Unusual concurrent presentation of a double hit (MYC/BCL2) and follicular lymphoma in a young patient; case report and review of key recent developments in double-hit lymphomas

Double-hit lymphomas, usually refer to the MYC/BCL2 lymphomas, and are characterized by MYC 8q rearrangement and BCL2-IgH translocation in the same cells. They mainly comprise of a subset of the new entity "B cell lymphomas unclassifiable with features intermediate between diffuse large B cell lymphomas (DLBCL) and Burkitt lymphoma" included in the World Health Organization 2008 classification. In addition, they also include a small subset of other DLBCL. They have been reported to have worse prognosis than either Burkitt or DLBCL, with which they share overlapping morphological and immunophenotypical features. These cases usually present de novo and have been reported in the older age group (Snuderl et al. in Am J Surg Pathol 34(3): 327-340, 2010; Le Gouill et al. in Haematologica 92(10): 1335-1342, 2007; Macpherson et al. in J Clin Oncol 17(5): 1558-1567, 1999; Johnson et al. in Blood 114(11): 22732279, 2009; Bertrand et al. in Leuk Off J Leuk Soc Am Leuk Res Fund UK 21(3): 515-523, 2007). Here, we describe an unusual simultaneous presentation of MYC/BCL2 double-hit lymphoma with low-grade follicular lymphoma, occurring at two different sites, in a young patient. This has not been reported to the best of our knowledge.