DLBCL


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  • Clinical

    • 25-30% of adult non-Hodgkins
    • median age 70s
    • association: immunodeficiency, EBV
    • assumed to be DLBCL NOS unless specified
    • treatment
      • limited disease: abbreviated R-CHOP + IFRT
      • GC type: standard R-CHOP
      • ABC type: R-CHOP + another (lenalidomide, ibrutinib, bortezomib) or R-ACVBP
      • Double hit: clinical trial
      • Double expressor: clinical trial if available

  • Morphology variants

    • centroblastic: most common, multiple nucleoli
    • immunoblastic: single central nucleoli
    • anaplastic: really large and bizzare cells
    • rare variants

  • Subtype

    • germinal center type
      • CD10 > 30% or
      • BCL6+ and MUM1-
    • non-germinal center type

  • Panel

    • CD3, 5, 20, PAX5, cyclinD1
    • GC eval: CD10, BCl6, Mum1
    • Double hit eval: BCL2, cMyc (cutoffs 50%, 40%)
    • clinical trials: CD30
    • Ki67, EBV
    • cutoffs
      • 30% for CD10, Mum1, BCL6
      • 40% for myc
      • 70% for BCL2

  • Molecular

    • 30% have 3q27 BCL6 abnormality
    • 20% have t(14;18) like follicular lymphoma

  • Signout

    • Diffuse large B cell lymphoma, not otherwise specified, see comment
    • Comment
      • The lymphoma has a *** germinal center immunophenotype
      • The Ki67 proliferation index is ***%, BCL2 stains ***% of the neoplastic cells, and c-Myc intensely stains approximately ***% of the neoplastic cells
    • Routine cytogenetic studies are pending

  • Specific types

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