Halcu Georgian, Evsei-Seceleanu Anca, Cerbu Mihai, Bara Marina Alina, Turbatu Andrei, Ceausu Mihail Constantin
Anatomical Pathology Department, Faculty of General Medicine, Universitatea de Medicina si Farmacie Carol Davila, Bulevardul Eroii Sanitari 8, 050474 București, Romania.
Spitalul Clinic Coltea, Bulevardul Ion C. Brătianu 1, 030167 București, Romania.
Medicina (Kaunas). 2025 May 2;61(5):842. doi: 10.3390/medicina61050842.
Diffuse large B-cell lymphoma (DLBCL), recognized as the most prevalent variant of adult non-Hodgkin lymphoma, presents considerable challenges in diagnosis owing to its diverse morphological features and frequent extranodal involvement, which may frequently mimic nonhematopoietic neoplasms. The 2022 WHO Classification of Lymphoid and Hematopoietic Tissues provides essential updates, highlighting the necessity of combining morphology, immunohistochemistry, cytogenetics, and molecular testing for precise subclassification. This review presents a practical method for differentiating DLBCL from other aggressive B-cell neoplasms, such as Burkitt lymphoma, B-lymphoblastic lymphoma, and mantle cell lymphoma. It highlights vital diagnostic tools, including CD45, B/T-cell markers, germinal center markers, and the Hans algorithm, as well as the role of FISH in identifying rearrangements of key genes MYC, BCL2, and BCL6, which are significant for recognizing double-hit and triple-hit lymphomas. Special focus is given to EBV-associated DLBCL and uncommon subtypes featuring plasmablastic or ALK-positive traits. This review aims to enhance diagnostic accuracy and ensure appropriate treatment strategies for patients with large B-cell lymphomas by emphasizing thorough morphological evaluation, specific adjunct testing, and adherence to the most recent classification standards.
弥漫性大B细胞淋巴瘤（DLBCL）被认为是成人非霍奇金淋巴瘤最常见的亚型，由于其多样的形态学特征和频繁的结外受累，在诊断方面面临着相当大的挑战，这可能经常模仿非造血系统肿瘤。2022年世界卫生组织淋巴和造血组织分类提供了重要更新，强调了结合形态学、免疫组织化学、细胞遗传学和分子检测进行精确亚分类的必要性。本综述介绍了一种将DLBCL与其他侵袭性B细胞肿瘤（如伯基特淋巴瘤、B淋巴母细胞淋巴瘤和套细胞淋巴瘤）区分开来的实用方法。它强调了重要的诊断工具，包括CD45、B/T细胞标志物、生发中心标志物和汉斯算法，以及荧光原位杂交（FISH）在识别关键基因MYC、BCL2和BCL6重排中的作用，这些基因对于识别双打击和三打击淋巴瘤具有重要意义。特别关注了EBV相关的DLBCL以及具有浆母细胞样或ALK阳性特征的罕见亚型。本综述旨在通过强调全面的形态学评估、特定的辅助检测以及遵循最新的分类标准，提高诊断准确性，并确保为大B细胞淋巴瘤患者制定适当的治疗策略。
