Spleen
Hematogenous neoplasms
Diffuse large B cell lymphoma

Author: Jaleh Mansouri, M.D. (see Authors page)

Revised: 5 March 2018, last major update January 2013

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Diffuse large B cell lymphoma[TI] spleen

Cite this page: Mansouri, J. Diffuse large B cell lymphoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/spleendiffuselargeBcell.html. Accessed July 22nd, 2018.
Definition / general
  • Most frequent splenic lymphoma (50%), usually due to secondary dissemination from other sites
  • Splenomegaly, left upper quadrant pain, fever, weight loss, elevated erythrocyte sedimentation rate; also hypersplenism
  • May be associated with HIV
  • Commonly metastasizes to hilar and retroperitoneal lymph nodes
  • May coexist with SLL / CLL
Treatment
  • Splenectomy, chemotherapy
Gross description
  • Large or small nodules or diffuse red pulp infiltration, may invade splenic capsule and adjacent structures
Microscopic (histologic) description
  • Sheets of pleomorphic large cells (centroblasts, immunoblasts, anaplastic) with frequent mitotic figures, often plasmacytoid features; T cell / histiocyte rich tumors mimic reactive lesions
  • Patterns: macronodular (60%, usually stage I, usually favorable outcome, BCL6+), micronodular (30%, advanced clinical stage and often death due to disease, BCL6+, includes T cell rich B cell subtype), diffuse red pulp infiltration (10%, advanced clinical stage and often death due to disease, BCL6+) (Am J Surg Pathol 2003;27:895)
    • Macronodular:
      • Homogenous compact masses of large lymphocytes effacing splenic architecture, usually necrosis, often sclerosis
      • Tumor cells usually centroblasts, also immunoblasts and polylobated cells
      • Often macrophages, occasional epithelioid histiocytes
    • Micronodular:
      • Includes T cell / histiocyte rich B cell lymphoma (Am J Surg Pathol 2003;27:903)
      • Uniform miliary pattern with focal coalescence of splenic white pulp micronodules
      • Variable infiltration of red pulp
      • Nodules composed of large B cells with occasional small T cells and CD68+ histiocytes
      • No residual mantle zone, no follicular dendritic cell network
      • Small areas of necrosis and macrophages occasionally seen
      • May mimic reactive conditions
    • Diffuse red pulp infiltration:
      • Diffuse tumor infiltration of red pulp cords and sinusoids with scattered residual white pulp islands
      • No pseudosinuses
      • Tumor cells are centroblastic, polylobated or pleomorphic
      • Usually no necrosis
Positive stains
Negative stains
Differential diagnosis