TNIP1 is an essential gene for nuclear factor-κB activation, same as MYD88, which could highlight the need of more than one alteration in the nuclear factor-κB pathway to be significant for the transformation process, where nuclear factor-κB signaling is known to be involved.12 Furthermore, this patient also showed other differences with respect to the other cases, such as a much higher frequency of mutations at transformation (n=165), diffuse spleen infiltration by aggressive lymphoma cells, and an unmutated CD79B. This evidence concerns the gene MYD88 and lymphoma.