LAUSR

Dear Editor, Burkitt-like lymphoma with 11q aberration (BLL-11q) is a new provisional classification in the revised fourth edition of WHO classification of lymphomas that resembles Burkitt lymphoma (BL) morphologically and phenotypically, but has unique features, including gains in 11q23.2–23.3 and losses of 11q24.1– qter, with no MYC translocation [1]. BLL-11q predominantly occurs in young adult males, and characteristic cytogenetic features have been frequently observed in post-transplant patients [2–4]. However, the association between BLL-11q and immune deficiency remains unclear due to the limited number of cases [2, 4–6]. We report a case of BLL-11q with HIV co-infection in East Asia, and review previous cases of BLL-11q with immunodeficiency. The Institutional Review Board of Samsung Medical Center, Seoul, Korea, approved this study (IRB No: SMC-202005-125) and waived the need for informed consent. A 23-year-old male who was previously healthy was admitted to Samsung Medical Center in January 2020 for investigation of a palpable mass on the left axilla and back pain. Axillary lymphnode biopsy was positive for CD10, BCL6, and Ki-67 (>90%), and negative for BCL2, CD3, and MUM-1 (IRF-4). FISH was negative for BCL2 or BCL6 rearrangement. Bone marrow (BM) aspirate and section revealed an increase in mediumto largesized lymphoma cells (Fig. 1A and 1B). Flow cytometry was performed on BM aspirates. After staining with monoclonal antibodies against B-cell associated antigens, data acquisition and analysis were performed using the FACSLyric flow cytometer (Becton Dickinson, San Jose, CA, USA) and Kaluza flow cytometry analysis software (Beckman Coulter Inc., Indianapolis, IN, USA), respectively. Lymphoma cells were positive for CD10, CD19, CD20, and cCD79a, moderately positive for cCD22, and negative for CD34, terminal deoxynucleotidyl transferase (TdT), CD5, and kappa/lambda surface immunoglobulins. Immunohistochemical staining was performed on formalin-fixed, paraffin-embedded BM sections using monoclonal antibodies against CD3, CD20, CD34, and TdT (DAKO, Santa Clara, CA, USA), and showed lymphoma cells diffusely positive for CD20 (Fig. 1C) and reactive T cells positive for CD3 (Fig. 1D). Epstein-Barr virus in-situ hybridization was negative. Chromosomal analysis revealed 46,XY,der (11)dup(11)(q24q13)del(q24)[18]/46,XY[2] (Fig. 1E). FISH analysis using LSI IGH/MYC/CEP8 Tri-Color Dual Fusion probe (Vysis, Abbott Park, IL, USA), LSI KMT2A (MLL) Dual-Color Break Apart probe (Vysis), and TelVysion 11q SpectrumOrange probe (Vysis) indicated the presence of 11q aberrations (Fig. 1F, 1G), with no MYC rearrangement. Chromosomal microarray analysis was conducted using GeneChip System 3000Dx v.2 (Thermo Fisher Scientific, Carlsbad, CA, USA) and a CytoScan Dx Assay (Thermo Fisher Scientific).