Large B-cell lymphomas

Question 1

Diffuse large B-Cell Lymphoma (Germinal vs Non germinal flow chart)

Answer 1

Question 2

3 Types of DLBCL, NOS?

Which has better prognosis?

Morphology?

Answer 2

Germinal center, Non-germinal center, CD5+

Germinal center type

Centroblasts (vesicular chromatin with nuceoli attached to inner membrane) and immunoblasts (central nucleoli)

Question 3

DLBCL IHC Pattern?

Ki-67% range?

Answer 3

CD20+/PAX5+/BCL2+ (follicular vs reactive; BCL2-) CD10+/BCL6+/MUM1-

30-100% Ki-67

Question 4

Morphology of T-cell/histeocyte rich DLBCL?

T-cell/histeocyte rich DLBCL aggressive or indolent?

Answer 4

CD20+ Large cells with lots of background CD3+ and CD68+ cells

Aggressive

Question 5

Primary mediastinal Large B-cell Lympma arises from?

Patient populations; prognosis?

IHC and diff from Hodgkin’s?

Answer 5

Thymic remnants; delicate trebecular fibrosis

Middle age females; good prognosis

PMLBCL: CD30+, PAX5+, CD19,20,22,79a+, BCL6+/-, CD15 (mostly) -, CD10 (<30%), MUM1+
Hodgkins: CD20-, PAX5-, BCL6-

Question 6

Burkitt lymphoma, aggressive or not?

Translocations (3 of them)?

IHC?

Answer 6

Aggressive stary sky morphology

t(8;13)(q23;q32) c-myc -IgH
t(2;8)(p12;q24) c-myc and IgK
t(8;22)(q24;q11) c-myc and IgL

CD20+, CD10+, PAX5+, CD10+, BCL6-, BCL2- (must be -), MUM1-, Light chain restriction common

Question 7

Endemic BL (EBV and MYC)?

Sporatic: Population, most common location in body?

Cell morphology in blood or aspirates?

Answer 7

EBV +, MYC +; Jaw in kids

GI common at IC valve, EBV rarely positive

Large cells with vacuoles in cytoplasm and nuclei

Question 8

Plasmablastic lymphoma is associated with?

IHC?
CD56 IHC?

EBV and HHV8 status?

Answer 8

HIV+!

CD45-, CD20-, PAX5-, CD79a+/-, CD38+, CD138+, MUM1+,
CD56-; if + consister anaplastic plasmacytoma or myeloma

Ki-67 >90%

EBV +, HHV8-

Question 9

Lymphomatoid granulomatosis histologic findings; indolent vs aggressive?

Main differential/ IHC?

EBV status?

Grading based on?

Answer 9

Angiocentric and angiodestructive disease in Lungs; indolent

NK nasal: CD2+, CD16+,CD7+, CD57+, CD56+, CD3-, EBER+

LG: CD45/LCA(+), CD30(+/-), CD15(-), CD19+, CD20+, CD22+, PAX5+, CD79a+ EBER(+)

EBV+
EBV+ cell/hpf and nerosis

Question 10

Primary effusion lymphoma associated with?

HHV8 and EBV status?

IHC?

Answer 10

Immunodeficency associated

HHV8+, and EBV+

CD45+, CD30+/-, CD38+, CD138+, CD20-, CD79a-, PAX5-, CD22-, Aberrant T-cell markers possible

Question 11

HHV8 positive DLBCL, NOS associated with?

What is commonly positive?

Morphology?

Answer 11

Multicentric Castleman and HIV and HHV8+

IgM

HHV8+, Plasmablastic lymphoma morphology and phenotype

Question 12

High grade B-cell lymphoma has what (double/triple hit; up to 3) mutations?

What is the diagnosis if CCDN1/Cyclin D1?

High or low grade?

Morphology?

Answer 12

MYC, BCL2, and or BCL6

Not HGBCL but Follicular lymphoma

High; most present as stage 4 disease

DLBCL or Burkitt type