Diffuse large B cell lymphoma classification: Difference between revisions
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==Overview== | ==Overview== | ||
Diffuse large B cell lymphoma may be classified into variants, subgroups, subtypes, and entities based on the World Health Organization Classification (WHO). | Diffuse large B cell lymphoma may be classified into variants, subgroups, subtypes, and entities based on the World Health Organization Classification (WHO). | ||
==Overview== | |||
Diffuse large B cell lymphoma may be classified based on location into nodal and extranodal disease and based on molecular, genetic, and immunohistochemical features into more than 20 subgroups. | |||
==Classification== | ==Classification== | ||
Diffuse large B | Diffuse large B cell lymphoma may be classified based on location: | ||
*Nodal disease | |||
*Extranodal disease | |||
According to the WHO 2008 classification, diffuse large B cell lymphoma may be classified based on molecular, genetic, and immunohistochemical features into the following:<ref name=WHO>{{cite book |last=Stein H, Chan JKC, Warnke RA |date=2008 |title=Diffuse large B-cell lymphoma not otherwise specified. In:Swerdlow SH, Campo E, Harris NL, et al. editors. WHO classification of tumours of haematopoietic and lymphoid tissues |location=Lyon |publisher=IARC |page=233-7 |isbn=}}</ref> | |||
* | ===Diffuse large B cell lymphoma, not otherwise specified=== | ||
* | ====Morphologic subgroups==== | ||
*Other | * Centroblastic | ||
* Immunoblastic | |||
* Anaplastic | |||
*Other | |||
====Immunophenotypic subgroups==== | |||
* Germinal center-derived B-cell (GCB) | |||
* Activated B-cell-like (ABC) | |||
====Genetic subgroups==== | |||
*''BCL6'' | |||
*''BCL2'' | |||
*''C-MYC'' | |||
*Other | |||
====Immunohistochemical subgroups==== | |||
* CD5-positive de-novo diffuse large B cell lymphoma | |||
* Germinal center B-cell like (GCB) | |||
*Non-germinal center B-cell-like (non-GCB) | |||
Diffuse large B | ===Diffuse Large B Cell Lymphoma subtypes=== | ||
* | *T-cell/histiocyte-rich large B cell lymphoma | ||
* | *Primary diffuse large B cell lymphoma of the central nervous system (CNS) | ||
*Epstein-Barr virus positive diffuse large B cell lymphoma of the elderly | |||
===Other lymphomas of large B cells=== | |||
===Other lymphomas of large B | |||
* Primary mediastinal (thymic) large B-cell lymphoma | * Primary mediastinal (thymic) large B-cell lymphoma | ||
* Intravascular large B-cell lymphoma | * Intravascular large B-cell lymphoma | ||
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* Large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease | * Large B-cell lymphoma arising in HHV8-associated multicentric Castleman disease | ||
* Primary effusion lymphoma | * Primary effusion lymphoma | ||
===Borderline cases B-cell 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 Burkitt lymphoma B-cell lymphoma, | ||
Revision as of 01:16, 25 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).
Overview
Diffuse large B cell lymphoma may be classified based on location into nodal and extranodal disease and based on molecular, genetic, and immunohistochemical features into more than 20 subgroups.
Classification
Diffuse large B cell lymphoma may be classified based on location:
- Nodal disease
- Extranodal disease
According to the WHO 2008 classification, diffuse large B cell lymphoma may be classified based on molecular, genetic, and immunohistochemical features into the following:[1]
Diffuse large B cell lymphoma, not otherwise specified
Morphologic subgroups
- Centroblastic
- Immunoblastic
- Anaplastic
- Other
Immunophenotypic subgroups
- Germinal center-derived B-cell (GCB)
- Activated B-cell-like (ABC)
Genetic subgroups
- BCL6
- BCL2
- C-MYC
- Other
Immunohistochemical subgroups
- CD5-positive de-novo diffuse large B cell lymphoma
- Germinal center B-cell like (GCB)
- Non-germinal center B-cell-like (non-GCB)
Diffuse Large B Cell Lymphoma subtypes
- T-cell/histiocyte-rich large B cell lymphoma
- Primary diffuse large B cell lymphoma of the central nervous system (CNS)
- Epstein-Barr virus positive diffuse large B cell lymphoma 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
- ↑ Stein H, Chan JKC, Warnke RA (2008). Diffuse large B-cell lymphoma not otherwise specified. In:Swerdlow SH, Campo E, Harris NL, et al. editors. WHO classification of tumours of haematopoietic and lymphoid tissues. Lyon: IARC. p. 233-7.
- ↑ 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.