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Int J Clin Exp Pathol 2013;6(4):788-794

Case Report
Double-hit and triple-hit lymphomas arising from follicular lymphoma following
acquisition of MYC: report of two cases and literature review

Xiaoxiao Xu, Le Zhang, Yafei Wang, Qing Zhang, Lianyu Zhang, Baocun Sun, Yizhuo Zhang

Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, Tianjin key laboratory of cancer prevention and therapy,
Tianjin 300060, PR China; Department of pathology, Tianjin Cancer Hospital and Institute, Tianjin Medical University, Tianjin key laboratory of
cancer prevention and therapy, Tianjin 300060, PR China

Received January 31, 2013; Accepted February 16, 2013; Epub March 15, 2013; Published April 1, 2013

Abstract: Double-hit or triple-hit B-cell lymphomas (DHL and THL) are rare subtype lymphomas usually associated with poor prognosis. It is
defined by two or three recurrent chromosome translocations; MYC/8q24 loci, usually in combination with the t (14; 18) (q32; q21) bcl-2 gene
or/and BCL6/3q27 chromosomal translocation. DHL was often observed both in de-novo diffuse large B cell lymphomas (DLBCL). It is
otherwise unclassifiable, showing features intermediate that of large B-cell lymphoma and Burkitt lymphoma. Here, we present two follicular
lymphoma patients; one transformed to THL, another transformed to DHL. Both cases revealed aggressive clinical courses with poor
prognosis and associated with acquisition of c-Myc gene (MYC) and central nervous system (CNS) involvement. We reviewed the related
literature, correlated the immunophenotype and clinical manifestations such as response to therapy and prognosis. Although the incidence of
DHT and THL is low, cytogenetic and FISH analyses should be included when B-cell lymphoma patients experience relapse or refractory
course of disease. We concluded that c-Myc may contribute to aggressive transformation, and more mechanism-based therapy should be
explored. (IJCEP1301063).

Keywords: Double hit, follicular lymphoma, MYC, BCL2, BCL6, cases report

Address correspondence to: Dr. Yizhuo Zhang, Department of hematology, Tianjin Cancer Hospital and Institute, Tianjin Medical University,
Tianjin 300060, PR China. Phone: +86 22 23340123x1029; Fax: +86 22 23537196; E-mail: yizhuozhang@yahoo.com