Difference between revisions of "Diffuse large B-cell lymphoma"

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*[http://commons.wikimedia.org/wiki/File:Diffuse_large_B_cell_lymphoma_-_cytology_low_mag.jpg DLBCL - cytology (WC)].
*[http://commons.wikimedia.org/wiki/File:Diffuse_large_B_cell_lymphoma_-_cytology_low_mag.jpg DLBCL - cytology (WC)].


==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:
==Special DLBCL subtypes==
*[[Primary mediastinal B-cell lymphoma]] (PMBL) - esp. in young adults.
*[[Primary mediastinal B-cell lymphoma]] (PMBL) - esp. in young adults.
*T-cell/histiocyte-rich large B cell lymphoma.
*T-cell/histiocyte-rich large B cell lymphoma.
Line 43: Line 35:
*Primary effusion lymphoma.
*Primary effusion lymphoma.
*Lymphomatoid granulomatosis.
*Lymphomatoid granulomatosis.
==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.


==IHC==
==IHC==

Revision as of 02:20, 17 October 2011

Diffuse large B cell lymphoma, abbreviated DLBCL, is a very common lymphoma with a poor prognosis.

General

Microscopic

Features:[1][2]

  • 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.

Notes:

  • Large bizarre cells can occasionally mimic Reed-Sternberg cells, seen in Hodgkin lymphoma.

Images:


Special DLBCL subtypes

Differential diagnosis

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

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ Online 'Mendelian Inheritance in Man' (OMIM) 109565
  4. ↑ 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.
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