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*Unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma B-cell lymphoma, | *Unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma B-cell lymphoma, | ||
*Unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma | *Unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma | ||
==Baed on Microscopic pathology== | |||
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| [[image:215px-diffuse large B cell lymphoma - cytology low mag.jpg|thumb|350px|Micrograph of a diffuse large B cell lymphoma]] | |||
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* Three variants are most commonly seen: centroblastic, immunoblastic, and anaplastic. | |||
===Centroblastic=== | |||
* Most cases of are diffuse large B cell lymphoma centroblastic, having the appearance of medium-to-large-sized [[lymphocyte]]s with scanty [[cytoplasm]]. | |||
* Oval or round [[Cell nucleus|nuclei]] containing fine [[chromatin]] are prominently visible, having two to four [[nucleoli]] within each nucleus. | |||
* Sometimes the tumour may be monomorphic, composed almost entirely of centroblasts. | |||
* However, most cases are polymorphic, with a mixture of centroblastic and immunoblastic cells. | |||
===Immunoblastic=== | |||
* Immunoblasts have significant [[basophilic]] cytoplasm and a central nucleolus. | |||
* A tumour can be classified as immunoblastic if greater than 90% of its cells are immunoblasts. This distinction can be problematic, however, because hematopathologists reviewing the microscope slides may often disagree on whether a collection of cells is best characterized as centroblasts or immunoblasts.<ref name="Harris1994">{{cite journal |pmid=8068936 |year=1994 |last1=Harris |first1=N. L. |title=A revised European-American classification of lymphoid neoplasms: A proposal from the International Lymphoma Study Group |journal=Blood |volume=84 |issue=5 |pages=1361–92 |last2=Jaffe |first2=E. S. |last3=Stein |first3=H |last4=Banks |first4=P. M. |last5=Chan |first5=J. K. |last6=Cleary |first6=M. L. |last7=Delsol |first7=G |last8=De Wolf-Peeters |first8=C |last9=Falini |first9=B |last10=Gatter |first10=K. C. |url=http://www.bloodjournal.org/content/84/5/1361 }}</ref> Such disagreement indicates poor [[inter-rater reliability]]. | |||
===Anaplastic=== | |||
* The third morphologic variant, [[Anaplasia|anaplastic]], consists of tumour cells which appear very differently from their normal B cell counterparts. | |||
* The cells are generally very large with a round, oval, or polygonal shape and [[Pleomorphism (cytology)|pleomorphic]] nuclei, and may resemble [[Hodgkin's lymphoma#Pathology|Hodgkin cells]] or [[Reed–Sternberg cell|Reed-Sternberg cells]]. | |||
==References== | ==References== | ||
Revision as of 21:55, 24 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diffuse large B cell lymphoma may be classified into variants, subgroups, subtypes, and entities based on the World Health Organization Classification (WHO).
Classification
Diffuse large B-cell lymphoma encompasses a biologically and clinically diverse set of diseases,[1] many of which cannot be separated from one another by well-defined and widely accepted criteria.
The World Health Organization (WHO) classification system defines more than a dozen subtypes, each of which can be differentiated based on the
- Location of the tumor
- Presence of other cells within the tumor (such as T cells)
- Other illnesses related to diffuse large B-cell lymphoma.
- One of these well-defined groupings of particular note is Primary mediastinal B-cell lymphoma, which arises within the thymus or mediastinal lymph nodes.
Diffuse large B-cell lymphoma, not otherwise specified
- When a case of Diffuse large B-cell lymphoma does not conform to any of the well-defined subtypes, and is also not considered unclassifiable.
- The majority of Diffuse large B-cell lymphoma cases fall into this category.
- Much research has been devoted to separating this still-heterogeneous group; such distinctions are usually made along lines of
- cellular morphology
- gene expression
- immunohistochemical properties.
Diffuse large B-cell lymphoma (DLBCL): variants, subgroups, subtypes, and entities based on the World Health Organization Classification (WHO)
DLBCL, not otherwise specified (DLBCL, NOS)
- Common morphological variants
- Centroblastic
- Immunoblastic
- Anaplastic
- Rare morphological variants
- Molecular subgroups
- Germinal center B-cell-like (GCB)
- Activated B-cell-like (ABC)
- Immunohistochemical subgroups
- CD5-positive DLBCL
- Germinal center B-cell-like (GCB)
- Non-germinal center B-cell-like (non-GCB)
DLBCL subtypes
- T-cell-/histiocyte-rich large B-cell lymphoma
- Primary DLBCL of the central nervous system
- Primary cutaneous DLBCL
- Leg type EBV-positive DLBCL of the elderly
Other lymphomas of large B-cells
- Primary mediastinal (thymic) large B-cell lymphoma
- Intravascular large B-cell lymphoma
- DLBCL associated with chronic inflammation
- Lymphomatoid granulomatosis
- ALK-positive LBCL
- Plasmablastic lymphoma
- Large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease
- Primary effusion lymphoma
Borderline cases B-cell lymphoma
- Unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma B-cell lymphoma,
- Unclassifiable, with features intermediate between DLBCL and classical Hodgkin lymphoma
Baed on Microscopic pathology
- Three variants are most commonly seen: centroblastic, immunoblastic, and anaplastic.
Centroblastic
- Most cases of are diffuse large B cell lymphoma centroblastic, having the appearance of medium-to-large-sized lymphocytes with scanty cytoplasm.
- Oval or round nuclei containing fine chromatin are prominently visible, having two to four nucleoli within each nucleus.
- Sometimes the tumour may be monomorphic, composed almost entirely of centroblasts.
- However, most cases are polymorphic, with a mixture of centroblastic and immunoblastic cells.
Immunoblastic
- Immunoblasts have significant basophilic cytoplasm and a central nucleolus.
- A tumour can be classified as immunoblastic if greater than 90% of its cells are immunoblasts. This distinction can be problematic, however, because hematopathologists reviewing the microscope slides may often disagree on whether a collection of cells is best characterized as centroblasts or immunoblasts.[2] Such disagreement indicates poor inter-rater reliability.
Anaplastic
- The third morphologic variant, anaplastic, consists of tumour cells which appear very differently from their normal B cell counterparts.
- The cells are generally very large with a round, oval, or polygonal shape and pleomorphic nuclei, and may resemble Hodgkin cells or Reed-Sternberg cells.
References
- ↑ Alizadeh, Ash A.; Eisen, Michael B.; Davis, R. Eric; Ma, Chi; Lossos, Izidore S.; Rosenwald, Andreas; Boldrick, Jennifer C.; Sabet, Hajeer; Tran, Truc; Yu, Xin; Powell, John I.; Yang, Liming; Marti, Gerald E.; Moore, Troy; Hudson, James; Lu, Lisheng; Lewis, David B.; Tibshirani, Robert; Sherlock, Gavin; Chan, Wing C.; Greiner, Timothy C.; Weisenburger, Dennis D.; Armitage, James O.; Warnke, Roger; Levy, Ronald; Wilson, Wyndham; Grever, Michael R.; Byrd, John C.; Botstein, David; et al. (2000). "Distinct types of diffuse large B-cell lymphoma identified by gene expression
profiling". Nature. 403 (6769): 503–11. Bibcode:2000Natur.403..503A. doi:10.1038/35000501. PMID 10676951. line feed character in
|title=at position 78 (help) - ↑ Harris, N. L.; Jaffe, E. S.; Stein, H; Banks, P. M.; Chan, J. K.; Cleary, M. L.; Delsol, G; De Wolf-Peeters, C; Falini, B; Gatter, K. C. (1994). "A revised European-American classification of lymphoid neoplasms: A proposal from the International Lymphoma Study Group". Blood. 84 (5): 1361–92. PMID 8068936.