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Lymphoma, Diffuse Large Cell: Differential Diagnoses & Workup
Updated: Nov 4, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
| Lymphoma, Diffuse Mixed | Lymphoma, Mantle Cell |
| Lymphoma, Follicular | Lymphoma, Mediastinal |
| Lymphoma, Lymphoblastic | Lymphoma, Non-Hodgkin |
| Lymphoma, Malignant Anaplastic (Ki 1+) | Lymphomatoid Granulomatosis |
Other Problems to Be Considered
Benign inoculation lymphoreticulosis
Workup
Laboratory Studies
- After histology and immunology confirm the diagnosis of DLCL, a pretreatment staging evaluation should be performed.
- At minimum, patients should have routine blood counts and blood chemistries, particularly a lactate dehydrogenase (LDH) level, which is a prognostic parameter.
- Carefully examine the peripheral blood smear for any abnormal lymphoid cells.
Imaging Studies
- Radiologic staging studies include chest radiograph and CT scan of the chest, abdomen, and pelvis.
- Upper and lower gastrointestinal series, in conjunction with appropriate endoscopic studies, are indicated in patients with gastrointestinal symptoms but need not be performed routinely in asymptomatic patients.
- Patients with CNS symptoms require brain evaluation by CT scan with contrast (see image below and Image 2) or MRI with gadolinium. Examination of the CSF for malignant cells may be indicated.
Computed tomography (CT) scan of the abdomen showing mesenteric and retroperitoneal adenopathy in a patient with diffuse large cell lymphoma.
- Additional studies, such as bone scans, gallium scans, positron emission tomography (PET) scans, and plain films, may be helpful in selected patients.
- Patients with unexplained bone pain or elevated alkaline phosphatase levels should be evaluated with a bone scan. Obtain plain radiographs of any abnormal area on the bone scan to check for lymphomatous involvement of the skeleton.
- Gallium-67 scans are valuable in the staging of DLCLs. Gallium uptake correlates with disease activity and is useful as an indicator of response and prognosis. Uptake of gallium-67 occurs in approximately 50% of indolent lymphomas and in most aggressive and highly aggressive types.
- PET scans increasingly are being used to stage disease by using fructose diphosphate glucose as a measure of disease metabolic activity.4 PET scanning may be more sensitive than gallium scans for more indolent lymphoproliferative diseases, but definitive data comparing gallium to PET scanning in lymphomas are not available.
Procedures
- An excisional lymph node biopsy should be performed (see image below and Image 1).
- Bilateral iliac crest bone marrow biopsies should be performed as a part of the staging.
- Because bone marrow involvement increases the likelihood of lymphomatous involvement of the meninges, in patients with advanced stage disease, a lumbar puncture for cytologic and chemical analysis of the CSF may be necessary.
Biopsy of a cervical lymph node showing infiltration with a population of large cells (B cells) consistent with diffuse large cell lymphoma.
Staging
The Ann Arbor staging system, originally designed for Hodgkin disease, traditionally is used to assess extent of disease involvement by NHL.- Stage I is disease involvement of a single lymph node region or of a single extranodal organ or site (I E).
- Stage II is involvement of 2 or more lymph node regions on the same side of the diaphragm or localized involvement of an extranodal site or organ (II E) and involvement of 1 or more lymph node region on the same side of the diaphragm.
- Stage III is involvement of lymph node regions on both sides of the diaphragm, which may be accompanied by localized involvement of an extranodal organ or site (III E), the spleen (III S), or both (III SE).
- Stage IV is diffuse or disseminated involvement of 1 or more distant extranodal organ, with or without associated lymph node involvement.
- The presence of systemic symptoms, including fever higher than 38°C, night sweats, and/or weight loss of more than 10% of body weight in the 6 months preceding diagnosis, are denoted by the suffix B. Staging of asymptomatic patients is denoted by the suffix A.
More on Lymphoma, Diffuse Large Cell |
| Overview: Lymphoma, Diffuse Large Cell |
 Differential Diagnoses & Workup: Lymphoma, Diffuse Large Cell |
| Treatment & Medication: Lymphoma, Diffuse Large Cell |
| Follow-up: Lymphoma, Diffuse Large Cell |
| Multimedia: Lymphoma, Diffuse Large Cell |
| References |
| Further Reading |
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References
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Further Reading
Related eMedicine topics
Lymphoma, B-Cell
Lymphoma, High-Grade Malignant Immunoblastic
Lymphoma, Mediastinal
Lymphoma, Non-Hodgkin
HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma
Clinical guidelines
Rituximab in lymphoma and chronic lymphocytic leukemia: a clinical practice guideline.
Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. 2005 Feb 17 (revised 2005 Dec 22). 46 pages. NGC:005095
Clinical trials
Lenalidomide and Rituximab in the Treatment of Relapsed Mantle Cell Lymphoma (MCL) and Diffuse Large B-Cell Lymphoma
Combination Chemotherapy in Treating Children With Anaplastic Large Cell Lymphoma
Combination Chemotherapy Followed By Stem Cell Transplant in Treating Young Patients With Progressive or Relapsed Anaplastic Large Cell Lymphoma
Keywords
diffuse large cell lymphoma, lymphoma, non-Hodgkin's lymphoma, B-cell lymphoma, large B-cell lymphoma, diffuse B-cell lymphoma, non-Hodgkin lymphoma, B-cell lymphoma, diffuse large B-cell lymphoma, intermediate-grade lymphoma, large cell lymphoma, immunoblastic lymphoma
