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Updated: Jul 3, 2026

VDJ-Seq: Deep Sequencing Analysis of Rearranged Immunoglobulin Heavy Chain Gene to Reveal Clonal Evolution Patterns of B Cell Lymphoma
Published on: December 28, 2015
Discrepancy of Hans' criteria for clonally related nodal and pericardiac fluid diffuse large B-cell lymphoma with
Toshiki Terao1,2, Yumiko Sato3, Yoshiaki Kuroda4
1Department of Hematology, NHO Iwakuni Clinical Center, Iwakuni, Japan.
Insights
This case study identifies two distinct large B-cell lymphomas in a patient, one in the pericardial fluid and another in a lymph node. Genetic analysis revealed a clonal relationship and a shared MYD88 mutation, suggesting a common origin despite differing cell-of-origin classifications.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Large B-cell lymphoma (LBCL) is a heterogeneous group of lymphoid malignancies.
- Accurate cell-of-origin classification is crucial for prognosis and treatment selection.
- Discrepancies in classification can arise from different diagnostic criteria.
Abstract:
A 79-year-old Japanese woman presented with exertional dyspnea. She had cardiac tamponade and urgent pericardial drainage was performed. Pathological findings from the pericardial fluid revealed non-germinal center B-cell (non-GCB) pericardial large B-cell lymphoma (CD10-, BCL6+, and MUM1+). Although a diagnosis of fluid overload-associated large B-cell lymphoma was considered, GCB nodal diffuse large B-cell lymphoma (CD10+, BCL6+, and MUM1+) was discovered through needle biopsy of the enlarged left axillary lymph node. Despite the two lymphomas exhibiting different expression levels of CD10, polymerase chain reaction assessing IgH gene rearrangement suggested a clonal relationship between them. Additionally, MYD88 L265P mutation was confirmed using Sanger sequencing in both samples, suggesting the MCD type. Our case highlights a discrepancy between the Hans' criteria and the gene expression profile-based cell of origin.
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