Abstract
Background : Malignant lymphoma with more than two chromosomal translocations including MYC/8q24 is called double-hit lymphoma (DHL), the prognosis of which tends to be very poor. We report herein an autopsy case of relapsed DHL to describe the cytologic features.
Case : A 60-year-old man noticed a left neck mass two years previously. Six months later, fine-needle aspiration cytology of the left cervical lymph node was performed which showed small to large lymphoid cells with markedly irregular nuclei. The cytologic features suggested malignant lymphoma, and a left cervical lymph node biopsy was subsequently performed. The specimens showed diffuse growth of atypical lymphoid cells. Immunohistochemically, the lymphoid cells were positive for CD20, CD10, BCL6, MUM1, and BCL2. EBER was negative, Approximately 50% of cells were positive for Ki-67. Based on these findings, the pathological diagnosis of diffuse large B-cell lymphoma was established. A genetic analysis revealed the gene translocations of MYC/IGH and BCL2/IGH, indicating this particular tumor should be classified as DHL. The patient died of recurrent disease after remission with standard chemotherapy.
Conclusion : DHL with concurrent BCL2/IGH and MYC/IGH has characteristic findings in immunohistochemical and cytological morphology. These features are helpful to select the cases which need genetic analysis.
