Reclassification of diffuse large B cell lymphoma to large B cell lymphoma with IRF4 rearrangement in an adult population.

AIMS: Large B cell lymphoma with IRF4 rearrangement (LBCL-IRF4) is a new entity in the 2017 revised World Health Organisation (WHO) classification that was initially mainly reported in children. After identification of a 79-year-old patient, we assessed how often IRF4 rearrangements can be detected in adult diffuse large B cell lymphomas (DLBCLs) which have to be reclassified to LBCL-IRF4 based on fluorescence in-situ hybridisation (FISH) for IRF4. METHODS AND RESULTS: With FISH, we studied the presence of IRF4 rearrangements in 238 lymphomas that were diagnosed as DLBCL according to the previous WHO classification of 2008. CONCLUSIONS: In addition to the index patient, an IRF4 rearrangement was detected in another five of 237 patients (2%). The immunohistochemical profile of these five IRF4 rearranged lymphomas was consistent with previous reports of LBCL-IRF4. One case was recognised to represent transformation of follicular lymphoma rather than de-novo LBCL-IRF4. BCL6 rearrangements were found in two cases of LBCL-IRF4; BCL2 and MYC rearrangements were excluded. Patients presented with limited stage disease with involvement of the head and neck in three patients, and involvement of the lung and thyroid in two others. This study shows that, although rare, LBCL-IRF4 should also be considered in older patients and at localisations other than the head and neck region.

[A gynaecological cause of upper abdominal pain: Fitz-Hugh-Curtis syndrome]. / Een gynaecologische oorzaak van bovenbuikpijn: Het Fitz-Hugh-Curtis-syndroom.

A 19-year-old woman was admitted to our hospital because of unexplained pain in the right upper abdomen and fever. Her medical history noted a recent uncomplicated pregnancy and birth of a healthy child. Our differential diagnosis included pyelonephritis, pulmonary embolism, pneumonia causing pleural pain, a gastrointestinal cause, or a subphrenic abscess. A vaginal culture was taken as part of a second opinion by a gynaecologist. However, after a few days PCR on the vaginal sample was positive for Chlamydia trachomatis, indicating a case of Fitz-Hugh-Curtis syndrome. This syndrome is a complication of pelvic inflammatory disease caused by a bacterial infection, most frequently Gonococcal or Chlamydia species. The patient was treated with doxycycline and recovered quickly. As a result of ignoring a possible gynaecological cause in this patient, the time to diagnosis and treatment was delayed. Left untreated, this disease might result in infertility and in complications in the newborn. A broad differential diagnosis is therefore important.