Cytopathology of “double-hit” non-Hodgkin lymphoma

Authors

  • Camille T. Elkins MD,

    1. Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
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  • Paul E. Wakely Jr MD

    Corresponding author
    1. Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio
    • Department of Pathology, The Ohio State University College of Medicine, 414 Doan Hall/410 West 10th Ave, Columbus, OH 43210
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    • Fax: (614) 293-7626


Abstract

BACKGROUND:

B-cell lymphomas with concurrent IGH-BCL2 and c-MYC rearrangements (so-called “double-hit lymphomas” [DHL]) are a relatively rare, recently described category in the 2008 World Health Organization classification of hematopoietic neoplasms. Response to chemotherapy and survival are poor.

METHODS:

The authors reviewed files of cytogenetically documented DHL to identify cytologic features that would allow its possible recognition.

RESULTS:

Twelve fine-needle aspirates (FNAs), 2 pleural fluids, and 1 touch imprint of cytogenetically proven DHL were uncovered. Primary DHL was correctly recognized in 3 of 12 FNA cases using Ki-67 staining coupled with a positive bcl-2 result as the basis for performing fluorescence in situ hybridization (FISH) analysis of c-MYC and IGH-BCL2 rearrangements. Remaining FNAs and non-FNA cases were diagnosed as non-Hodgkin lymphoma, B-cell lymphoma, or atypical lymphocytosis. Ten cases had cell block material available. All cases had high cellularity with a dissociated smear pattern and background lymphoglandular bodies. Cell size ranged from intermediate to large. Nuclei were predominantly rounded or slightly irregular in contour; 4 FNAs had markedly cleaved nuclei. Some nuclei harbored discrete but small nucleoli, whereas in others coarse chromatin and indistinct or multiple small nucleoli existed. A variable number of mitotic figures, tingible body macrophages, and background apoptotic cells were also present.

CONCLUSIONS:

No specific cytomorphologic feature(s) were found to reliably identify DHL using FNA or exfoliative cytology. A high Ki-67 proliferation index and positive bcl-2 staining (on cytospin slides or cell block material) of cases not conforming to typical Burkitt lymphoma morphology should prompt FISH analysis for c-MYC and/or IGH-BCL2 rearrangements to identify DHL, particularly if tissue biopsy is not expected. Cancer (Cancer Cytopathol) 2011;. © 2011 American Cancer Society

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