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Diffuse large B-cell lymphoma (view source)
Revision as of 10:46, 29 March 2017
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| Width = | | Width = | ||
| Caption = DLBCL - cytology. | | Caption = DLBCL - cytology. | ||
| Micro = large lymphoid cells ( | | Micro = large lymphoid cells (>=2x resting lymphocyte), nucleolus, sheeting architecture | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = | | LMDDx = [[follicular lymphoma]], [[Hodgkin lymphoma]], [[PTLD]], primary effusion lymphoma, carcinoma | ||
| Stains = | | Stains = | ||
| IHC = CD20+, CD10+, BCL6+, CD45 | | IHC = CD20+, CD10+/-, BCL6+/-, CD45+ | ||
| EM = | | EM = | ||
| Molecular = | | Molecular = t(14;18)(q32;q21)/IGH-BCL2 - esp. when arising from follicular lymphoma | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
| Line 17: | Line 17: | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = | |||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = | | Prevalence = | ||
| Bloodwork = | | Bloodwork = +/- cytopenia | ||
| Rads = | | Rads = lymphadenopathy | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = | | Prognosis = poor | ||
| Other = | | Other = | ||
| ClinDDx = metastatic carcinoma, reactive lymphadenopathy, infective lymphadenopathy}} | | ClinDDx = metastatic carcinoma, reactive lymphadenopathy, infective lymphadenopathy}} | ||
'''Diffuse large B cell lymphoma''', abbreviated '''DLBCL''', is a very common [[lymphoma]] with a poor prognosis. | '''Diffuse large B-cell lymphoma''', abbreviated '''DLBCL''', is a very common [[lymphoma]] with a poor prognosis. | ||
==General== | ==General== | ||
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*Most common form of non-Hodgkin lymphoma (in the USA).<ref name=Ref_PCPBoD8_321>{{Ref PCPBoD8|321}}</ref> | *Most common form of non-Hodgkin lymphoma (in the USA).<ref name=Ref_PCPBoD8_321>{{Ref PCPBoD8|321}}</ref> | ||
*Most common lymphoma of the [[spleen]].<ref name=pmid22924843>{{Cite journal | last1 = Shimizu-Kohno | first1 = K. | last2 = Kimura | first2 = Y. | last3 = Kiyasu | first3 = J. | last4 = Miyoshi | first4 = H. | last5 = Yoshida | first5 = M. | last6 = Ichikawa | first6 = R. | last7 = Niino | first7 = D. | last8 = Ohshima | first8 = K. | title = Malignant lymphoma of the spleen in Japan: a clinicopathological analysis of 115 cases. | journal = Pathol Int | volume = 62 | issue = 9 | pages = 577-82 | month = Sep | year = 2012 | doi = 10.1111/j.1440-1827.2012.02844.x | PMID = 22924843 }}</ref> | *Most common lymphoma of the [[spleen]].<ref name=pmid22924843>{{Cite journal | last1 = Shimizu-Kohno | first1 = K. | last2 = Kimura | first2 = Y. | last3 = Kiyasu | first3 = J. | last4 = Miyoshi | first4 = H. | last5 = Yoshida | first5 = M. | last6 = Ichikawa | first6 = R. | last7 = Niino | first7 = D. | last8 = Ohshima | first8 = K. | title = Malignant lymphoma of the spleen in Japan: a clinicopathological analysis of 115 cases. | journal = Pathol Int | volume = 62 | issue = 9 | pages = 577-82 | month = Sep | year = 2012 | doi = 10.1111/j.1440-1827.2012.02844.x | PMID = 22924843 }}</ref> | ||
*Obesity is a risk factor.<ref>{{Cite journal | last1 = Castillo | first1 = JJ. | last2 = Ingham | first2 = RR. | last3 = Reagan | first3 = JL. | last4 = Furman | first4 = M. | last5 = Dalia | first5 = S. | last6 = Mitri | first6 = J. | title = Obesity is associated with increased relative risk of diffuse large B-cell lymphoma: a meta-analysis of observational studies. | journal = Clin Lymphoma Myeloma Leuk | volume = 14 | issue = 2 | pages = 122-30 | month = Apr | year = 2014 | doi = 10.1016/j.clml.2013.10.005 | PMID = 24360912 }}</ref> | |||
*Suscepibility loci located on 6p, 2p and 8q.<ref>{{Cite journal | last1 = Cerhan | first1 = JR. | last2 = Berndt | first2 = SI. | last3 = Vijai | first3 = J. | last4 = Ghesquières | first4 = H. | last5 = McKay | first5 = J. | last6 = Wang | first6 = SS. | last7 = Wang | first7 = Z. | last8 = Yeager | first8 = M. | last9 = Conde | first9 = L. | title = Genome-wide association study identifies multiple susceptibility loci for diffuse large B cell lymphoma. | journal = Nat Genet | volume = 46 | issue = 11 | pages = 1233-8 | month = Nov | year = 2014 | doi = 10.1038/ng.3105 | PMID = 25261932 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
Features:<ref name=Ref_PCPBoD8_321>{{Ref PCPBoD8|321}}</ref><ref name=Ref_PBoD676>{{Ref PBoD|676 (???)}}</ref> | Features:<ref name=Ref_PCPBoD8_321>{{Ref PCPBoD8|321}}</ref><ref name=Ref_PBoD676>{{Ref PBoD|676 (???)}}</ref> | ||
*Large lymphoid cells: | *Large lymphoid cells: | ||
** | **>= 2x the diameter of a small lymphocytes. | ||
**Marked cell-to-cell variation in size and shape. | **Marked cell-to-cell variation in size and shape. | ||
**Cytoplasm usually basophilic and moderate in abundance. | **Cytoplasm usually basophilic and moderate in abundance. | ||
**+/-Prominent nucleoli, may be peripheral and/or multiple. | **+/-Prominent nucleoli, may be peripheral and/or multiple. | ||
*'''Not''' follicular | *'''Not''' follicular/nodular arrangement. | ||
**Follicular arrangement = [[follicular lymphoma]]. | **Follicular arrangement = [[follicular lymphoma]]. | ||
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*Large bizarre cells can occasionally mimic Reed-Sternberg cells, seen in [[Hodgkin lymphoma]]. | *Large bizarre cells can occasionally mimic Reed-Sternberg cells, seen in [[Hodgkin lymphoma]]. | ||
===Differential diagnosis=== | |||
*[http:// | *[[Carcinoma]] - esp. [[small cell 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. | |||
*B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma.<ref name=pmid22222636>{{Cite journal | last1 = Gualco | first1 = G. | last2 = Natkunam | first2 = Y. | last3 = Bacchi | first3 = CE. | title = The spectrum of B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma: a description of 10 cases. | journal = Mod Pathol | volume = | issue = | pages = | month = Jan | year = 2012 | doi = 10.1038/modpathol.2011.200 | PMID = 22222636 | URL = http://www.nature.com/modpathol/journal/vaop/ncurrent/full/modpathol2011200a.html }}</ref> | |||
*Other [[small round cell tumours]]. | |||
===Images=== | |||
<gallery> | |||
Image: Diffuse large B cell lymphoma (1) tonsil.jpg | DLBCL. (WC/KGH) | |||
Image: Diffuse large B cell lymphoma (2) tonsil.jpg | DLBCL. (WC/KGH) | |||
Image: Diffuse large B cell lymphoma (3) tonsil.jpg | DLBCL. (WC/KGH) | |||
</gallery> | |||
<gallery> | |||
Image: DLBCL of testis - 2 -- intermed mag.jpg | DLBCL (testis) - intermed. mag. (WC) | |||
Image: DLBCL of testis - 2 -- high mag.jpg | DLBCL (testis) - high mag. (WC) | |||
Image: DLBCL of testis - 2 -- very high mag.jpg | DLBCL (testis) - very high mag. (WC) | |||
</gallery> | |||
<gallery> | |||
Image:Diffuse_large_B_cell_lymphoma_-_cytology_low_mag.jpg | DLBCL - cytology (WC) | |||
</gallery> | |||
==Special | ===Special subtypes of diffuse large B-cell lymphoma=== | ||
*[[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. | ||
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*Plasmablastic lymphoma. | *Plasmablastic lymphoma. | ||
*LBCL arising in [[HHV-8]] associated multicentric [[Castleman disease]]. | *LBCL arising in [[HHV-8]] associated multicentric [[Castleman disease]]. | ||
*Primary effusion lymphoma. | *Primary effusion lymphoma - associated with [[human immunodeficiency virus]]. | ||
*Lymphomatoid granulomatosis. | *Lymphomatoid granulomatosis. | ||
==IHC== | ==IHC== | ||
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{{familytree/end}} | {{familytree/end}} | ||
=== | ===A panel=== | ||
*H&E 2 micrometers. | *H&E 2 micrometers. | ||
*CD20 -- B cells. | *CD20 -- B cells. | ||
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*MUM1 -- B cells. | *MUM1 -- B cells. | ||
*CD21 -- highlight FDC networks if present. | *CD21 -- highlight FDC networks if present. | ||
*CD23 -- highlight FDC networks if present. | *[[CD23]] -- highlight FDC networks if present. | ||
*MIB1 -- proliferative rate. | *MIB1 -- proliferative rate. | ||
*EBER -- [[EBV]]. | *EBER -- [[EBV]]. | ||