Don’t Miss the Low Grade Component in the Background: Diffuse Large B-Cell Lymphoma Arising from Low Grade Follicular Lymphoma

Lessons From the Friday Unknowns

Histologic sections of a lymph node excisional biopsy specimen show enlarged lymph nodes extensively replaced by lymphoma with a low grade and a high grade component:

Most of the lymph nodes are replaced by diffuse large B-cell lymphoma. The neoplasm has a partial starry sky appearance and is composed of large cells with vesicular nuclear chromatin. Apoptosis is abundant and mitotic figures are easily identified.

The second component is follicular lymphoma which is low-grade and composed of a mixture of centrocytes and centroblasts supporting grade 1–2.

Both the diffuse large B-cell lymphoma and the follicular lymphoma are positive for CD10, CD20, BCL–2 and BCL–6, and are negative for MYC. The antibody specific for Ki-67 shows a proliferation rate of approximately 95% in the diffuse large B-cell lymphoma and 5–10% in the follicular lymphoma.

This case highlights the importance of not missing the low grade component at the edges while assessing the more obvious aggressive component.

Link to digital slides | Slides labeled case 3:




Practical insights for clinical practice

Recommended from Medium

Corona Virus epidemic in the US is deaccelerating…

Africa’s plan to fight COVID-19

Life Begins (to fail) at 40

Decorative. A scattering of floppy discs; an original Apple Watch with no strap; an original but broken Nintendo DS; and a Lego figure with its legs removed.

Cervical Stenosis And Neck Pain

Sensible Ways To Stay Safe and Drink Responsibly This Holiday Season


Global map showing COVID19 cases worldwide

Time Speeds Up

On the adversarial relationship between women, feminism and medicine — collection of texts (WIP)

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store
Siba El Hussein, MD

Siba El Hussein, MD

Hematopathology | Cytopathology | Molecular pathology | Digital pathology | Data science | Machine learning

More from Medium

Reflection 3: Race After Technology

Divercity, Inc., Now a Techstars Workforce Development Portfolio Company

Blind Face Restoration with GFP-GAN