Double- and triple-hit lymphomas can present with features suggestive of immaturity, including TdT expression, and create diagnostic challenges

Laura Moench, Zohar Sachs, Garth Aasen, Michelle Dolan, Vanessa Dayton, Elizabeth L. Courville

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Double- and triple-hit lymphomas (DHL/THL) are aggressive B-cell neoplasms characterized by translocation of MYC with concurrent BCL2 and/or BCL6 translocation. In this retrospective study from one institution, we report clinicopathologic features of 13 cases (9 DHL/4 THL). The median age was 59 years (range 30–74) and patients included eight females and five males. Presentation included enlarging lymphadenopathy/masses (11 patients) and abnormal peripheral blood findings (2 patients). Features which raised the differential of an immature neoplasm included terminal deoxynucleotidyl transferase positivity (four cases, two THL/two DHL); dim CD45 expression (seven cases), lack of CD20 (two cases), or lack of surface immunoglobulin light chain (three cases) by flow cytometry; and blastoid morphology (two cases). We conclude that expression of TdT in a B-cell lymphoma with mature features or expression of surface light chain in a case otherwise suggestive of B-lymphoblastic leukemia/lymphoma should prompt an expedited evaluation for DHL/THL.

Original languageEnglish (US)
Pages (from-to)2626-2635
Number of pages10
JournalLeukemia and Lymphoma
Volume57
Issue number11
DOIs
StatePublished - Nov 1 2016

Keywords

  • B lymphoblastic leukemia/lymphoma
  • B-cell lymphoma unclassifiable
  • diffuse large B-cell lymphoma
  • double-hit lymphoma
  • triple-hit lymphoma

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