A non-Hodgkin’s lymphoma,
also very common,
a diffuse large B-cell lymphoma.
you will be responsible for
at least three different ways
in which your patient is going to
develop diffuse large B-cell lymphoma.
We officially have spoken and completed
one possible method or progression
and that’s from your follicular B cell
lymphoma with translocation 14;18.
A second that I briefly mentioned
would be your Richter syndrome
that then developed from CLL.
With that said, 30% of your
diffuse large B-cell lymphoma,
where are you?
With involvement of the lymph node,
this will be the follicle
and large replacement.
You have large B-cells.
In follicular lymphoma, in the follicle,
these are small cleaved B-cells.
These are large B-cells
located in the follicle.
Also, what I wish to mention here
because at some point, when you have
a discussion with an oncologist,
they might be referring to diffuse
large B-cell lymphoma of the GI.
And that’s extranodal involvement
of diffuse large B-cell lymphoma.
I said extranodal because what category
or family does DLBCL come under?
It comes under
Give me some common characteristics
of non-Hodgkin’s lymphoma.
What kind of spread
in lymph node?
And what about the involvement of
extranodal sites, common or rare in NHL?
Commonly in the GI.
20-30% carry translocation and here’s your
third type of development of your DLBCL.
And this would be BCL-6,
and that’s something that you
absolutely must memorize.
The gene involved in regulation
of BCL differentiation,
and a third one that we will mention
in going to greater detail,
will be Richter syndrome.
Diffuse large B-cell lymphoma is
common in immunodeficient patients.
Therefore, look for patients
who may then develop
diffuse large B-cell lymphoma with HIV
involving both EBV or
perhaps even HHV-8.
Now, remember EBV could
be all over the place.
And the fact that you may actually
develop large B-cell lymphoma.
In HHV8, be careful,
sure you know about Kaposi's sarcoma.
Apart from Kaposi's,
remember immunocompromised patient
with HHV-8 may also then give rise to
diffuse large B-cell lymphoma.
Pay special attention to HIV or
immunocompromised patients with DLBCL.
Students tend to forget about
this manifestation of HIV.
As you would expect on morphology,
there will be diffuse replacement
of lymph node parenchyma with large
What does pleomorphic mean to you?
Different sizes and shapes
of your particular cell.
In this case, yes, you have large B-cells,
but they’re not all uniform in size,
but they’re definitely large.
Where are you right now?
In your lymph node.
And tell me about the
characteristic of a lymph node.
It doesn’t hurt.
DLBCL, who’s your patient?
Older, but with a wide range.
Patients usually present
with rapidly enlarging mass.
You do not have an indolent
course rapidly involving.
Once again, an important point,
not only do you have nodal involvement,
but commonly you would have
extranodal involvement usually
affecting the GI system.
Because of involvement of the lymph
node and the rapid growth of it,
the symptoms oftentimes you would
expect to see would be mass effect
because of the enlargement of the
lymph node, tissue destruction.
Now DLBCL is very aggressive,
but may respond quite
well to chemotherapy
with the lasting remissions
seen in 50% of the patients.
Thank goodness that is a
very impressive number.
A lot of times what you’ll notice
and you talked about this when you
did antineoplastics in pharmacology,
is the fact that if you have a cell
that is rapidly, rapidly dividing,
the cells that inhibit the division might
be quite effective against such cancers.
Example for this as well, HER-2/neu
positive in breast cancer.