Double Hit Lymphoma Mimicking B Cell Precursor Phenotype Burkitt Lymphoma/Leukemia in an Elderly

Background : The differential diagnosis of Burkitt lymphoma/leukemia (BL) and the double or triple hit lymphomas remains often problematic in terms of immunophenotyping in association with MYC gene analysis. In the past, BL-like B-cell malignancy with B-cell precursor phenotype (BCP-ALL) was described. Case Report : We report here an 84-year-old male with massive ascites without superficial lymphadenopathy. Abdominal paracentesis revealed chylous (non-bloody) ascites consisting of mostly abnormal BL-like blasts showing CD20-negative BCP phenotype. However, molecular study indicated no MYC/IGH , but probable involvements of MYC/IGL and BCL6/IGH translocations, which were confirmed by FISH studies. The patient was diagnosed as double hit lymphoma mimicking BCP-ALL.