Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 26, 2024; 12(15): 2655-2663
Published online May 26, 2024. doi: 10.12998/wjcc.v12.i15.2655
Transformation of marginal zone lymphoma into high-grade B-cell lymphoma expressing terminal deoxynucleotidyl transferase: A case report
Zhi-Min Fan, Dao-Lei Wu, Neng-Wen Xu, Li Ye, Li-Ping Yan, Lin-Jie Li, Jun-Yu Zhang
Zhi-Min Fan, Neng-Wen Xu, Lin-Jie Li, Jun-Yu Zhang, Department of Hematology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Dao-Lei Wu, Department of Ophthalmology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Li Ye, Department of General Practice, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Li-Ping Yan, Department of Pathology, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
Author contributions: Fan ZM and Wu DL contributed equally to this work; Fan ZM and Wu DL wrote the first draft of the manuscript; Yan LP participation in pathological analysis; Xu NW, Ye L, Li LJ and Zhang JY revised the manuscript. All authors have read and approve the final manuscript.
Supported by The Lishui Science and Technology Planing Projects, No. 2020SJZC048.
Informed consent statement: The patient’s daughter and wife provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dao-Lei Wu, MMed, Attending Doctor, Department of Ophthalmology, Lishui Municipal Central Hospital, No. 289 Kuocang Road, Lishui 323000, Zhejiang Province, China. zxnhh1967@163.com
Received: February 8, 2024
Revised: March 15, 2024
Accepted: April 9, 2024
Published online: May 26, 2024
Processing time: 96 Days and 1.4 Hours
Abstract
BACKGROUND

High-grade B-cell lymphoma (HGBL) is an unusual malignancy that includes myelocytomatosis viral oncogene (MYC), B-cell lymphoma-2 (BCL-2), and/or BCL-6 rearrangements, termed double-hit or triple-hit lymphomas, and HGBL-not otherwise specific (HGBL-NOS), which are morphologically characteristic of HGBL but lack MYC, BCL-2, or BCL-6 rearrangements. HGBL is partially transformed by follicular lymphoma and other indolent lymphoma, with few cases of marginal zone lymphoma (MZL) transformation. HGBL often has a poor prognosis and intensive therapy is currently mainly advocated, but there is no good treatment for these patients who cannot tolerate chemotherapy.

CASE SUMMARY

We reported a case of MZL transformed into HGBL-NOS with TP53 mutation and terminal deoxynucleotidyl transferase expression. Gene analysis revealed the gene expression profile was identical in the pre- and post-transformed tissues, suggesting that the two diseases are homologous, not secondary tumors. The chemotherapy was ineffective and the side effect was severe, so we tried combination therapy including venetoclax and obinutuzumab. The patient tolerated treatment well, and reached partial response. The patient had recurrence of hepatocellular carcinoma and died of multifunctional organ failure. He survived for 12 months after diagnosis.

CONCLUSION

Venetoclax combined with obinutuzumab might improve the survival in some HGBL patients, who are unsuitable for chemotherapy.

Keywords: Marginal zone lymphoma; High-grade B-cell lymphoma; Terminal deoxynucleotidyl transferase; Venetoclax; TP53 mutation; Case report

Core Tip: Marginal zone lymphoma (MZL) are a group of B-cell malignant neoplastic diseases with the most common transformation to diffuse large B-cell lymphoma. Herein, we report one rare case of MZL converted to high-grade B-cell lymphoma, not otherwise specific (HGBL-NOS) and concomitant terminal deoxynucleotidyl transferase expression in a 63-year-old male for the first time. HGBL-NOS often has a poor prognosis. The current treatment advocates high-dose chemotherapy, but there is currently no effective treatment for patients who cannot tolerate chemotherapy. We have attempted targeted pharmacological combinations and achieved certain therapeutic effects, which may provide new treatment for these patients.