CD20-negative primary middle ear diffuse large B-cell lymphoma coexpressing MYC and BCL-2 secondary to acute lymphoblastic leukemia: A case report.

Authors:
Chao Ding
Chao Ding
Shenzhen Graduate School
China
Ying Huang
Ying Huang
Fred Hutchinson Cancer Research Center
Seattle | United States
Mingxia Shi
Mingxia Shi
Louisiana State University Health Sciences Center
Bo Nie
Bo Nie
Beijing University of Chinese Medicine
China
Yuntao Li
Yuntao Li
College of Materials Science and Engineering
China
Kun Wu
Kun Wu
Harbin Medical University
China
Jinrong Yang
Jinrong Yang
West China Hospital
China
Yun Zeng
Yun Zeng
North Sichuan Medical College
China

Medicine (Baltimore) 2019 Apr;98(15):e15204

Department of Hematology, The First Affiliated Hospital, Kunming Medical University, Kunming, Yunnan Province, China.

Rationale: Second diffuse large B-cell lymphoma (DLBCL) after treatment of acute lymphoblastic leukemia (ALL) is uncommon. To our knowledge, primary middle ear DLBCL which presents CD20-negative and coexpression of MYC and BCL-2 has not been reported yet.

Patient Concerns: A 20-year-old Chinese man complained fever and weakness for 2 months. Subsequently bone marrow morphology and flow cytometry immunophenotype suggested ALL. Administrated with 9 cycles of multiagent combined chemotherapy, he felt right ear progressive hearing loss, otalgia, aural fullness. Otoendoscopic examination revealed a pitchy mass obstructing the right external auditory canal. Then the mass resection was performed for biopsy and immunohistochemistry examination.

Diagnosis: The mass was diagnosed as DLBCL which was negative for CD20 and double expression of MYC and BCL-2.

Interventions: Chemotherapy.

Outcomes: The patient eventually gave up and died of severe infection.

Lessons: Although intensive chemotherapy has markedly improved the survival of ALL, more and more secondary cancers have been reported. In addition, primary middle ear lymphoma is much rare; hence, it is easy to be misdiagnosed. Furthermore, DLBCL with negative CD20 and double expression of MYC and BCL-2 is aggressive, which is characterized by chemotherapy resistance and inferior survival rates. We discuss this case aiming at raising awareness of tumors secondary to ALL and exploring the appropriate treatment options for the rare DLBCL.

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Source
http://dx.doi.org/10.1097/MD.0000000000015204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485888PMC
April 2019
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