We report the case of a 64-year-old patient, known for follicular lymphoma, admitted with facial paralysis accompanied by acute cervicobrachialgia. A lumbar puncture revealed the presence of centroblastic lymphoma cells whose clonal nature was confirmed by immunophenotyping. The histological examination of a lymph node biopsy was consistent with Burkitt-like high-grade lymphoma. Cytogenetic analysis showed the concomitant presence of a rearrangement of MYC as well as of BCL2 and BCL6. A final diagnosis of “triple-hit” high-grade B cell lymphoma (HGBL) was thus made. This entity belongs to the HGBL category of the WHO 2016 classification and shares characteristics with diffuse large B-cell lymphoma and Burkitt lymphoma. The diagnosis of this entity can be complex, in particular in view of a significant morphological variability. The cytogenetic work-up is thus essential for the differential diagnosis.

(BELG J HEMATOL 2021;12(7):318–22)