Diffuse Large B-Cell Lymphoma/High-Grade B-Cell Lymphoma With BCL2 & MYC rearrangements

Lessons From the Friday Unknowns

Histologic sections show needle-shaped fragments of lymphoma with large areas of necrosis. The neoplasm has a diffuse pattern and a prominent starry sky appearance. The neoplastic cells are intermediate-size and there are many apoptotic cells. Residual breast ducts are also present surrounded by the neoplasm.

The neoplastic cells are reported to be positive for CD10, CD20, CD45, BCL–2 (strong) and MYC (strong), and are negative for CD5, CD21, CD34, MUM1/IRF4 and TdT.

The antibody specific for Ki-67 shows a proliferation rate of approximately 95%.

FISH analysis showed evidence of MYC, BCL2 and BCL6 rearrangements.

In summary, these morphologic findings combined with the immunohistochemical and FISH studies support the diagnosis of DLBCL/high–grade B–cell lymphoma with MYC & BCL2 rearrangements (former triple hit lymphoma).

Link to digital slides: bit.ly/3oFkQqh | Case 3