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Sequential Development of Histiocytic Sarcoma and Diffuse Large B-cell Lymphoma in a Patient With a Remote History of Follicular Lymphoma With Genotypic Evidence of a Clonal Relationship: A Divergent (Bilineal) Neoplastic Transformation of an Indolent B-cell Lymphoma in a Single Individual.
MedLine Citation:
PMID:  21317718     Owner:  NLM     Status:  In-Data-Review    
Follicular lymphoma (FL) often transforms to diffuse large B-cell lymphoma (DLBCL) during its protracted clinical course. Rarely, histiocytic sarcoma (HS) occurs secondary to or concurrent with FL, although the biological relationship between these 2 morphologically and immunophenotypically distinct entities in the same individual has not been well characterized. We report a unique case showing the sequential occurrence of first, HS and then DLBCL in a patient with a remote history of FL. In this case, HS developed 17 years after the diagnosis of FL and was shown to partly retain the immunophenotypic features characteristic of FL, while showing the morphologic and immunophenotypic profiles diagnostic of HS. DLBCL occurred 18.5 years after FL. Both HS and DLBCL harbored the IGH/BCL2 fusion gene, a hallmark of FL, per interphase fluorescence in situ hybridization analysis. Immunoglobulin gene rearrangement studies showed a clonal rearrangement of the IGH gene in both HS and DLBCL with identical amplicons, suggesting a shared origin of the neoplastic clones. These data support the hypothesis of transdifferentiation or transevolution in a mature B-cell neoplasm, and, in addition, suggest the possibility of a divergent (bilineal) neoplastic transformation of FL in a single individual.
Endi Wang; John Papalas; Charles Blake Hutchinson; Evan Kulbacki; Qin Huang; Siby Sebastian; Catherine Rehder; Damian Silbermins; Joseph Moore; Michael Datto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The American journal of surgical pathology     Volume:  35     ISSN:  1532-0979     ISO Abbreviation:  Am. J. Surg. Pathol.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7707904     Medline TA:  Am J Surg Pathol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  457-63     Citation Subset:  IM    
*Department of Pathology ‡Division of Hematology/Oncology, Department of Medicine, Duke University Medical Center, Durham, NC †Department of Pathology, City of Hope National Medical Center, Duarte, CA.
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