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Burkitt/“Double Hit” Large B-cell Lymphoma Panel by FISH

Test Code

F BURKITT; FP BURKITT

Test Synonyms

C-MYC 8q24, BCL2 t(14;18), BCL6 3q27

Associations

"double hit" B-cell lymphoma

Methodology

Fluorescence in situ Hybridization (FISH)

Turnaround Time

3-5 days

Specimen Requirements

F BURKITT
2.0 mL (min. 1.0 mL) peripheral blood in sodium heparin, EDTA accepted
1.0 mL (min. 0.5 mL) bone marrow in sodium heparin, EDTA accepted
5 mm^3 fresh tissue or 3.0 mL (min. 2.0 mL) FNA in MPLN RPMI media

FP BURKITT
10% neutral buffered formalin fixed paraffin embedded tissue

Specimen Stability
Peripheral blood and bone marrow stable at 18-25°C for 72 hours
Fresh tissue or FNA stable at 2-8°C for 72 hours
FFPE stable indefinately
Storage & Handling

Whole blood and bone marrow, ship ambient
Fresh tissue, FNA or paraffin embedded tissue, ship in a Styrofoam container with a cool/refrigerated pack (Do not allow cool pack to directly contact sample)

Causes for Rejection

Clotted specimen; Specimen exposed to extreme temperature; Anticoagulant toxic to cells; Insufficient number of cells; Improper fixative

Description

This small, multiprobe panel contributes to the distinction of Burkitt’s from large B-cell lymphoma on problematic specimens demonstrating borderline morphologic or immunophenotypic features, limited sample volume, or zero to low probability for successful karyotyping.  Burkitt’s lymphoma characteristically demonstrates a very high Ki67 staining index, strong CD10, and positive bcl-6 staining with negative staining for bcl-2.  Burkitt’s lymphomas typically reveal MYC translocation partnered to Ig heavy or light chain genes in the background of an otherwise simple karyotype.  Rarely, Burkitt’s lymphomas may lack MYC translocation.
Among large B-cell lymphomas, MYC translocation is demonstrated in a small but significant subset, almost always in the background of a complex karyotype, presumably representing secondarily acquired genetic change.  Frequently, these MYC+ large B-cell lymphomas are also positive for BCL2 or BCL6 rearrangements.  Incomplete clinical evidence suggests that MYC+ large B-cell lymphomas may benefit from Burkitt-like chemotherapeutic regimens.
When confronted with fresh or paraffin embedded tissue specimens containing CD10+ Ki67+(high) bcl2- B-cell neoplasia, this multiprobe FISH panel often facilitates distinction of Burkitt’s from large B-cell lymphoma.

References
  1. Hummel M, et al. (2006) A biologic definition of Burkitt’s lymphoma from transcriptional and genomic profiling.N Engl J Med 354:2419-30.
  2. de Jong D. (2009) Novel lymphoid neoplasms—the borderland between diffuse large B-cell lymphoma and Burkitt’s lymphoma. Haematologica 94(7): 894-896.
  3. Zhao X, et al. (2008) C-MYC rearrangements are frequent in aggressive mature B-Cell lymphoma with atypical morphology. Int J Clin Exp Pathol; 1:65-74.