Diffuse large B-cell lymphoma
- Lesion
The commonest aggressive lymphoma: sheets of large B cells grow fast in a node or organ. With treatment many patients are cured.
What it is
Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma. It is a group of aggressive tumours of large B cells that grow in diffuse sheets and often arise outside nodes (gut, skin, bone, brain). Some arise de novo and others transform from indolent lymphomas such as follicular lymphoma or CLL. Special subtypes are tied to particular settings: immunodeficiency and EBV, the mediastinum, body cavities and HHV-8, and the CNS.
Structure
- Node or organ effaced by sheets of large cells with vesicular nuclei and prominent nucleoli (centroblast-like or immunoblastic).
- Necrosis and many mitoses; no follicles.
- Extranodal masses: destructive, fleshy, white tumours, for example in the stomach wall or brain.
Step by step
- A germinal centre or post-germinal centre B cell acquires lesions in BCL6, BCL2, MYC or B-cell receptor signalling genes (CD79B, MYD88).
- Misdirected somatic hypermutation scatters mutations into oncogenes.
- In immunodeficiency, EBV-driven B-cell proliferation escapes T-cell control.
- Large transformed cells divide rapidly, form masses and spread to many sites.
Markers
- CD19
- CD20
- BCL6
- CD10 (variable)
- MYC
- BCL2
- Ki-67 high
Clinical notes
- A rapidly enlarging mass at one node or extranodal site; B symptoms are common.
- Combination chemotherapy with anti-CD20 antibody cures many patients; CD19-directed CAR-T cells are used in relapse.
- Primary CNS lymphoma, usually a DLBCL, is linked to EBV in people with HIV.
Test yourself
Think of the answer, then tap the question to see it.
What is a 'double-hit' lymphoma?
A high-grade B-cell lymphoma with rearrangements of both MYC and BCL2, combining fast growth with resistance to apoptosis.
Which virus is associated with primary effusion lymphoma?
Human herpesvirus 8 (KSHV), mostly in advanced HIV infection.
How does primary mediastinal large B-cell lymphoma typically present?
As an anterior mediastinal mass in a young adult woman, sometimes with superior vena cava syndrome.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Non-Hodgkin Lymphoma Treatment (PDQ®)–Patient Version (National Cancer Institute (NCI), 2026).
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Representative model, for educational purposes only.