Simultaneous Occurrence of Double-Hit Lymphoma and Acute Myeloid Leukemia in Bone Marrow

Abstract

An 81-year-old man presented at hospital with general fatigue, loss of body weight, and high fever. A blood examination showed anemia, thrombocytopenia, neutrophil dysplasia, and the presence of blastoid cells. Bone marrow aspiration also revealed the presence of blast cells and dysmorphic lymphocytes. Flow cytometric analysis of bone marrow cells identified three distinct aberrant cell populations: small and large cells both positive for CD10, CD19 and CD20, and medium-sized to large cells positive for CD13, CD34, and CD117. Cytogenetic analysis of the bone marrow cells showed two distinct populations having either 46, XY, t(8;22)(q24;q11.2), t(14;18)(q32;q21) or 46XY, +mar1, +mar2, +mar3. This is an extremely rare case with concurrence of DHL and AML, and his lymphoma cells and leukemia cells in the bone marrow were difficult to distinguish morphologically. It is essential to fully perform cytogenetic analysis and immunophenotyping for accurate evaluation of bone marrow involvement of DHL.