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The T and B lymphocytes of the adaptive immune system develop from common lymphoid progenitor cells in the bone marrow. These progenitors give rise to precursors that eventually develop into both T and B lymphocytes. As these precursors mature, they gain the ability to detect and respond to foreign antigens in the body, a process known as immunocompetence. Additionally, these precursors acquire self-tolerance, a process that ensures they do not react to self-antigens. This intricate system...
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Diffuse large B-cell lymphoma presenting in the leukemic phase.

Patricia Puccetti Pires1, Marcia Yoshie Kanegae2, Jairo Rays2

  • 1Internal Medicine Department - Faculty of Medicine - Universidade de São Paulo, São Paulo/SP - Brazil .

Autopsy & Case Reports
|June 11, 2016
PubMed
Summary

Diffuse large B-cell lymphoma (DLBCL) can rarely present as leukemia. Diagnosis was achieved through peripheral blood and bone marrow analysis when lymph node biopsy was not feasible.

Keywords:
DiagnosisDiffuseFlow citometryLarge B-cellLeukemiaLymphoma

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Area of Science:

  • Hematology
  • Oncology

Background:

  • Diffuse large B-cell lymphoma (DLBCL) is a common non-Hodgkin lymphoma.
  • DLBCL typically presents with distinct histological and clinical behaviors.
  • Leukemic presentation is unusual for DLBCL compared to other lymphomas.

Observation:

  • A middle-aged male presented with malaise, weight loss, and low-grade fever.
  • Peripheral blood showed leukocytosis with blasts and thrombocytopenia.
  • Patient's critical condition precluded invasive lymph node biopsy.

Findings:

  • Cytological morphology and immunophenotyping of peripheral blood and bone marrow aspirate were performed.
  • Bone marrow biopsy with immunohistochemical analysis confirmed DLBCL in leukemic phase.
  • Diagnosis was established without a lymph node biopsy.

Implications:

  • Highlights a rare leukemic presentation of DLBCL.
  • Demonstrates the utility of peripheral blood and bone marrow analysis for DLBCL diagnosis when lymph node biopsy is contraindicated.
  • Successful treatment with R-CHOP regimen achieved a favorable outcome.