Circulating lymphoma cells of double-hit lymphoma

Description

A Caucasian man aged 65 years presented with generalised weakness, 20 pounds weight loss and occult gastrointestinal (GI) bleeding. Laboratory findings revealed pancytopenia with WCC of 2500/mm³, haemoglobin of 7.4 g/dL and platelets of 86 000/mm³. Peripheral smear revealed characteristic immature lymphoid cells (figure 1A). Flow cytometry of peripheral blood confirmed the presence of abnormal monoclonal B-cells representing lymphoma cells. Full-body CT scan showed bilateral pleural effusions, splenomegaly, kidney lesions and presacral mass. Upper GI endoscopy revealed gastric ulcers. Bone marrow biopsy established the diagnosis of B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma (BCLU) (figures 1B, C and 2B). Biopsy of gastric ulcers (figure 1D), presacral mass and pleural fluid cytology showed the presence of lymphoma. Immunohistochemical stains showed the tumour cells to be positive for CD10 and CD20, while tumour cells were negative for...

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