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Tumor Engraftment in a Xenograft Mouse Model of Human Mantle Cell Lymphoma
Published on: March 30, 2018
An Uncommon Case of Double-Hit Mantle Cell Lymphoma That Demonstrates a Transformation Process
Jihao Zhou1, Lina Hu1, Min Zuo2
1Department of Hematology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen, China.
Insights
This study reports a rare case of mantle cell lymphoma (MCL) with double-hit rearrangements (CCND1/IGH and MYC/IGH). These genetic alterations likely drove the aggressive progression and transformation of MCL in this patient.
Area of Science:
- Hematology
- Oncology
- Genetics
Background:
- Mantle cell lymphoma (MCL) is a mature B-cell neoplasm typically defined by the CCND1/IGH rearrangement.
- Aggressive clinical courses in MCL can be associated with complex genetic alterations.
Observation:
- A case of blastoid variant MCL was identified in gallbladder and bone marrow biopsies.
- Flow cytometry revealed two distinct malignant lymphocyte populations.
Findings:
- Fluorescence in situ hybridization (FISH) confirmed CCND1/IGH and MYC/IGH rearrangements in bone marrow samples.
- Next-generation sequencing (NGS) detected CCND1/IGH rearrangements and TP53 mutations in both lymphocyte populations.
- The CD19+/CD10+ cells additionally harbored MYC/IGH rearrangement and a NOTCH2 mutation.
Implications:
- The concurrent MYC rearrangement and NOTCH2 mutation are implicated in the transformation of MCL.
- This case highlights an uncommon double-hit MCL, illustrating a potential pathway for disease transformation.
Objectives:
Mantle cell lymphoma (MCL) is a mature B-cell lymphoma characterized by CCND1/IGH rearrangement. We reported a case of MCL harboring both CCND1/IGH and MYC/IGH rearrangements that also presented with an aggressive clinical course.
Methods:
Biopsy specimens were evaluated by morphological staining, immunohistochemistry, flow cytometry, conventional cytogenetics, fluorescence in situ hybridization (FISH), and next-generation sequencing (NGS).
Results:
Morphological and immunohistochemical staining of gallbladder samples demonstrated blastoid variant MCL. However, in the bone marrow sample, FISH indicated rearrangements in CCND1/IGH and MYC/IGH. Flow cytometry identified two groups of malignant lymphocytes. We sorted these two groups of cells. NGS then revealed that both cell types carried CCND1/IGH rearrangements and TP53 mutations. Furthermore, the CD19+/CD10+ cells carried additional MYC/IGH rearrangement and NOTCH2 mutation.
Conclusions:
The rearrangement of MYC and a mutation in NOTCH2 probably induced the transformation of MCL cells in this patient. This uncommon double-hit MCL case clearly demonstrates a transformation process.
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