Hypereosinophilia: Acute Lymphoblastic Leukemia. The association presented is infrequent and its aggressiveness is determined by the physiological limitations imposed by the damages secondary to eosinophilia.