Diffuse large B-cell lymphoma

From Libre Pathology
Revision as of 03:00, 17 October 2011 by Michael (talk | contribs) (→‎IHC: more)
Jump to navigation Jump to search

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

Subclassification

There is a subclassification based on molecular testing:

  1. Germinal centre (GC) subtype.
  2. Non-germinal centre (Non-GC) subtype.

The following IHC algorithm has been subsequently developed to reproduce the molecular categorization:[3]

 
 
 
 
 
 
DLBCL
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
CD10 -ve
 
 
 
CD10 +ve
GC
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
BCL6 -ve
Non-GC
 
 
 
BCL6 +ve
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
MUM1 -ve
GC
 
 
 
MUM1 +ve
Non-GC

"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.[4]
    • Can be assessed with an ISH break apart probe.
  • Translocation typical of follicular lymphoma: t(14;18)(q32;q21)/IGH-BCL2.[5]

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. Choi, WW.; Weisenburger, DD.; Greiner, TC.; Piris, MA.; Banham, AH.; Delabie, J.; Braziel, RM.; Geng, H. et al. (Sep 2009). "A new immunostain algorithm classifies diffuse large B-cell lymphoma into molecular subtypes with high accuracy.". Clin Cancer Res 15 (17): 5494-502. doi:10.1158/1078-0432.CCR-09-0113. PMID 19706817.
  4. Online 'Mendelian Inheritance in Man' (OMIM) 109565
  5. 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.