Case Report

B Cell Lymphoma, Unclassifiable, Transformed from Follicular Lymphoma: A Rare Presentation with Review of the Literature

Table 1

A review of reported cases of nonmediastinal BCLu DLBCL/CHL.

Study CasesAge/sexSiteInitial diagnosisImmunohistochemical stainingRebiopsy diagnosisTreatment Outcome

Index case1 case56/MRight neck massFollicular lymphomaCD20+, CD15+, CD30+, CD79a+, PAX5+, bcl-2, and bcl-6+; Ki-67 80% Negative for CD3, CD5, CD10, ALK-1 protein, EMA, and EBV (EBER by ISH) Cyclin D1 equivocal, CD21+
Large cells binucleated and multinucleated were noted
B cell lymphoma, unclassifiableACVBP + radiationGood response

Iwaki et al. [16]1 case78/FIleocecal tumorNodular sclerosis cHL+ for CD30, CD20, CD79a, PAX5, BOB.1, and OCT-2, but negative for CD15 Increased level of soluble IL-2 receptorBCLu-DLBCL/CHLABVDPartial response

Wang et al. [17]1 case67/FLeft supraclavicular LN, right axillary LN, bilateral inguinal LADNACD30 and CD15+; CD20−, PAX5, and CD45 were down-regulated; EBV+EBV + DLBCL and EBV + CHLNANA

Eberle et al. [9]1 case55/MNeck LNNACD20+, CD30+, CD15,
CD79a+, BOB.1+, Oct-2+, p63−, cyclin E−, and HLA-DR4
GZLNANA

Eberle et al. [9]1 case67/F Neck massNACD20+, CD30+, CD15−,
CD79a+, BOB.1+, Oct-2+, p63+, cyclin E+, and HLA-DR4
GZLNANA

Eberle et al. [9]1 case58/FInguinal LNNACD20+, CD30−,
CD15, CD79a+, BOB.1+, Oct-2+, p63−, cyclin E−, and HLA-DR4
GZLNANA

Eberle et al. [9]1 case26/MNeck massNACD20+, CD30+, CD15+, CD79a+, BOB.1+, Oct-2+, p63−, cyclin E+, and HLA-DR3GZLNANA

Eberle et al. [9]1 case91/FAxillary LNNACD20−, CD30+, CD15+, CD79a+ BOB.1+, Oct-2+, p63+, cyclin E+, and HLA-DR4GZLNANA

Eberle et al. [9]1 case24/FCervical LNNACD20+, CD30+, CD15+, CD79a+, BOB.1+, Oct-2+, p63−, cyclin E+, and HLA-DR4GZLNANA

Eberle et al. [9]1 case48/FAxillary LNNACD20+, CD30+, CD15+, CD79a+, BOB.1+, Oct-2+, p63+, cyclin E+, and HLA-DR1GZLNANA

Eberle et al. [9]1 case85/MAxillary massNACD20+, CD30+, CD15− CD79a+, BOB.1+, OCT2+, p63−, cyclin E+, and HLA-DR4GZLNANA

Eberle et al. [9]1 case25/FNeck LNNACD20− CD30+, CD15+, CD79a−, BOB.1−, Oct-2−, p63−, cyclin E−, and HLA-DR3GZLNANA

Quintanilla-Martinez et al. [12]1 case (under subheading: “Classical Hodgkin’s lymphoma with immunophenotypic deviations”)38 yoAxillary LNNACD20+, PAX5−, OCT-2−, and CD79a−CHL morphology but strong CD20 expression in the RS cellsNANA

Gualco et al. [14]10 cases37 y median age8 mediastinal, 2 extramediastinalNACD30+ (100%), CD20+ (100%), CD45+ (95%), CD15+ (40%), BOB1+ (40%), OCT2 (50%+, 30%), PAX5+ (90%), bcl-6 (40%), P63 (50%+), and CD79a (70%+)B cell lymphoma, unclassifiablecombination chemotherapy for non-Hodgkin’s lymphomasGood response

García et al. [5]9 casesYoung males3 extramediastinal, 6 mediastinalNACD30+, CD15+ (6/9) 
CD45RB+, CD20+, CD79a+, OCT2+, and EBV (2/9)
Shared features of DLBCL and classical HLNANA

Nadeem et al. [10]49 cases; 11% extramediastinal33.5 Y median age; M > F11% extramediastinal, 89% mediastinalNACD20+ (90%), CD30+ (95%), 63% CD15+, and EBV+ (9/22 patients)GZLInitial cHL regimens (BEACOPP, ABVD) or DLBCL regimens (CHOP, EPOCH, with or without rituximab)7 pts received ABVD, 57% NR and 43% PR; no CRs
7 pts received CHOP; 5 had clinical outcome data available; 80% CR (received consolidation radiation therapy) and 20% PR
7 pts received autologous SCT and 2 of them had relapse in 6 months

Zarate-Osorno et al. [18]9 cases: 7 follicular, 1 DLBCL, and 1 large cell immunoblastic54-year median age7 (primarily nodal) 
Name of node not specified in the article
NHLRS and Hodgkin’s cells were LeuM1 or BerH2+ and LCA− in 8/9 biopsiesHD4 chemotherapies 
3 chemotherapies + radiation
NA