A novel atypical signal pattern for MYC, BCL2 and BCL6 by fluorescent in situ hybridization in a case of triple hit lymphoma

Triple hit lymphomas are uncommon subset of aggressive high-grade lymphomas that carry translocations involving MYC, BCL2, and BCL6 associated with aggressive behavior. Due to the rarity of these cases, documenting the atypical rare findings would lead to better characterization of these tumors. We present a case of Triple Hit diffuse large B-cell lymphoma (DLBCL) with an unusual atypical unbalanced rearrangements by fluorescent in situ hybridization (FISH) in all the MYC, BCL2, and BCL6 genes showing a MYC-IGH subtype indicating clonal evolution with complexity. This should be considered a warning sign towards a highly aggressive behavior that would aid in appropriate treatment selection. As the FISH patterns in TH remain under explored and our study reinforces the importance of characterizing the abnormal patterns for refinement of prognosis and treatment selection.