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T-cell/Histiocyte-rich Large B-cell Lymphoma : Prognosis

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Prognosis of T-cell/histiocyte-rich large B-cell lymphoma (THRLBCL): It was initially considered to be an aggressive lymphoma with worse prognosis than diffuse large B-cell lymphoma, NOS. However, subsequent studies have found no difference in the outcomes when matched for stage. The poor prognosis is related to advanced stage at presention (stage III or IV). Cases with a prominent histiocytic component may have a worse prognosis. A cutaneous variant with good outcome has been reported.

Splenic Involvement in THRLBCL: Splenic involvement is characterized by a micronodular pattern in the white pulp. Individual micronodules have similar composition to the nodal lesions - they are composed of scant numbers of large atypical B-cells in a background of abundant reactive T-cells.

Case History: This 72 y/o female presented with pancytopenias and splenomegaly. Splenectomy showed multiple nodules and involvement of hilar lymph nodes. Immunophenotyping revealed a small population of CD20 positive cells and a large subset of lymphocytes expressing CD3, CD5, and CD43. At low magnification, the white pulp appears expanded with coalescence of adjoining nodules.

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