Diffuse Large Bcell Lymphoma

General: Diffuse large B-cell lymphoma (DLBCL) is the most common NHL. It occurs most commonly in adults with a median age of 64 years and a slight male predominance. Unlike indolent lymphomas, only 17% of patients have bone marrow involvement.1 This lymphoma is potentially curable with a cure rate of approximately 35% with anthracycline-based thera-

pies.53

Pathology: DLBCL is characterized by a diffuse infiltrate of large cells. Size can be gauged by histiocyte or endothelial cells within the tissue. DLBCL cells are typically larger than these cells. The cytologic features can be variable. Many cases have a predominance of cen-troblasts with vesicular chromatin and multiple small nucleoli. The nucleus can be round or lobulated. Some cells resemble immunoblasts with prominent central nucleoli. Cytoplasm is generally moderate in amount.

Figure 52.13 Diffuse large B-cell lymphoma. Sheets of centroblastic cells are present. Immunostains show the cells lack CD10 (top inset), but express bcl-6 (middle inset) and MUM1(bottom inset). This phenotype is consistent with a nongerminal center-type DLBCL, associated with a worse outcome compared the germinal center-type DLBCL

Figure 52.13 Diffuse large B-cell lymphoma. Sheets of centroblastic cells are present. Immunostains show the cells lack CD10 (top inset), but express bcl-6 (middle inset) and MUM1(bottom inset). This phenotype is consistent with a nongerminal center-type DLBCL, associated with a worse outcome compared the germinal center-type DLBCL

using expression data from just a few genes62-64 or immunohistochemical staining for three genes58 have been shown to be prognostically significant. Using a model of weighted gene expression, investigators showed that just six genes yielded prognostic information independent of the IPI in two independent data sets. Three genes (BCL2, SCYA3, and CCND2) were associated with worse prognosis and three genes (LMO2, BCL6, and FN1) were associated with good prognosis.64

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