Miljan S. Krstic1,2*, Slavica M. Stojnev1,2*, Ivan Z. Petkovic3,4, Irena K. Conic3,4, Janko T. Zujovic5, Velimir S. Milosevic6
1Center for Pathology, University Clinical Center Nis, Nis, Serbia.
2Department of Pathology, Faculty of Medicine, University of Nis, Nis, Serbia.
3Clinic of Oncology, University Clinical Center Nis, Nis, Serbia.
4Department of Oncology, Faculty of Medicine, University of Nis, Nis, Serbia.
5Clinical Centre of Montenegro, Centre for Abdominal Surgery, Podgorica, Montenegro.
6General Hospital, Niksic, Montenegro.
*These authors contributed equally to this work.
Summary
Purpose: This study aimed to comprehensively analyze pathological features of diffuse large B-cell lymphoma (DLBCL), an aggressive non-Hodgkin lymphoma, in patients from Southearstern Serbia, as well as to determine the frequency of extranodal disease and certain morphologic variants and immunophenotypic subtypes of DLBCL.
Methods: A total of 229 DLBCL cases that were diagnosed at the Center for Pathology, University Clinical Center, Nis, between January 2014 and December 2020 were analyzed.
Results: DLBCL constituted 32.2% of all lymphoid neoplasms diagnosed during the designated period. The majority of DLBCL had extranodal presentation (58.5%). Gastrointestinal system was the most common extranodal location, and stomach was the single leading site. The most frequent DLBCL immunophenotypic subtype was germinal center (GCB) in 47.2%, followed by non-GCB DLBCL in 39.7%, while in 5.2% DLBCL was classified as CD5-positive. DLBCL with nodal and extranodal initial location did not differ significantly in respect of immunophenotypic subtype. The vast majority of DLBCL showed centroblastic morphology (81.6%), 6.6% was immunoblastic, while anaplastic and rare variants constituted 3.1% and 8.2%, respectively. Anaplastic morphologic variant was the more frequently found in nodal DLBCL than in cases with extranodal presentation (p≤0.05).
Conclusions: The task of the pathologist is to provide the clinician with the most precise diagnosis required for therapeutic and prognostic stratification of patients, selection of adequate additional diagnostic procedures and application of modern personalized and targeted therapy. Accurate and precise diagnosis of DLBCL is crucial for the timely application of contemporary immunochemotherapy, which transformed DLBCL into a curable disease in over 60% of patients.
Key words: diffuse large B-cell lymphoma, diagnosis, pathology, extranodal, immunophenotype, morphology.
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