At a Glance
T-cell histiocyte rich large B-cell lymphoma (THRLB-CL) is considered a diffuse large B-cell lymphoma, but it is difficult to diagnose because of the paucity of large B-cells and the preponderance of T-cells and/or histiocytes. It is a rare lymphoma, accounting for less than 10% of diffuse large B-cell lymphomas and affects predominantly middle-age males (most reports indicate approximately 75% of patients are males). Unlike the typical diffuse large B-cell lymphoma, patients with THRLB-CL frequently present with bone marrow, liver, and spleen involvement and with systemic symptoms of fever and malaise.
What Tests Should I Request to Confirm My Clinical Dx? In addition, what follow-up tests might be useful?
Diagnosis is often difficult, but is usually made on a biopsy of an enlarged lymph node or bone marrow. Because there are relatively few neoplastic large B-cells, flow cytometry on fresh tissue is frequently non-diagnostic. Immunohistochemistry studies performed on sections of paraffin embedded tissue are essential to demonstrate the large neoplastic cells as B-cells (CD20 positive) that are positive for CD45 (leukocyte common antigen). Frequently, a large panel of immunohistochemistry studies is needed to distinguish THRLB-CL from Hodgkin’s lymphoma, which may have a similar histologic appearance.
Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications – OTC drugs or Herbals – that might affect the lab results?
As indicated, morphologically, the differential diagnosis includes classical Hodgkin’s lymphoma, as well as nodular lymphocyte predominant Hodgkin’s lymphoma (NLPHL) and T-cell lymphoma. An extensive panel of immunohistochemistry studies is usually needed to distinguish between these entities.
The patient should be referred to an oncologist experienced in treating lymphomas. THRLBCL is considered an aggressive lymphoma, although a considerable amount of clinical variability is described. Once the diagnosis is made, staging includes imaging studies and a bone marrow biopsy performed to assess the extent of disease.
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- At a Glance
- Are There Any Factors That Might Affect the Lab Results? In particular, does your patient take any medications - OTC drugs or Herbals - that might affect the lab results?