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How I diagnose high-grade B-cell lymphoma.

Erika M Moore1, Sarah E Gibson2

  • 1University of Pittsburgh School of Medicine, Pittsburgh, PA, US.

American Journal of Clinical Pathology
|December 17, 2024
PubMed
Summary

Diagnosing high-grade B-cell lymphoma (HGBL) requires integrating morphology, immunophenotype, and genetics. Accurate classification under WHO-5 and ICC is crucial for appropriate patient treatment.

Keywords:
BCL2BCL6MYC11q aberrationBurkitt lymphomadouble hithigh-grade B-cell lymphomalymphoma diagnosistriple hit

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Area of Science:

  • Hematopathology
  • Oncology
  • Molecular Diagnostics

Background:

  • High-grade B-cell lymphoma (HGBL) was introduced in the 2016 WHO classification, encompassing lymphomas with specific genetic rearrangements or high-grade morphology.
  • Diagnostic criteria and nomenclature for HGBL have been updated in the 2022 WHO fifth edition (WHO-5) and International Consensus Classification (ICC) systems.
  • Accurate diagnosis of HGBL is essential for guiding appropriate therapeutic strategies.

Purpose of the Study:

  • To describe a diagnostic approach for high-grade B-cell lymphoma (HGBL).
  • To highlight the importance of integrating morphology, immunophenotype, and genetic findings in HGBL diagnosis.
  • To emphasize the correct nomenclature and classification of HGBL according to WHO-5 and ICC guidelines.

Main Methods:

  • Presentation of two illustrative cases of HGBL.
  • Case 1: HGBL with MYC and BCL6 rearrangements.
  • Case 2: HGBL with MYC and BCL2 rearrangements and TdT expression, emphasizing differential diagnosis from other high-grade lymphomas and B-lymphoblastic leukemia/lymphoma (B-LBL/ALL).

Main Results:

  • HGBL diagnosis necessitates a comprehensive integration of morphologic, immunophenotypic, and genetic data.
  • Differential diagnosis must exclude other high-grade lymphomas such as Burkitt lymphoma, B-LBL/ALL, and blastoid mantle cell lymphoma.
  • Consideration of HGBL/large B-cell lymphoma with 11q aberration is important in specific patient cohorts.

Conclusions:

  • HGBL subclassification relies on distinct morphologic and genetic features.
  • Nomenclature and definitions differ between WHO-5 and ICC classifications for HGBL.
  • Distinguishing HGBLs from other mature B-cell lymphomas and B-LBL/ALL is critical for optimal patient management.