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The Oncologist, Vol. 11, No. 4, 384-392, April 2006; doi:10.1634/theoncologist.11-4-384
© 2006 AlphaMed Press

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 T-Cell/Histiocyte-Rich B-Cell Lymphoma: Biology, Diagnosis, and Management
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Lymphoma Series: Variants of Large-Cell Lymphoma

T-Cell/Histiocyte-Rich B-Cell Lymphoma: Biology, Diagnosis, and Management

Jeremy S. Abramson

Department of Medical Oncology, Dana-Farber Cancer Institute and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA

Key Words. DLBCL • Lymphoma • Tumor-infiltrating lymphocytes • Nodular lymphocyte-predominant Hodgkin’s lymphoma • Hodgkin’s disease

Correspondence: Jeremy S. Abramson, M.D., Dana-Farber Cancer Institute, 44 Binney Street, Boston Massachusetts 02115, USA. Telephone: 617-632-3779; Fax: 617-632-5822; e-mail: jeremy_abramson{at}dfci.harvard.edu

T-cell/histiocyte-rich B-cell lymphoma (T/HRBCL) is an uncommon morphologic variant of diffuse large B-cell lymphoma (DLBCL). Pathologically, it is distinguished by <10% malignant B cells amid a majority population of reactive T lymphocytes and histiocytes. Diagnosis of this entity is occasionally difficult, as it may appear similar to other lymphoid diseases, such as nodular lymphocyte-predominant Hodgkin’s lymphoma and classic Hodgkin’s lymphoma. Accurate diagnosis therefore rests with careful immunohistochemical analysis of the tumor cells and the inflammatory microenvironment. Clinically, T/HRBCL occurs in younger patients, predominantly affects men, and involves the liver, spleen, and bone marrow with greater frequency than traditional DLBCL. Despite the unique clinical features and robust host inflammatory response, T/HRBCL follows a natural history similar to those of other DLBCLs and responds similarly to therapy. Recent gene expression analysis demonstrates that a productive relationship with the host immune response may extend beyond this small DLBCL variant to include as many as one third of all DLBCLs. At present, T/HRBCL should be treated similarly to other stage-matched DLBCLs, though future therapies will likely be targeted at the relationship of the tumor cells with their inflammatory microenvironment.




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