Aggressive B-cell lymphoma with co-occurrence of MYC gene gain and TP53 deletion: a rare case report and brief literature review

This report delineates a case of aggressive B-cell lymphoma with a poor clinical outcome and its contributing factors. A 45-year-old man was admitted with symptoms including hepatosplenomegaly and lymphadenopathy, along with other constitutional symptoms lasting 3 months. The primary diagnosis of aggressive high-grade b-cell lymphoma, not otherwise specified was confirmed, characterized by a three to four MYC gene gain and TP53 deletion, based on peripheral blood and bone marrow morphology, immunophenotyping, fluorescence in situ hybridization, and molecular analysis. The patient exhibited an aggressive clinical course and was transferred to the ICU with tumor lysis syndrome, ultimately succumbing to the condition without responding to therapy. Aggressive high-grade b-cell lymphoma, not otherwise specified, characterized by a non-GCB/ABC-like phenotype and associated with MYC gene copy gain and TP53 deletion, represents a highly aggressive, “double-hit-like” molecular subtype that is uncommon. Even minimal MYC gene copy gains, coupled with TP53 deletion/alteration, may indicate a poor prognosis. This highlights the necessity of a comprehensive diagnostic approach to distinguish these cases from other conflicting subtypes and to leverage extensive knowledge of related disorders to achieve a precise diagnosis and appropriate treatment.