{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T06:27:44Z","timestamp":1772000864369,"version":"3.50.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Follicular lymphoma (FL) typically follows an indolent clinical course, however, a subset of patients develops an aggressive and treatment refractory phenotype. Here we report a fatal case of a 46-year-old male with FL grade 3A characterized by recurrent severe tumor-associated lactic acidosis (&amp;gt;15 mmol\/L) and rapid therapeutic failure. The patient presented with B symptoms, extensive lymphadenopathy, profound hyperlactatemia, and serum IgM-\u03ba monoclonal protein. Immunohistochemistry confirmed FL grade 3A diagnosis and revealed MYC protein overexpression within 4 months, manifesting new nodal lesions, markedly elevated lactate levels, sustained MYC overexpression, and emergence of both IgG-\u03ba and IgM-\u03ba monoclonal proteins, a serological signature of ongoing clonal evolution. Subsequent treatments (R-CHOP, R-CDOP, BR, and G-EPOCH) over 6 months failed to achieve durable disease control. The clinical course was dominated by refractory, recurrent type B lactic acidosis that correlated directly with tumor activity. The patient ultimately died of fulminant lactic acidosis complicated by tumor lysis syndrome, 7 months after initial diagnosis. This case identifies an ultra-aggressive variant of FL defined by MYC-driven metabolic dysregulation and dynamic clonal evolution, underscoring the need for early recognition and development of novel therapeutic strategies targeting metabolic reprogramming.<\/jats:p>","DOI":"10.3389\/fonc.2026.1781821","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T05:34:00Z","timestamp":1771997640000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["MYC-positive follicular lymphoma complicated by refractory lactate and clonal evolution: a case report"],"prefix":"10.3389","volume":"16","author":[{"given":"Yu-Qing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ke-Xin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hong-Juan","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kun-Peng","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan-Yang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pathology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiao","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shu-Ye","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Hematology, The First Affiliated Hospital of Harbin Medical University","place":["Harbin, 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