CASE REPORT article
Front. Oncol.
Sec. Hematologic Malignancies
Case Report: Clonal Evolution of Diffuse Large B-Cell Lymphoma to Plasmablastic Lymphoma: Diagnostic Challenges in a Case of Gastric Lesion With EBV-Negative PBL
Jie Xu
Yueli Liu
Xi Feng
Dejie Zhao
Kui Liu
Siyuan Cui
Yan Wang
Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Abstract
Background: The clonal evolution from a diffuse large B-cell lymphoma (DLBCL) to a plasmablastic lymphoma (PBL) is uncommon, presenting remarkable clinical challenges. This phenomenon has critical diagnostic and therapeutic implications, particularly in cases of EBV-negative lesions that show immunophenotypic divergence. Case summary: We herein report an unusual case of two different immunophenotypes, namely DLBCL in the porta hepatis and concomitant PBL in the stomach. Immunoglobulin gene rearrangement analysis confirmed that the two tumors had the same clonal origin. The patient presented with characteristic PBL features, including loss of CD20 expression, high MYC expression, co-expression of BCL2, and a distinctive clinical manifestation involving gastric mucosa. The patient demonstrated only a transient response to initial therapy with R-CHOP plus bortezomib, following which she had rapid disease progression, resulting in an overall survival of 10 months. Conclusion: For extranodal lymphomas, multisite sampling should be performed for a confirmed diagnosis to prevent misdiagnosis or oversight of concurrent lesions. This diagnostically challenging case highlights the importance of molecular testing for identifying and understanding the clonal evolution of lymphomas and suggests how immunophenotypic heterogeneity may lead to misdiagnosis. It also provides important insights into the biology of DLBCL-to-PBL evolution. These findings highlight the need for more precise molecular diagnostic tools and novel approaches to improve outcomes for patients with such highly aggressive lymphoma.
Summary
Keywords
Clonal relationship, compositelymphoma, Diffuse large B-cell lymphoma, evolution, Plasmablastic lymphoma
Received
10 January 2026
Accepted
17 February 2026
Copyright
© 2026 Xu, Liu, Feng, Zhao, Liu, Cui and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Yan Wang
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