Large B-cell lymphoma presenting in the spleen

The spleen is most commonly involved by small B-cell lymphomas:

Less commonly, it is the presenting site of large B-cell lymphoma. These can be subdivided into:

Group A: those forming a discrete macroscopic mass with stage 1 disease and a good prognosis1.
Group B: those with a micronodular/miliary pattern, some of which are T-cell rich B-cell lymphomas, usually presenting at an advanced stage, although nodal involvement is minimal2. The prognosis is poor1,2. A population of macrophages may be present.
Group C: those with diffuse red pulp infiltration, presenting at an advanced stage with aggressive disease1.

	Group A	Group B, other than TCRBCLT-cell rich B-cell lymphoma	Group B, TCRBCLT-cell rich B-cell lymphoma (immunophenotype of the large cells)	Group C
CD3	0/201	0/61	0/31, 0/172	0/41
CD5	0/131	0/61	0/21	0/41
CD10	7/201	0/61	0/31, 0/172	2/41
CD15			0/31, 0/172
CD20	20/201	6/61	3/31, 17/172	4/41
CD30			0/31, 6/162
CD38	5/201	1/61	1/21	1/31
CD43	5/201	1/61	0/31	0/31
CD79a			9/92
CD138			0/92
Cyclin D1	0/191	0/61	0/31	0/41
bcl-2	11/201	5/61	3/31, 11/152	2/41
bcl-6	18/181	5/51	3/31, 17/172	2/31
Oct-2			15/152
IgM			7/172
IgD	6/201	3/61	1/31, 0/172	3/41
DBA44	0/181	1/61	0/31	2/41
p16	14/16(loss of expression in only 2 cases)1	2/3(i.e. loss of expression in 2 cases)1	0/11	2/2(i.e. no loss of expression)1
p53	10/20(intense over-expression in 7 cases)1	1/61	0/31	3/4(over-expression in 2 cases)1
MIB1	20/201	6/61	3/31	4/41
EMA			3/31, 8/162
EBER	1/141	0/31	0/31, 0/82	0/31
LMP-1			0/122
t(11;14)	0/91	0/51		0/41
t(14;18)	0/121	1/61		0/41

Group A: follicle centre cell lymphoma, grade 3: follicular dendritic cells are present, demonstrable with CD21 and CD35. CD10 is positive.
Group B:
- splenic marginal zone lymphoma with increased blasts: there is a biphasic morphology, infiltration of the red pulp and intrasinusoidal involvement of bone marrow.
- mantle cell lymphoma: Cyclin D1 is positive.
- follicular lymphoma: follicular dendritic cells are present, demonstrable with CD21 and CD35. CD10 is positive.
- T-cell rich B-cell lymphoma: reactive hyperplasia. Normal lymphoid follicles are present. CD20 may help to visualise the scattered neoplastic cells in T-cell rich B-cell lymphoma. See also the other differentials of T-cell rich B-cell lymphoma.
Group C: hairy cell leukaemia variant.

This page last revised 13.1.2004.