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7 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
A lymphoma in which the cancer cells are a tiny minority of what the pathologist sees: scattered large B cells in a dense crowd of normal T cells and macrophages. It is a form of large B-cell lymphoma, it usually presents with disease in the liver, spleen or bone marrow, and it is easy to mistake for a different disease in both directions.
What it is. A large B-cell lymphoma in which the malignant cells make up a very small fraction of the tissue. The rest is a reaction: sheets of normal T cells and histiocytes, the tissue form of the macrophage. The diagnosis therefore depends on recognising the scattered large B cells in a background that looks inflammatory, and on the pattern of markers they carry.
How it differs from its family. Ordinary diffuse large B-cell lymphoma is made of sheets of tumour cells. Here the tumour is outnumbered, and the clinical behaviour is different too: it tends to present at an advanced stage with the liver, the spleen and the bone marrow involved rather than with enlarged lymph nodes alone, and it affects men more often and at a younger age than most large B-cell lymphomas.
| Setting | Approach | Guideline |
|---|---|---|
| Making the diagnosis, and the two ways it goes wrong | Both errors are common and they point in opposite directions. Called inflammatory, the lymphoma is missed, because the tumour cells are a small minority and the tissue looks reactive. Called nodular lymphocyte predominant Hodgkin lymphoma, an aggressive disease is treated as an indolent one. WHO-HAEM5 states that a clear distinction from the diffuse pattern of that disease may not be possible in some cases, and that small biopsies are the hardest. A generous biopsy, read by a haematopathologist, with the surrounding cells examined as carefully as the tumour cells, is the answer the classification gives. | not mapped |
| Treatment | Treated as diffuse large B-cell lymphoma, with rituximab-containing immunochemotherapy, which is appropriate for a disease that carries CD20 and behaves aggressively. The staging usually finds advanced disease with the liver, spleen or bone marrow involved. No randomised trial has been confined to this entity; the regimens, the cycles and the evidence are on the diffuse large B-cell lymphoma page and in the treatment layer of this family. | not mapped |