Diffuse Large B Cell Lymphoma
Diffuse Large B Cell Lymphoma
Updated: 05/21/2025
© Jun Wang, MD, PhD
General features
- Most common non-Hodgkin lymphoma
- High grade
- Fast growing, aggressive
- Either de novo or transformed from other low grade lymphoma
- Most common testicle tumor in patient older than 65
- WHO has subclassifications
Clinical presentations
- Rapid growing mass, nodal or extranodal
- Systemic "B" symptoms: Fever, weight loss, drenching night sweats
Key pathogenesis
- Bcl 6 associated NF-kB pathway
Key morphological features of
tumor cells
- Diffuse infiltration
- Sheets of tumor cells
- Pleomorphic large tumor cells
- Irregular size, shape, chromatin pattern, prominent nucleoli
Markers
- Positive: B cell markers CD19, CD20
- Negative: T cell markers CD3, CD4, CD8
- Negative: Epithelial markers: cytokeratin, etc
- High proliferative index per ki67, but less than 100%
Genetic abnormalities
- Various
- Translocations involving bcl2 or bcl 6
Primary CNS lymphoma
- A type of diffuse large B cell lymphoma arising within CNS or vitreous/retina
- WHO 2022 (5th edition) classifies as primary LBCL of immune privileged sites
- EBV+ if HIV+ patients, but EBV- if immunocompetent
- MYD88 mutation common
- Neurological presentations depending on site involved: commonly cognitive impairment and balance disorders
- Identical pathological features and immunoprofile
- Worse prognosis if immunocompromised
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