Transformation of Follicular Lymphoma to Double Hit B-cell Lymphoma Causing Hypercalcemia in a 69-year-old Female: a Case Report and Review of the Literature

Overview

Journal Case Rep Hematol

Publisher Wiley

Specialty Hematology

Date 2014 Aug 28

PMID 25161781

Citations 3

Authors

Sakshi Kapur

Miles B Levin

Affiliations

Soon will be listed here.

Abstract

Double hit B-cell lymphomas are rare tumors that are defined by a chromosomal breakpoint affecting the MYC/8q24 locus in combination with another recurrent breakpoint, mainly a t(14;18)(q32;q21) involving BCL2. These tumors mostly occur in adults and carry a very poor prognosis. Double hit lymphomas can occur de novo, or arise from transformation of follicular lymphoma. We report a case of a 69-year-old female with abdominal distention and progressively worsening weakness over six months. Patient presented with severe hypercalcemia and multiple intra-abdominal/pelvic masses. Histopathology results of the abdominal mass were compatible with a double hit B-cell lymphoma. However, bone marrow biopsy results showed a low grade follicular lymphoma, thus suggesting peripheral transformation of follicular lymphoma to double hit B-cell lymphoma. Patient was transferred to a tertiary care center and was started on combination chemotherapy (EPOCH: doxorubicin, etoposide, vincristine, cyclophosphamide, and prednisone). Our paper highlights not only transformation of follicular lymphoma to double hit B-cell lymphoma and the challenges encountered in diagnosing and treating these aggressive tumors, but also the association of new onset/worsening hypercalcemia in such patients.

Citing Articles

High-grade B-cell Lymphoma with and Rearrangement Arising from Follicular Lymphoma: Presentation as a Large Peripancreatic Mass.

Shestakova A, Rezk S, Ghasemizadeh D, Nael A, Zhao X Diagnostics (Basel). 2020; 10(3).

PMID: 32183313 PMC: 7151221. DOI: 10.3390/diagnostics10030157.

Hypercalcemia in T-Cell/Histiocyte-Rich Large B-Cell Lymphoma: An Unusual Presentation of a Rare Disease and Literature Review.

Conte G, Harmon J, Le M, Sun X, Schuler J, Levitt M World J Oncol. 2020; 10(6):231-236.

PMID: 31921379 PMC: 6940034. DOI: 10.14740/wjon1246.

Primary Bone Marrow B-Cell Lymphoma Undetected by Multiple Imaging Modalities That Initially Presented with Hypercalcemia.

Yoo J, Kim J, Kwon H, Lim J Case Rep Endocrinol. 2018; 2018:7676580.

PMID: 30147967 PMC: 6083738. DOI: 10.1155/2018/7676580.

References

Perry A, Crockett D, Dave B, Althof P, Winkler L, Smith L . B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and burkitt lymphoma: study of 39 cases. Br J Haematol. 2013; 162(1):40-9. DOI: 10.1111/bjh.12343. View

Ratcliffe W, Hutchesson A, Bundred N, Ratcliffe J . Role of assays for parathyroid-hormone-related protein in investigation of hypercalcaemia. Lancet. 1992; 339(8786):164-7. DOI: 10.1016/0140-6736(92)90220-w. View

Bastion Y, Sebban C, Berger F, Felman P, Salles G, Dumontet C . Incidence, predictive factors, and outcome of lymphoma transformation in follicular lymphoma patients. J Clin Oncol. 1997; 15(4):1587-94. DOI: 10.1200/JCO.1997.15.4.1587. View

Montoto S, Davies A, Matthews J, Calaminici M, Norton A, Amess J . Risk and clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma. J Clin Oncol. 2007; 25(17):2426-33. DOI: 10.1200/JCO.2006.09.3260. View

Seymour J, Gagel R . Calcitriol: the major humoral mediator of hypercalcemia in Hodgkin's disease and non-Hodgkin's lymphomas. Blood. 1993; 82(5):1383-94. View

Aukema S, Siebert R, Schuuring E, van Imhoff G, Kluin-Nelemans H, Boerma E . Double-hit B-cell lymphomas. Blood. 2010; 117(8):2319-31. DOI: 10.1182/blood-2010-09-297879. View

Song Y, Tan Y, Yuan Y, Guo W, Pan Z, Bai O . Current perspectives in genetics of "double-hit" lymphoma with possible clinical implications. Cell Biochem Biophys. 2013; 69(2):203-8. DOI: 10.1007/s12013-013-9790-6. View

HICKS E, Rappaport H, WINTER W . Follicular lymphoma; a re-evaluation of its position in the scheme of malignant lymphoma, based on a survey of 253 cases. Cancer. 1956; 9(4):792-821. DOI: 10.1002/1097-0142(195607/08)9:4<792::aid-cncr2820090429>3.0.co;2-b. View

Parker S, Olteanu H, vanTuinen P, Lawton C, Schultz C, Christians K . Follicular lymphoma transformation to dual translocated Burkitt-like lymphoma: improved disease control associated with radiation therapy. Int J Hematol. 2009; 90(5):616-622. DOI: 10.1007/s12185-009-0444-9. View

10.

Oviatt D, Cousar J, Collins R, FLEXNER J, Stein R . Malignant lymphomas of follicular center cell origin in humans. V. Incidence, clinical features, and prognostic implications of transformation of small cleaved cell nodular lymphoma. Cancer. 1984; 53(5):1109-14. DOI: 10.1002/1097-0142(19840301)53:5<1109::aid-cncr2820530516>3.0.co;2-o. View

11.

Gine E, Montoto S, Bosch F, Arenillas L, Mercadal S, Villamor N . The Follicular Lymphoma International Prognostic Index (FLIPI) and the histological subtype are the most important factors to predict histological transformation in follicular lymphoma. Ann Oncol. 2006; 17(10):1539-45. DOI: 10.1093/annonc/mdl162. View

12.

Munoz J, Vekaria M, Hanbali A, Janakiraman N . Progression of double-hit lymphoma in the midst of R-hyper CVAD. Am J Hematol. 2012; 88(1):87-8. DOI: 10.1002/ajh.23206. View

13.

Stewart A . Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005; 352(4):373-9. DOI: 10.1056/NEJMcp042806. View

14.

Xu X, Zhang L, Wang Y, Zhang Q, Zhang L, Sun B . Double-hit and triple-hit lymphomas arising from follicular lymphoma following acquisition of MYC: report of two cases and literature review. Int J Clin Exp Pathol. 2013; 6(4):788-94. PMC: 3606871. View

15.

Yuen A, Kamel O, Halpern J, Horning S . Long-term survival after histologic transformation of low-grade follicular lymphoma. J Clin Oncol. 1995; 13(7):1726-33. DOI: 10.1200/JCO.1995.13.7.1726. View

16.

Kaminski M, Zelenetz A, Press O, Saleh M, Leonard J, Fehrenbacher L . Pivotal study of iodine I 131 tositumomab for chemotherapy-refractory low-grade or transformed low-grade B-cell non-Hodgkin's lymphomas. J Clin Oncol. 2001; 19(19):3918-28. DOI: 10.1200/JCO.2001.19.19.3918. View

17.

Magro C, Wang X, Subramaniyam S, Darras N, Mathew S . Cutaneous double-hit B-cell lymphoma: an aggressive form of B-cell lymphoma with a propensity for cutaneous dissemination. Am J Dermatopathol. 2013; 36(4):303-10. DOI: 10.1097/DAD.0b013e31829beaa7. View

18.

Luo D, Liu Y, Zhang F, Xu F, Yan L, Chen J . [B-cell lymphomas with concurrent myc and bcl-2/IgH or bcl-6 translocations]. Zhonghua Bing Li Xue Za Zhi. 2013; 42(9):584-8. View

19.

Schouten H, Bierman P, Vaughan W, Kessinger A, Vose J, Weisenburger D . Autologous bone marrow transplantation in follicular non-Hodgkin's lymphoma before and after histologic transformation. Blood. 1989; 74(7):2579-84. View

20.

Al-Tourah A, Gill K, Chhanabhai M, Hoskins P, Klasa R, Savage K . Population-based analysis of incidence and outcome of transformed non-Hodgkin's lymphoma. J Clin Oncol. 2008; 26(32):5165-9. DOI: 10.1200/JCO.2008.16.0283. View