Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 16, 2021; 9(2): 482-488
Published online Jan 16, 2021. doi: 10.12998/wjcc.v9.i2.482
Double-hit lymphoma (rearrangements of MYC, BCL-2) during pregnancy: A case report
Fan Xie, Li-Hui Zhang, Ya-Qing Yue, Lu-Lu Gu, Fei Wu
Fan Xie, Li-Hui Zhang, Ya-Qing Yue, Lu-Lu Gu, Fei Wu, Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
Author contributions: Xie F reviewed the literature, collected the related data and drafted the manuscript; Xie F, Zhang LH and Wu F were the patient’s gynecologists and involved in direct patient care; Zhang LH conducted the analysis and interpreted the data; Yue YQ and Gu LL collected the related data; Wu F revised the manuscript; All authors issued final approval for the version to be submitted.
Supported by Special Talent Project of Jilin Provincial Health Department, No. 2019SCZT038.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fei Wu, MD, PhD, Associate Professor, Doctor, Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Changchun 130041, Jilin Province, China. wufei_1977@163.com
Received: September 11, 2020
Peer-review started: September 11, 2020
First decision: November 14, 2020
Revised: November 16, 2020
Accepted: November 21, 2020
Article in press: November 21, 2020
Published online: January 16, 2021
Processing time: 118 Days and 19.9 Hours
Abstract
BACKGROUND

Double-hit lymphoma is a highly aggressive B-cell lymphoma that is genetically characterized by rearrangements of MYC and BCL2 and/or BCL6. Lymphoma is often accompanied by atypical systemic symptoms similar to physiological changes during pregnancy and is often ignored. Herein, we describe a gravid patient with high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body.

CASE SUMMARY

A 32-year-old female, gestational age 22+5 wk, complained of abdominal distension, chest tightness and limb weakness lasting approximately 4 wk, and ovarian tumors were found 14 d ago. Auxiliary examinations and a trimanual gynecologic examination suggested malignant ovarian tumor and frozen pelvis. Coupled with rapid progression, severe compression symptoms of hydrothorax, ascites and moderate anemia, labor was induced. Next, biopsy and imaging examinations showed high-grade B-cell lymphoma with a MYC and BCL-2 gene rearrangement involving multiple parts of the body. She was referred to the Department of Oncology and Hematology for chemotherapy. Because of multiple recurrences after complete remission, chemotherapy plans were continuously adjusted. At present, the patient remains in treatment and follow-up.

CONCLUSION

The early detection and accurate diagnosis of lymphoma during pregnancy can help expedite proper multidisciplinary treatment to delay disease progression and decrease the mortality rate.

Keywords: Ovarian neoplasms; Double-hit lymphoma; Lymphoma, non-Hodgkin; Pregnancy; Case report; Multidisciplinary treatment

Core Tip: To our knowledge, this is the first study to describe a patient with double-hit lymphoma during pregnancy. We should be well aware of the gynecological manifestations of lymphoma and consider it in the differential diagnosis of pelvic tumors. To avoid an unnecessary radical operation, biopsy should be considered instead of exploratory laparotomy in young women with suspected malignant tumors as well as acute onset, rapid progression and growing chylous pleural effusion containing abundant lymphocytes. The early detection and accurate diagnosis of lymphoma during pregnancy can help expedite proper multidisciplinary treatment to delay disease progression and decrease the mortality rate.