Difference between revisions of "Diffuse large B-cell lymphoma"
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**If a nodular architecture is present it is follicular lymphoma. | **If a nodular architecture is present it is follicular lymphoma. | ||
*[[Post-transplant lymphoproliferative disorder]] (PTLD) - in organ transplant recipients. | *[[Post-transplant lymphoproliferative disorder]] (PTLD) - in organ transplant recipients. | ||
*Primary effusion lymphoma - seen in [[HIV]] infections. | |||
*Mixed cellularity [[Hodgkin lymphoma]] - esp. for T-cell/histiocyte-rich large B cell lymphoma. | |||
Special DLBCL subtypes: | |||
*[[Primary mediastinal B-cell lymphoma]] (PMBL) - esp. in young adults. | *[[Primary mediastinal B-cell lymphoma]] (PMBL) - esp. in young adults. | ||
*Primary | *T-cell/histiocyte-rich large B cell lymphoma. | ||
*[[CNS lymphoma|Primary DLBCL of the CNS]]. | |||
*EBV-positive DLBCL of the elderly. | |||
*DLBCL associated with chronic inflammation. | |||
*[[Intravascular lymphoma|Intravscular LBCL]]. | |||
*ALK-positive LBCL. | |||
*Plasmablastic lymphoma. | |||
*LBCL arising in HHV-8 associated multicentric [[Castleman disease]]. | |||
*Primary effusion lymphoma. | |||
*Lymphomatoid granulomatosis. | |||
==IHC== | ==IHC== | ||
Revision as of 02:19, 17 October 2011
Diffuse large B cell lymphoma, abbreviated DLBCL, is a very common lymphoma with a poor prognosis.
General
- Poor prognosis.
- May arise from follicular lymphoma.
- Most common form of non-Hodgkin lymphoma (in the USA).[1]
Microscopic
- Large lymphoid cells:
- 4-5x the diameter of a small lymphocytes.
- Marked cell-to-cell variation in size and shape.
- Cytoplasm usually basophilic and moderate in abundance.
- +/-Prominent nucleoli, may be peripheral and/or multiple.
- Not follicular - nodular arrangement.
- Follicular arrangement = follicular lymphoma.
Notes:
- Large bizarre cells can occasionally mimic Reed-Sternberg cells, seen in Hodgkin lymphoma.
Images:
Differential diagnosis
- Carcinoma.
- Anaplastic large cell lymphoma (ALCL).
- Follicular lymphoma.
- If a nodular architecture is present it is follicular lymphoma.
- Post-transplant lymphoproliferative disorder (PTLD) - in organ transplant recipients.
- Primary effusion lymphoma - seen in HIV infections.
- Mixed cellularity Hodgkin lymphoma - esp. for T-cell/histiocyte-rich large B cell lymphoma.
Special DLBCL subtypes:
- Primary mediastinal B-cell lymphoma (PMBL) - esp. in young adults.
- T-cell/histiocyte-rich large B cell lymphoma.
- Primary DLBCL of the CNS.
- EBV-positive DLBCL of the elderly.
- DLBCL associated with chronic inflammation.
- Intravscular LBCL.
- ALK-positive LBCL.
- Plasmablastic lymphoma.
- LBCL arising in HHV-8 associated multicentric Castleman disease.
- Primary effusion lymphoma.
- Lymphomatoid granulomatosis.
IHC
"UHN panel"
- H&E 2 micrometers.
- CD20 -- B cells.
- CD10 -- follicular lymphoma.
- BCL6 -- follicular lymphoma.
- BCL2 -- follicular lymphoma.
- MUM1 -- B cells.
- CD21 -- highlight FDC networks if present.
- CD23 -- highlight FDC networks if present.
- MIB1 -- proliferative rate.
- EBER -- EBV.
- CD3 -- T cells.
- CD5 -- T cells.
- Unstained x4.
Molecular
- Rearrangements of BCL6.[3]
- Can be assessed with an ISH break apart probe.
- Translocation typical of follicular lymphoma: t(14;18)(q32;q21)/IGH-BCL2.[4]
See also
- Haematopathology.
- Lymph nodes.
- Lymph node pathology.
- Lymphoma.
- Small round cell tumours.
- Post-transplant lymphoproliferative disorder (PTLD).
References
- ↑ 1.0 1.1 Mitchell, Richard; Kumar, Vinay; Fausto, Nelson; Abbas, Abul K.; Aster, Jon (2011). Pocket Companion to Robbins & Cotran Pathologic Basis of Disease (8th ed.). Elsevier Saunders. pp. 321. ISBN 978-1416054542.
- ↑ Cotran, Ramzi S.; Kumar, Vinay; Fausto, Nelson; Nelso Fausto; Robbins, Stanley L.; Abbas, Abul K. (2005). Robbins and Cotran pathologic basis of disease (7th ed.). St. Louis, Mo: Elsevier Saunders. pp. 676 (???). ISBN 0-7216-0187-1.
- ↑ Online 'Mendelian Inheritance in Man' (OMIM) 109565
- ↑ Vitolo U, Ferreri AJ, Montoto S (June 2008). "Follicular lymphomas". Crit. Rev. Oncol. Hematol. 66 (3): 248–61. doi:10.1016/j.critrevonc.2008.01.014. PMID 18359244.