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Chapter 105. Malignancies of Lymphoid Cells (Part 18)

Patients with follicular lymphoma have a high rate of histologic transformation to diffuse large B cell lymphoma (5–7% per year). This is recognized ~40% of the time during the course of the illness by repeat biopsy and is present in almost all patients at autopsy. This transformation is usually heralded by rapid growth of lymph nodes—often localized—and the development of systemic symptoms such as fevers, sweats, and weight loss. Although these patients have a poor prognosis, aggressive combination chemotherapy regimens can sometimes cause a complete remission in the diffuse large B cell lymphoma, at times leaving the patient with. | Chapter 105. Malignancies of Lymphoid Cells Part 18 Patients with follicular lymphoma have a high rate of histologic transformation to diffuse large B cell lymphoma 5-7 per year . This is recognized 40 of the time during the course of the illness by repeat biopsy and is present in almost all patients at autopsy. This transformation is usually heralded by rapid growth of lymph nodes often localized and the development of systemic symptoms such as fevers sweats and weight loss. Although these patients have a poor prognosis aggressive combination chemotherapy regimens can sometimes cause a complete remission in the diffuse large B cell lymphoma at times leaving the patient with persisting follicular lymphoma. Diffuse Large B Cell Lymphoma Diffuse large B cell lymphoma is the most common type of non-Hodgkin s lymphoma representing approximately one-third of all cases. This lymphoma makes up the majority of cases in previous clinical trials of aggressive or intermediate-grade lymphoma. Table 105-10 shows the clinical characteristics of diffuse large B cell lymphoma. The diagnosis of diffuse large B cell lymphoma can be made accurately by an expert hematopathologist Fig. 105-8 . Cytogenetic and molecular genetic studies are not necessary for diagnosis but some evidence has accumulated that patients whose tumors overexpress the BCL-2 protein might be more likely to relapse than others. Patients with prominent mediastinal involvement are sometimes diagnosed as a separate subgroup having primary mediastinal diffuse large B cell lymphoma. This latter group of patients has a younger median age i.e. 37 years and a female predominance 66 . Subtypes of diffuse large B cell lymphoma including those with an immunoblastic subtype and tumors with extensive fibrosis are recognized by pathologists but do not appear to have important independent prognostic significance. Figure 105-8 Sour fiuíi as. Kasper CL E Hauser SL. Longo DL James on JL. Losc l o J ttom sort f Pria dp Xts af .