A unique case of follicular large B-cell lymphoma arising in the background of thymic follicular hyperplasia

IF 0.5

Human Pathology Reports Pub Date : 2026-03-01 Epub Date: 2025-12-12 DOI:10.1016/j.hpr.2025.300810

Gord Guo Zhu , Tina B. Edmonston , Eric Behling , Roland Schwarting

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Abstract

Follicular large B-cell lymphoma (FLBCL) is an aggressive variant of follicular lymphoma, rarely reported at extranodal sites. We describe, to our knowledge, the first case of FLBCL arising in a background of thymic follicular hyperplasia (TFH). A 76-year-old man undergoing evaluation for cardiac surgery was incidentally found to have a mediastinal mass, which revealed thymic tissue with prominent TFH on resection. Within this TFH background, follicles with sheets of centroblasts and brisk mitotic activity and a “starry sky” pattern were identified. Immunohistochemistry confirmed germinal center B-cell phenotype (CD20, CD10, BCL6, weak BCL2) with a Ki-67 > 90 %. Molecular studies demonstrated a clonal IGK rearrangement, IGH::MYC fusion, and DDX3X mutation, while hyperplastic areas lacked clonal rearrangements. This case highlights the thymus as a rare site of B-cell lymphomagenesis and underscores the importance of recognizing FLBCL in unusual locations.

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以胸腺滤泡增生为背景的滤泡性大b细胞淋巴瘤一例

滤泡性大b细胞淋巴瘤（FLBCL）是一种侵袭性滤泡性淋巴瘤，很少在结外部位报道。我们描述，据我们所知，在胸腺滤泡增生（TFH）的背景下出现的第一例FLBCL。一位76岁的男性在接受心脏手术评估时偶然发现有纵隔肿块，切除后发现胸腺组织有明显的TFH。在这种TFH背景下，鉴定出具有成丝细胞片和活跃的有丝分裂活性和“星空”模式的卵泡。免疫组织化学证实生发中心b细胞表型（CD20, CD10, BCL6，弱BCL2）， Ki-67 > 90%。分子研究证实了克隆性IGK重排、IGH::MYC融合和DDX3X突变，而增生区域缺乏克隆性重排。这个病例强调了胸腺是一个罕见的b细胞淋巴瘤发生部位，并强调了在不寻常部位识别FLBCL的重要性。

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来源期刊

Human Pathology Reports

CiteScore

0.60

自引率

0.00%

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