[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [White cells, lymph nodes, spleen and thymus](https://durgical.com/en/general-pathology/areas/hematolymphoid/) › Diffuse large B-cell lymphoma # 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. Updated Nov 12, 2026 ## Key points - Large cells (several times a small lymphocyte) growing diffusely; CD19 and CD20 positive. - BCL6 dysregulation (3q27 rearrangement or promoter mutations) is the commonest genetic event; some have t(14;18). - MYC plus BCL2 rearrangement ('double-hit') lymphomas are very aggressive. - Primary mediastinal large B-cell lymphoma: young women, anterior mediastinal mass, superior vena cava syndrome. - Primary effusion lymphoma (HHV-8) presents as a malignant pleural, pericardial or peritoneal effusion in advanced HIV. ## 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. ## Memory aid Diffuse, large, B and fast: the lymphoma most often met, and most often cured among the aggressive ones. ## 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. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/general-pathology/diffuse-large-b-cell-lymphoma/) [More Pathology questions →](https://durgical.com/en/practice/?f=pathology) ## Elsewhere in DurgiPedia - [B-cell activation, class switching and affinity maturation](https://durgical.com/en/immunology/b-cell-activation-class-switching-and-affinity-maturation/) ## Connections ## Related 5 - [Follicular lymphoma](https://durgical.com/en/general-pathology/follicular-lymphoma/) - [Chronic lymphocytic leukaemia (CLL/SLL)](https://durgical.com/en/general-pathology/chronic-lymphocytic-leukaemia/) - [Burkitt lymphoma](https://durgical.com/en/general-pathology/burkitt-lymphoma/) - [Gastrointestinal lymphoma](https://durgical.com/en/general-pathology/gastrointestinal-lymphoma/) - [Oncogenic viruses and H. pylori: the table to know](https://durgical.com/en/general-pathology/oncogenic-viruses-and-h-pylori-the-table-to-know/) ## Related conditions 5 - [Non-Hodgkin lymphoma](https://durgical.com/en/conditions/non-hodgkin-lymphoma/) - [Primary central nervous system lymphoma](https://durgical.com/en/conditions/primary-central-nervous-system-lymphoma/) - [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/) - [Superior vena cava syndrome](https://durgical.com/en/conditions/superior-vena-cava-syndrome/) - [Mediastinal masses (thymoma and anterior mediastinal mass)](https://durgical.com/en/conditions/mediastinal-masses/) ## Microorganisms 3 - [Epstein–Barr virus](https://durgical.com/en/microbiology/epstein-barr-virus/) - [Human herpesvirus 8](https://durgical.com/en/microbiology/human-herpesvirus-8/) - [Human immunodeficiency virus](https://durgical.com/en/microbiology/human-immunodeficiency-virus/) [← All of general pathology](https://durgical.com/en/general-pathology/) 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](https://www.cancer.gov/types/lymphoma/patient/adult-nhl-treatment-pdq) (National Cancer Institute (NCI), 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/general-pathology/diffuse-large-b-cell-lymphoma/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/diffuse-large-b-cell-lymphoma/