Double- and triple-hit lymphomas can present with features suggestive of immaturity, including TdT expression, and create diagnostic challenges

References

• Kluin PM, Harris NL, Stein H, et al. B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW, editors. WHO classification of tumours of haematopoietic and lytmphoid tissues. Lyon: IARC; 2008. p. 265–266.
   Google Scholar
• Snuderl M, Kolman OK, Chen YB, et al. B-cell lymphomas with concurrent IGH-BCL2 and MYC rearrangements are aggressive neoplasms with clinical and pathologic features distinct from Burkitt lymphoma and diffuse large B-cell lymphoma. Am J Surg Pathol. 2010;34:327–340.
   PubMed Web of Science ®Google Scholar
• Johnson NA, Savage KJ, Ludkovski O, et al. Lymphomas with concurrent BCL2 and MYC translocations: the critical factors associated with survival. Blood 2009;114:2273–2279.
   PubMed Web of Science ®Google Scholar
• De Jong D, Voetdijk BM, Beverstock GC, et al. Activation of the c-myc oncogene in a precursor-B-cell blast crisis of follicular lymphoma, presenting as composite lymphoma. N Engl J Med. 1988;318:1373–1378.
   PubMed Web of Science ®Google Scholar
• Geyer JT, Subramaniyam S, Jiang Y, et al. Lymphoblastic transformation of follicular lymphoma: a clinicopathologic and molecular analysis of 7 patients. Hum Pathol. 2015;46:260–271.
   PubMed Web of Science ®Google Scholar
• Young KH, Xie Q, Zhou G, et al. Transformation of follicular lymphoma to precursor B-cell lymphoblastic lymphoma with c-myc gene rearrangement as a critical event. Am J Clin Pathol. 2008;129:157–166.
   PubMed Web of Science ®Google Scholar
• Fiedler W, Weh HJ, Zeller W, et al. Translocation (14; 18) and (8; 22) in three patients with acute leukemia/lymphoma following centrocytic/centroblastic non-Hodgkin’s lymphoma. Ann Hematol. 1991;63:282–287.
   PubMed Web of Science ®Google Scholar
• Karsan A, Gascoyne RD, Coupland RW, et al. Combination of t(14;18) and a Burkitt’s type translocation in B-cell malignancies. Leuk Lymphoma. 1993;10:433–441.
   PubMed Web of Science ®Google Scholar
• D’Achille P, Seymour JF, Campbell LJ. Translocation (14;18)(q32;q21) in acute lymphoblastic leukemia: a study of 12 cases and review of the literature. Cancer Genet Cytogenet. 2006;171:52–56.
   PubMed Web of Science ®Google Scholar
• Subramaniyam S, Fraser CR, Rao PH, et al. De novo B lymphoblastic leukemia/lymphoma in an adult with t(14;18)(q32;q21) and c-MYC gene rearrangement involving 10p13. Leuk Lymphoma. 2011;52:2195–2199.
   PubMed Web of Science ®Google Scholar
• Petrich AM, Nabhan C, Smith SM. MYC-associated and double-hit lymphomas: A review of pathobiology, prognosis, and therapeutic approaches. Cancer 2014;.
   PubMed Web of Science ®Google Scholar
• Aukema SM, Siebert R, Schuuring E, et al. Double-hit B-cell lymphomas. Blood 2011;117:2319–2331.
   PubMed Web of Science ®Google Scholar
• Pillai RK, Sathanoori M, Van Oss SB, et al. Double-hit B-cell lymphomas with BCL6 and MYC translocations are aggressive, frequently extranodal lymphomas distinct from BCL2 double-hit B-cell lymphomas. Am J Surg Pathol. 2013;37:323–332.
   PubMed Web of Science ®Google Scholar
• Horn H, Ziepert M, Becher C, et al. MYC status in concert with BCL2 and BCL6 expression predicts outcome in diffuse large B-cell lymphoma. Blood 2013;121:2253–2263.
   PubMed Web of Science ®Google Scholar
• Nakayama S, Yokote T, Iwaki K, et al. Triple-hit B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma associated with a novel complex karyotype including t(2;3)(q21;q27), t(8;14)(q24;q32) and t(14;18)(q32;q21). Br J Haematol. 2013;160:569
   PubMed Web of Science ®Google Scholar
• Chen D, Ketterling RP. A leukemic presentation of a “triple-hit” lymphoma. Blood 2014;123:1126
   PubMed Web of Science ®Google Scholar
• Benz R, Tchinda J. Double hit, triple hit-look for it. Blood 2013;121:2383
   PubMed Web of Science ®Google Scholar
• Wang W, Hu S, Lu X, et al. Triple-hit B-cell lymphoma with MYC, BCL2, and BCL6 translocations/rearrangements: clinicopathologic features of 11 Cases. Am J Surg Pathol. 2015;39:1132–1139.
   PubMed Web of Science ®Google Scholar
• Aukema SM, Kreuz M, Kohler CW, et al. Biological characterization of adult MYC-translocation-positive mature B-cell lymphomas other than molecular Burkitt lymphoma. Haematologica 2014;99:726–735.
   PubMed Web of Science ®Google Scholar
• Motllo C, Grau J, Junca J, et al. Translocation (3;8)(q27;q24) in two cases of triple hit lymphoma. Cancer Genet Cytogenet. 2010;203:328–332.
   PubMedGoogle Scholar
• Xu X, Zhang L, Wang Y, et al. Double-hit and triple-hit lymphomas arising from follicular lymphoma following acquisition of MYC: report of two cases and literature review. Int J Clin Exp Pathol. 2013;6:788–794.
   PubMed Web of Science ®Google Scholar
• So CC, Yung KH, Chu ML, et al. Diagnostic challenges in a case of B cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Int J Hematol. 2013;98:478–482.
   PubMed Web of Science ®Google Scholar
• Barrans S, Crouch S, Smith A, et al. Rearrangement of MYC is associated with poor prognosis in patients with diffuse large B-cell lymphoma treated in the era of rituximab. J Clin Oncol. 2010;28:3360–3365.
   PubMed Web of Science ®Google Scholar
• ISCN 2013: An International System for Human Cytogenetic Nomenclature. S. Karger; 2013.
   Google Scholar
• Wu D, Wood BL, Dorer R, et al. "Double-hit" mature B-cell lymphomas show a common immunophenotype by flow cytometry that includes decreased CD20 expression. Am J Clin Pathol. 2010;134:258–265.
   PubMed Web of Science ®Google Scholar
• Platt MY, DeLelys ME, Preffer FI, et al. Flow cytometry is of limited utility in the early identification of “double-hit” B-cell lymphomas. Cytometry B Clin Cytom. 2013;84:143–148.
   PubMed Web of Science ®Google Scholar
• Harrington AM, Olteanu H, Kroft SH, et al. The unique immunophenotype of double-hit lymphomas. Am J Clin Pathol. 2011;135:649–650.
   PubMed Web of Science ®Google Scholar
• Tomita N, Tokunaka M, Nakamura N, et al. Clinicopathological features of lymphoma/leukemia patients carrying both BCL2 and MYC translocations. Haematologica 2009;94:935–943.
   PubMed Web of Science ®Google Scholar
• Le Gouill S, Talmant P, Touzeau C, et al. The clinical presentation and prognosis of diffuse large B-cell lymphoma with t(14;18) and 8q24/c-MYC rearrangement. Haematologica 2007;92:1335–1342.
   PubMed Web of Science ®Google Scholar
• Turakhia SK, Hill BT, Dufresne SD, et al. Aggressive B-cell lymphomas with translocations involving BCL6 and MYC have distinct clinical-pathologic characteristics. Am J Clin Pathol. 2014;142:339–346.
   PubMed Web of Science ®Google Scholar
• Rashidi A, Fisher SI. Double-hit lymphoma mimicking acute lymphoblastic leukemia at presentation. Eur J Haematol. 2014;.
   Web of Science ®Google Scholar
• Kroft SH, Domiati-Saad R, Finn WG, et al. Precursor B-lymphoblastic transformation of grade I follicle center lymphoma. Am J Clin Pathol. 2000;113:411–418.
   PubMed Web of Science ®Google Scholar
• Thangavelu M, Olopade O, Beckman E, et al. Clinical, morphologic, and cytogenetic characteristics of patients with lymphoid malignancies characterized by both t(14;18)(q32;q21) and t(8;14)(q24;q32) or t(8;22)(q24;q11). Genes Chromosomes Cancer. 1990;2:147–158.
   PubMed Web of Science ®Google Scholar
• Sun X, Gordon LI, Peterson LC. Transformation of follicular lymphoma to acute lymphoblastic leukemia. Arch Pathol Lab Med. 2002;126:997–998.
   PubMed Web of Science ®Google Scholar
• Kaplan A, Samad A, Dolan MM, et al. Follicular lymphoma transformed to “double-hit” B lymphoblastic lymphoma presenting in the peritoneal fluid. Diagn Cytopathol. 2013;41:986–990.
   PubMed Web of Science ®Google Scholar
• Gauwerky CE, Haluska FG, Tsujimoto Y, et al. Evolution of B-cell malignancy: pre-B-cell leukemia resulting from MYC activation in a B-cell neoplasm with a rearranged BCL2 gene. Proc Natl Acad Sci U S A. 1988;85:8548–8552.
   PubMed Web of Science ®Google Scholar
• Magro CM, Wang X, Subramaniyam S, et al. Cutaneous double-hit B-cell lymphoma: an aggressive form of B-cell lymphoma with a propensity for cutaneous dissemination. Am J Dermatopathol. 2014;36:303–310.
   PubMed Web of Science ®Google Scholar
• Loghavi S, Kutok JL, Jorgensen JL. B-Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma. Am J Clin Pathol. 2015;144:393–410.
   PubMed Web of Science ®Google Scholar