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Updated: Jun 11, 2026
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Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma
Published on: January 9, 2019
A "Double-Hit" Lymphoma With Plasmablastic Features and Aberrant Keratin Expression Likely Transforming From
Adam Lyle1, Jay L Patel1, Girish Venkataraman2
1ARUP Laboratories and Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA.
International Journal of Surgical Pathology
|June 10, 2026
Summary
This study details a rare double-hit lymphoma with plasmablastic features, originating from follicular lymphoma. Aberrant keratin expression in the transformed component created a diagnostic challenge, highlighting the need for comprehensive work-up.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Large B-cell lymphomas (LBCLs) present diverse morphologies, including diffuse large B-cell lymphoma (DLBCL) and Burkitt lymphoma.
- High-grade B-cell lymphoma (HGBL) encompasses intermediate/blastoid morphologies.
- Double-hit lymphomas (DHLs) involve rearrangements of *MYC* and *BCL2*, typically seen in HGBL or DLBCL, but rarely in plasmablastic lymphomas.
Purpose of the Study:
- To report a rare case of double-hit lymphoma with plasmablastic features.
- To describe the diagnostic challenges posed by aberrant keratin expression in a transformed follicular lymphoma.
- To emphasize the importance of integrated diagnostic approaches in complex hematologic malignancies.
Main Methods:
- Case report analysis.
- Immunohistochemistry for cellular markers and keratin.
- Molecular studies for gene rearrangements (*MYC*, *BCL2*).
- Review of clinical history, including prior follicular lymphoma diagnosis.
Main Results:
- A rare double-hit lymphoma with plasmablastic morphology was identified.
- The tumor exhibited aberrant keratin expression, mimicking other malignancies.
- The patient had a history of follicular lymphoma with transformation.
Conclusions:
- This case illustrates a diagnostic pitfall in classifying lymphomas with mixed features.
- Integrated immunohistochemistry, molecular analysis, and clinical history are crucial for accurate diagnosis.
- Recognition of aberrant keratin expression is key in diagnosing DHL with plasmablastic features.
