Stains & CD markers
BCL6


Last author update: 5 May 2022
Last staff update: 5 May 2022

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PubMed Search: BCL6

Elena M. Fenu, M.D.
Danielle Lameirinhas Vieira Maracaja, M.D.
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Cite this page: Fenu EM, Maracaja DLV. BCL6. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stainsbcl6.html. Accessed December 9th, 2022.
Definition / general
Essential features
Terminology
  • B cell lymphoma 6
Pathophysiology
  • Proto-oncogene: normally inhibits germinal center lymphocytes' response to DNA damage to allow for immunoglobulin somatic hypermutation by repressing tumor suppressor TP53 and CDKN1A, ATR and CHEK1 (Blood Cells Mol Dis 2008;41:95)
  • Suppresses the expression of antiapoptotic BCL2 (Front Cell Dev Biol 2019;7:272)
Diagrams / tables

Contributed by Elena M. Fenu, M.D.
Staining algorithm for DLBCL

Staining algorithm for DLBCL

Interpretation
  • Nuclear staining
Uses by pathologists
Prognostic factors
  • Large cell lymphomas with rearrangements of MYC, BCL2 or BCL6 (double or triple hit lymphomas) are classified as high grade B cell lymphomas and carry a poor prognosis (Diagn Pathol 2019;14:81)
  • DLBCL with a germinal center B cell-like phenotype have better prognosis compared to those that are nongerminal center type (Blood 2004;103:275)
Microscopic (histologic) images

Contributed by Elena M. Fenu, M.D.
Reactive follicular hyperplasia (H&E and BCL6) Reactive follicular hyperplasia (H&E and BCL6)

Reactive follicular hyperplasia

Follicular lymphoma, grade 1 - 2 (H&E and BCL6) Follicular lymphoma, grade 1 - 2 (H&E and BCL6)

Follicular lymphoma, grade 1 - 2

Follicular lymphoma, grade 3B (H&E and BCL6) Follicular lymphoma, grade 3B (H&E and BCL6)

Follicular lymphoma, grade 3B


Angioimmunoblastic T cell lymphoma (H&E and BCL6) Angioimmunoblastic T cell lymphoma (H&E and BCL6)

Angioimmunoblastic T cell lymphoma

Burkitt lymphoma (H&E and BCL6) Burkitt lymphoma (H&E and BCL6)

Burkitt lymphoma

T cell / histiocyte rich large B cell lymphoma (H&E and BCL6) T cell / histiocyte rich large B cell lymphoma (H&E and BCL6)

T cell / histiocyte rich large B cell lymphoma


Nodular lymphocyte predominant Hodgkin lymphoma (H&E and BCL6) Nodular lymphocyte predominant Hodgkin lymphoma (H&E and BCL6)

Nodular lymphocyte predominant Hodgkin lymphoma

Classic Hodgkin lymphoma Classic Hodgkin lymphoma

Classic Hodgkin lymphoma

Virtual slides

Images hosted on other servers:
Duodenal type follicular lymphoma (BCL6)

Duodenal type follicular lymphoma

In situ follicular neoplasm involving a lymph node (BCL6)

In situ follicular neoplasm involving a lymph node

Follicular lymphoma involving a lymph node (BCL6) Follicular lymphoma involving a lymph node (BCL6) Follicular lymphoma involving a lymph node (BCL6)

Follicular lymphoma involving a lymph node

Follicular lymphoma involving soft tissue (BCL6)

Follicular lymphoma involving soft tissue

Positive staining - normal
Positive staining - disease
Negative staining
Molecular / cytogenetics description
  • Diagnosis of double or triple hit DLBCL is based on break apart FISH of MYC, BCL2 and BCL6 (Ann Lab Med 2020;40:361)
Sample pathology report
  • Lymph node, left inguinal, excision:
    • Diffuse large B cell lymphoma, germinal center B cell subtype (see comment)
    • Comment: There is total replacement of the nodal architecture by diffuse sheets of large lymphocytes with irregular nuclear contours, open chromatin and distinct nucleoli. The tumor cells are immunoreactive for CD20, CD10, BCL6 and BCL2 and negative for MUM1, MYC and CD30, which confirms the diagnosis. The Ki67 proliferation rate is approximately 60 - 70%.
Board review style question #1


A lymph node biopsy morphologically demonstrates involvement by a large cell lymphoma. The neoplastic cells stain positive for CD20, BCL6, BCL2, MUM1 and MYC and negative for CD3, CD10, CD30 and CD138. What is the diagnosis?

  1. Anaplastic large cell lymphoma (ALCL)
  2. Diffuse large B cell lymphoma (DLBCL), germinal center subtype
  3. Diffuse large B cell lymphoma (DLBCL), nongerminal center subtype
  4. Plasmablastic lymphoma
  5. T cell / histiocyte rich large B cell lymphoma
Board review style answer #1
C. DLBCL, nongerminal center subtype. The neoplastic cells are positive for CD20, denoting a B cell origin. Following the Hans algorithm, a DLBCL that is negative for CD10 and positive for both BCL6 and MUM1 is nongerminal center subtype. ALCL is a T cell lymphoma and typically positive for CD30. Plasmablastic lymphoma expresses markers of plasmacytic differentiation like CD138 and is negative or only weakly positive for CD20.

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