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Lymphoma - B cell neoplasms

B cell lymphoma subtypes

Diffuse large B cell lymphoma - T cell/histiocyte rich


Reviewer: Nikhil Sangle, M.D., University of Utah and ARUP Laboratories (see Reviewers page)
Revised: 22 February 2011, last major update February 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Definition
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● Diffuse large B cell lymphoma subtype with abundant non-neoplastic T cells and histiocytes, that may obscure tumor cells

Clinical features
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● Usually middle-aged adults, often with advanced stage and involvement of lymph nodes, spleen, bone marrow
● Morphologic variants include L&H-like, centroblast/immunoblast-like and Reed-Sternberg-like
● L&H-like cases may be related to nodular lymphocyte predominant Hodgkin lymphoma

Case reports
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● CD5+ tumor (Mod Pathol 2002;15:1051)

Micro description
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● Neoplastic large B cells (<10% of cells) scattered among small reactive T cells and histiocytes, in fine fibrillary fibrous background
● Have diverse morphologic and immunophenotypic features (Am J Surg Pathol 2002;26:1458)
L&H-like: pale and indistinct cytoplasm, lobated and vesicular nuclei resembling popcorn cells with small central nucleoli; background of small lymphocytes and often histiocytes, no granulomas
Centroblast-like: pale eosinophilic cytoplasm, oval/round nuclei with vesicular chromatin and without nuclear atypia, small basophilic nucleoli adjacent to nuclear membrane
Reed-Sternberg-like: large multinucleated cells with abundant amphophilic cytoplasm, pleomorphic nuclei with prominent eosinophilic or amphophilic round/central nucleoli, in background of small lymphocytes and histiocytes; no eosinophils, no neutrophils, no plasma cells

Micro images
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Various images

           

Various images

Positive stains
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● CD20, CD79a (weaker than CD20), bcl6, EMA (37%, associated with L&H cells), CD30 (30%, usually stains Reed-Sternberg-like cells)
● Rarely positive for bcl2 (13%), CD10 (10%)
● Reactive T cells are CD3+, CD5+
● Reactive histiocytes are CD68+

Negative stains
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● CD15, CD30, CD138
● No T-cell rosetting around tumor cells

Differential diagnosis
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Nodular lymphocyte predominant Hodgkin lymphoma: has residual IgD positive mantle cells and follicular dendritic cell meshwork (not present in diffuse large B cell lymphoma)

End of Lymphoma - B cell neoplasms > B cell lymphoma subtypes > Diffuse large B cell lymphoma - T cell/histiocyte rich subtype


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