High performance of multiplex fluorescence in situ hybridization to simultaneous detection of BCL2 and BCL6 rearrangements: useful application in the characterization of DLBCLs

Federica Zito Marino1, Gabriella Aquino2, Matteo Brunelli3, Giosuè Scognamiglio2, Serena Pedron3, Andrea Ronchi1, Immacolata Cozzolino1, Lucianna Sparano4, Gerardo Botti2, Luigi Panico5, Anna De Chiara2, Renato Franco1
1Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania “L Vanvitelli”, Naples, Italy
2Pathology Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
3Pathology Unit, Department of Pathology and Diagnostics, University and Hospital Trust of Verona, Verona, Italy
4Pathology Unit, ‘Andrea Tortora’ Hospital, Salerno, Italy
5Pathology Unit, Monaldi Hospital, Avellino, Italy

Tóm tắt

Chromosomal rearrangements involving BCL2, BCL6 and MYC are commonly found in the most frequent B cell lymphomas, namely follicular lymphomas (FLs) and diffuse large B-cell lymphomas (DLBCLs). Particularly, BCL2-rearrangement represents a diagnostic hallmark in FLs, whereas MYC translocation can occur simultaneously with BCL2 and/or BCL6 rearrangements, defining a specific category of DLBCLs with a poorer prognosis. In this study, we aim to validate the diagnostic performance of multiplex BCL2/BCL6 FISH approach in formalin-fixed paraffin-embedded FLs and DBCLs and cytological samples of DLBCL comparing to the classic set of single break-apart probes. We collected a series of lymphomas, including 85 DLBCLs, 45 FLs and 36 other B-cell lymphoma histotypes and 16 cytological samples of DLBCLs. MYC, BCL2 and BCL6 rearrangements were previously assessed by a classic FISH test using single break-apart probes. All samples were analysed by a multiplex FISH assay. In the FL series, 38 cases showed BCL2-R; in the DLBCLs series, MYC-R was detected in 21 out of 85 DLBCL patients, BCL2-R in 10 out of 85 and BCL6-R in 33 out of 85. In the DLBCL cytological series, MYC-R was detected in 4 out of 16, BCL2-R in 4 out of 16 and BCL6-R in 1 out of 16. Notably, in FFPE, 13 double-hit lymphomas (DHLs) and 3 triple-hit lymphomas (THLs) were detected; in the cytological series, only 3 DHL cases were observed. The dual BCL2/BCL6 FISH probe test results were fully concordant with the results obtained using classic BCL2 and BCL6 single break apart. Particularly, multiplex FISH to simultaneously detect BCL2-R and BCL6-R on a single slide could find a wide application in the characterisation of double- and triple-hit DLBCLs.

Tài liệu tham khảo

Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES (2016) The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 127:2375–2390. https://doi.org/10.1182/blood-2016-01-643569 Gollub W, Stassek B, Huckhagel T, Bernd HW, Krokowski M, Merz H, Feller AC, Thorns C (2009) BCL6-translocations affect the phenotype of follicular lymphomas only in the absence of t(14;18) IgH/BCL2. Anticancer Res 29:4649–4655 Landsburg DJ, Petrich AM, Abramson JS, Sohani AR, Press O, Cassaday R, Chavez JC, Song K, Zelenetz AD, Gandhi M, Shah N, Fenske TS, Jaso J, Medeiros LJ, Yang DT, Nabhan C (2016) Impact of oncogene rearrangement patterns on outcomes in patients with double-hit non-Hodgkin lymphoma. Cancer 122:559–564. https://doi.org/10.1002/cncr.29781 Aukema SM, Siebert R, Schuuring E, van Imhoff GW, Kluin-Nelemans HC, Boerma EJ, Kluin PM (2011) Double-hit B-cell lymphomas. Blood 117:2319–2331. https://doi.org/10.1182/blood-2010-09-297879 Chiappella A, Crombie J, Guidetti A, Vitolo U, Armand P, Corradini P (2019) Are we ready to treat diffuse large B-cell and high-grade lymphoma according to major genetic subtypeS? HemaSphere 3:e284. https://doi.org/10.1097/HS9.0000000000000284 Quesada AE, Medeiros LJ, Desai PA, Lin P, Westin JR, Hawsawi HM, Wei P, Tang G, Seegmiller AC, Reddy NM, Yin CC, Wang W, Xu J, Miranda RN, Zuo, Li S (2017) Increased MYC copy number is an independent prognostic factor in patients with diffuse large B-cell lymphoma. Mod Pathol 30:1688–1697. https://doi.org/10.1038/modpathol.2017.93 Wang W, Hu S, Lu X, Young KH, Medeiros LJ (2015) Triple-hit B-cell lymphoma with MYC, BCL2, and BCL6 translocations/rearrangements: clinicopathologic features of 11 cases. Am J Surg Pathol 39:1132–1139. https://doi.org/10.1097/PAS.0000000000000434 Ok CY, Medeiros LJ (2020) High-grade B-cell lymphoma: a term re-purposed in the revised WHO classification. Pathology 52:68–77. https://doi.org/10.1016/j.pathol.2019.09.008 Di Napoli A, Remotti D, Agostinelli C, Ambrosio MR, Ascani S, Carbone A, Facchetti F, Lazzi S, Leoncini L, Lucioni M, Novero D, Pileri S, Ponzoni M, Sabattini E, Tripodo C, Zamò A, Paulli M, Ruco L (2019) A practical algorithmic approach to mature aggressive B cell lymphoma diagnosis in the double/triple hit era: selecting cases, matching clinical benefit : a position paper from the Italian Group of Haematopathology (G.I.E.). VirchowsArchiv 475:513–518. https://doi.org/10.1007/s00428-019-02637-2 Davies A (2019) Double-hit lymphoma: so what? Hematol Oncol 37:19–23. https://doi.org/10.1002/hon.2581 Zito Marino F, Rossi G, Cozzolino I, Montella M, Micheli M, Bogina G, Munari E, Brunelli M, Franco R (2020) Multiplex fluorescence in situ hybridisation to detect anaplastic lymphoma kinase and ROS proto-oncogene 1 receptor tyrosine kinase rearrangements in lung cancer cytological samples. J Clin Pathol 73:96–101. https://doi.org/10.1136/jclinpath-2019-206152 Tilly H, Gomes da Silva M, Vitolo U, Jack A, Meignan M, Lopez-Guillermo A, Walewski J, André M, Johnson PW, Pfreundschuh M, Ladetto M, ESMO Guidelines Committee (2015) Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 26:v116–v125. https://doi.org/10.1093/annonc/mdv304 da Cunha SG, Ko HM, Saieg MA, Boerner SL, Lai SW, Bailey D, Geddie WR (2011) Cytomorphologic findings of B-cell lymphomas with concurrent IGH/BCL2 and MYC rearrangements (dual-translocation lymphomas). Cancer Cytopathol 119:254–262. https://doi.org/10.1002/cncy.20156 Elkins CT, Wakely PE Jr (2011) Cytopathology of “double-hit” non-Hodgkin lymphoma. Cancer Cytopathol 119:263–271. https://doi.org/10.1002/cncy.20160 Sturgis CD, Monaco SE, Sakr H, Pantanowitz L (2017) Cytologic perspectives on neoteric B-cell lymphoproliferative disorders. Diagn Cytopathol 45:1005–1019. https://doi.org/10.1002/dc.23766 Ochs RC, Bagg A (2012) Molecular genetic characterization of lymphoma: application to cytology diagnosis. Diagn Cytopathol 40:542–555. https://doi.org/10.1002/dc.22819