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Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma

Double expressor lymphoma (DEL), defined as overexpression of BCL2 and MYC, is an aggressive subtype of diffuse large B cell lymphoma (DLBCL). Here we report a case of a 64-year-old female diagnosed with abdominal DEL transformed from jejunum follicular lymphoma (FL). 18F-fluorodeoxyglucose (FDG)-po...

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Autores principales: Takada, Ryutaro, Watanabe, Tomohiro, Sekai, Ikue, Yoshikawa, Keisuke, Hara, Akane, Otsuka, Yasuo, Yoshikawa, Tomoe, Kamata, Ken, Minaga, Kosuke, Komeda, Yoriaki, Chikugo, Takaaki, Arai, Yasuyuki, Yamashita, Kohei, Kudo, Masatoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187768/
https://www.ncbi.nlm.nih.gov/pubmed/34123811
http://dx.doi.org/10.3389/fonc.2021.656219
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author Takada, Ryutaro
Watanabe, Tomohiro
Sekai, Ikue
Yoshikawa, Keisuke
Hara, Akane
Otsuka, Yasuo
Yoshikawa, Tomoe
Kamata, Ken
Minaga, Kosuke
Komeda, Yoriaki
Chikugo, Takaaki
Arai, Yasuyuki
Yamashita, Kohei
Kudo, Masatoshi
author_facet Takada, Ryutaro
Watanabe, Tomohiro
Sekai, Ikue
Yoshikawa, Keisuke
Hara, Akane
Otsuka, Yasuo
Yoshikawa, Tomoe
Kamata, Ken
Minaga, Kosuke
Komeda, Yoriaki
Chikugo, Takaaki
Arai, Yasuyuki
Yamashita, Kohei
Kudo, Masatoshi
author_sort Takada, Ryutaro
collection PubMed
description Double expressor lymphoma (DEL), defined as overexpression of BCL2 and MYC, is an aggressive subtype of diffuse large B cell lymphoma (DLBCL). Here we report a case of a 64-year-old female diagnosed with abdominal DEL transformed from jejunum follicular lymphoma (FL). 18F-fluorodeoxyglucose (FDG)-positron emission tomography showed diffuse accumulation of FDG into the peritoneum and small bowel wall. Double balloon-assisted enteroscopy revealed whitish submucosal tumors in the proximal jejunum. Aggregation of atypical lymphocytes positive for CD20, CD79a, and BCL2 was seen in the jejunal biopsy samples. These atypical lymphocytes were monoclonal since cell surface expression of Ig light chains was limited to κ chain by flow-cytometry. Thus, immunohistochemical and flowcytometric analyses data were consistent with FL of the jejunum. Neoplastic lymphocytes obtained from ascites were positive for CD10, CD20, CD79a, BCL2, and BCL6. Fluorescence in situ hybridization (FISH) showed formation of BCL2/IgH fusion gene and extra copies of MYC, the former of which is a characteristic chromosomal abnormality of FL. These genetic alterations and protein expression profiles of ascitic fluid cells were consistent with those of DEL transformed from FL. Given that a significant population of patients with indolent FL of the gastrointestinal tract developed into aggressive DLBCL, it is likely that primary FL of the jejunum transformed into the abdominal aggressive DEL in this case. This case is unique in that concurrent occurrence of FL and DEL was confirmed by immunohistochemical and FISH analyses and that abdominal DEL transformed from jejunal FL was highly suspected.
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spelling pubmed-81877682021-06-10 Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma Takada, Ryutaro Watanabe, Tomohiro Sekai, Ikue Yoshikawa, Keisuke Hara, Akane Otsuka, Yasuo Yoshikawa, Tomoe Kamata, Ken Minaga, Kosuke Komeda, Yoriaki Chikugo, Takaaki Arai, Yasuyuki Yamashita, Kohei Kudo, Masatoshi Front Oncol Oncology Double expressor lymphoma (DEL), defined as overexpression of BCL2 and MYC, is an aggressive subtype of diffuse large B cell lymphoma (DLBCL). Here we report a case of a 64-year-old female diagnosed with abdominal DEL transformed from jejunum follicular lymphoma (FL). 18F-fluorodeoxyglucose (FDG)-positron emission tomography showed diffuse accumulation of FDG into the peritoneum and small bowel wall. Double balloon-assisted enteroscopy revealed whitish submucosal tumors in the proximal jejunum. Aggregation of atypical lymphocytes positive for CD20, CD79a, and BCL2 was seen in the jejunal biopsy samples. These atypical lymphocytes were monoclonal since cell surface expression of Ig light chains was limited to κ chain by flow-cytometry. Thus, immunohistochemical and flowcytometric analyses data were consistent with FL of the jejunum. Neoplastic lymphocytes obtained from ascites were positive for CD10, CD20, CD79a, BCL2, and BCL6. Fluorescence in situ hybridization (FISH) showed formation of BCL2/IgH fusion gene and extra copies of MYC, the former of which is a characteristic chromosomal abnormality of FL. These genetic alterations and protein expression profiles of ascitic fluid cells were consistent with those of DEL transformed from FL. Given that a significant population of patients with indolent FL of the gastrointestinal tract developed into aggressive DLBCL, it is likely that primary FL of the jejunum transformed into the abdominal aggressive DEL in this case. This case is unique in that concurrent occurrence of FL and DEL was confirmed by immunohistochemical and FISH analyses and that abdominal DEL transformed from jejunal FL was highly suspected. Frontiers Media S.A. 2021-05-26 /pmc/articles/PMC8187768/ /pubmed/34123811 http://dx.doi.org/10.3389/fonc.2021.656219 Text en Copyright © 2021 Takada, Watanabe, Sekai, Yoshikawa, Hara, Otsuka, Yoshikawa, Kamata, Minaga, Komeda, Chikugo, Arai, Yamashita and Kudo https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Takada, Ryutaro
Watanabe, Tomohiro
Sekai, Ikue
Yoshikawa, Keisuke
Hara, Akane
Otsuka, Yasuo
Yoshikawa, Tomoe
Kamata, Ken
Minaga, Kosuke
Komeda, Yoriaki
Chikugo, Takaaki
Arai, Yasuyuki
Yamashita, Kohei
Kudo, Masatoshi
Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma
title Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma
title_full Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma
title_fullStr Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma
title_full_unstemmed Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma
title_short Case Report: Concurrent Occurrence of Abdominal Double Expressor Lymphoma and Jejunum Follicular Lymphoma
title_sort case report: concurrent occurrence of abdominal double expressor lymphoma and jejunum follicular lymphoma
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187768/
https://www.ncbi.nlm.nih.gov/pubmed/34123811
http://dx.doi.org/10.3389/fonc.2021.656219
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