HaematopathologyIntermediateAnnotated

Diffuse large B-cell lymphoma

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Clinical history

63-year-old with rapidly enlarging cervical lymphadenopathy and B symptoms.

Specimen

Excisional lymph node biopsy · Stain: H&E and IHC

Microscopic description

Effacement of nodal architecture by a diffuse infiltrate of large cells with vesicular nuclei and prominent nucleoli. High mitotic rate with apoptotic debris.

Diagnostic question

Which immunohistochemical panel would you request and why?

Reveal differential diagnosis
  • Burkitt lymphoma
  • Classic Hodgkin lymphoma
  • Metastatic poorly differentiated carcinoma
Reveal final diagnosis

Diffuse large B-cell lymphoma, not otherwise specified

Learning points

  • CD20, CD3, CD10, BCL6, MUM1, BCL2, MYC and Ki-67 form a core panel
  • Hans algorithm assigns cell of origin
  • MYC and BCL2 rearrangement testing is indicated in selected cases

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