Cytopathology of “double‐hit” non‐Hodgkin lymphoma

Abstract

BACKGROUND:B‐cell lymphomas with concurrent IGH‐BCL2 and c‐MYC rearrangements (so‐called “double‐hit lymphomas” [DHL]) are a relatively rare, recently described category in the 2008 World Health Organization classification of hematopoietic neoplasms. Response to chemotherapy and survival are poor.METHODS:The authors reviewed files of cytogenetically documented DHL to identify cytologic features that would allow its possible recognition.RESULTS:Twelve fine‐needle aspirates (FNAs), 2 pleural fluids, and 1 touch imprint of cytogenetically proven DHL were uncovered. Primary DHL was correctly recognized in 3 of 12 FNA cases using Ki‐67 staining coupled with a positive bcl‐2 result as the basis for performing fluorescence in situ hybridization (FISH) analysis of c‐MYC and IGH‐BCL2 rearrangements. Remaining FNAs and non‐FNA cases were diagnosed as non‐Hodgkin lymphoma, B‐cell lymphoma, or atypical lymphocytosis. Ten cases had cell block material available. All cases had high cellularity with a dissociated smear pattern and background lymphoglandular bodies. Cell size ranged from intermediate to large. Nuclei were predominantly rounded or slightly irregular in contour; 4 FNAs had markedly cleaved nuclei. Some nuclei harbored discrete but small nucleoli, whereas in others coarse chromatin and indistinct or multiple small nucleoli existed. A variable number of mitotic figures, tingible body macrophages, and background apoptotic cells were also present.CONCLUSIONS:No specific cytomorphologic feature(s) were found to reliably identify DHL using FNA or exfoliative cytology. A high Ki‐67 proliferation index and positive bcl‐2 staining (on cytospin slides or cell block material) of cases not conforming to typical Burkitt lymphoma morphology should prompt FISH analysis for c‐MYC and/or IGH‐BCL2 rearrangements to identify DHL, particularly if tissue biopsy is not expected. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society

Lymph Node Fine-Needle Cytology: Beyond Flow Cytometry

“…Commercially available probes cover almost all the variable breakpoints of chromosomal alterations; as for their clinical applications, they are selected on the basis of initial clinical, (cyto)morphological and immunophenotypical data. FISH can be performed on tissues and any cytological sample, including LN FNC, where it is generally used after FNC/FC [3,5,9,10,11,12,13,14,15,16,17,18,20,21,22,23,24]. FISH on interphase nuclei is generally performed using fusion-signal FISH probes, which consist of two fluoresceinated probes that hybridize two regions proximal to the breakpoint of the chromosomes involved in a supposedly reciprocal translocation [3,5,10,12,13,14,16,17,18,20,21,22,23,24].…”

A Case of Advanced Primary Thyroid Double-Hit B Cell Lymphoma in Which Complete Remission has been Maintained After High-Dose Chemotherapy and Autologous Peripheral Blood Stem Cell Transplantation Performed During the Second Remission, with a Review of the Literature

“…As shown in Table 2, to the best of our knowledge, there have been only 3 reported cases of BCL-2 and C-MYC DHL of the thyroid gland, including the present case [8,9]. All 3 patients were women in their fifties.…”

“…According to a report by Tomita et al, DHL has an extremely poor prognosis, with a median survival time of approximately 6 months and 1-year survival rate of 22 % [7]. In the majority of cases, it is at an advanced stage at diagnosis, with bone marrow and central nervous system infiltration, with some reports suggesting that these patients have elevated serum LDH levels and are resistant to chemotherapy [8], and others suggesting a poor prognosis [9,24].…”

“…Double-hit lymphoma DLBCL of the thyroid gland is extremely rare and has been reported only in 3 patients, including the patient reported herein [8,9] and its precise prognosis is unknown. Local irradiation and total body irradiation (TBI) have been reported to be effective for DHL [10,11]; in our present case also, relapse did not Fig.…”

Efficacy of Fine Needle Aspiration Cytology in Diagnosis of Salivary Gland Tumors

“…Because of particular histology of lymphomas and the complexity of their classification the final diagnosis of these cases remains histological [21]. However, fine-needle aspiration cytology can be use for the initial assessment and management of these patients [22][23][24].…”