Figure 1a and 1b: Duodenal Biopsy histopathology results demonstrated lymphocytic infiltration.
Fluorescence in situ hybridization (FISH) was performed using probes specific for rearrangement involving BCL6, t(11:14), t(14:18), and MALT1, which are reported in low-grade small B-cell lymphomas. The break-apart signal pattern 1R1G1F was observed with BCL6 break-apart probe in 82 % of the analyzed nuclei (the normal reference range is <11.6 %). This represented an abnormal result indicative of a BCL6 gene rearrangement with an unknown gene and was suggestive of B-cell lymphoma. Immunohistochemical staining was positive for CD23, CD20, Bcl-6, and focally for Bcl-2. The bone marrow cytogenetics test demonstrated an abnormal female karyotype. Two cells from the culture stimulated with IL2 and DSP30 showed clonal abnormalities, while 18 cells show a normal karyotype. The abnormalities included three copies of the long arm of chromosome 3 along with loss of material from the short arm of chromosome 17, which is a poor prognostic indicator for DLBCL.
Based on the laboratory results, a diagnosis of low-grade B-cell lymphoma of the duodenum associated with a poor prognosis was established. The patient was started on chemotherapy using the R-CHOP regimen (rituximab, cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisone. The patient received 4 cycles of chemotherapy and responded well despite the poor prognosis.