Which histologic findings are characteristic of diffuse large B-cell lymphoma (DLBCL) of the prostate?

Updated: Dec 22, 2019
  • Author: Joshua I Warrick, MD; Chief Editor: Liang Cheng, MD  more...
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Answer

Answer

Diffuse large B-cell lymphoma (DLBCL) appears as an expansive proliferation of high-grade lymphoid cells that have enlarged nuclei with vesicular chromatin. Mitotic activity is increased and apoptotic debris is common. Tumor cells often demonstrate destructive growth and extend beyond the prostate. They may also infiltrate between benign glands. Expression of CD45 and CD20 is seen, consistent with B-cell lineage.

The main differential diagnosis of DLBCL is poorly differentiated carcinoma. DLBCL is CD45 positive and pan-cytokeratin negative in the great majority of cases, whereas prostatic adenocarcinoma and urothelial carcinoma are CD45 negative and pan-cytokeratin positive. Granulomatous prostatitis may also be in the differential diagnosis for DLBCL, as it demonstrates an expansive, destructive infiltrate of CD45-positive cells. The cells comprising granulomatous prostatitis are much less atypical than those of DLBCL, and they are CD68-positive histiocytes, whereas DLBCL is CD68 negative.

See the following images.

Pathology of prostate leukemia and lymphoma. Diffu Pathology of prostate leukemia and lymphoma. Diffuse large B-cell lymphoma (DLBCL) of the prostate, high power. The tumor cells are high grade, with vesicular chromatin.
Pathology of prostate leukemia and lymphoma. CD20 Pathology of prostate leukemia and lymphoma. CD20 immunostain of a diffuse large B-cell lymphoma (DLBCL) of the prostate.
Pathology of prostate leukemia and lymphoma. Diffu Pathology of prostate leukemia and lymphoma. Diffuse large B-cell lymphoma (DLBCL) of the prostate on needle core. Gland destruction is evident even at low power.
Pathology of prostate leukemia and lymphoma. Diffu Pathology of prostate leukemia and lymphoma. Diffuse large B-cell lymphoma (DLBCL) of the prostate on needle core. CD20 immunohistochemistry shows strong, diffuse expression in the lymphoma cells.
Pathology of prostate leukemia and lymphoma. Diffu Pathology of prostate leukemia and lymphoma. Diffuse large B-cell lymphoma (DLBCL) of the prostate, high power.
Pathology of prostate leukemia and lymphoma. Diffu Pathology of prostate leukemia and lymphoma. Diffuse large B-cell lymphoma (DLBCL) of the prostate, high power. The lymphoma cells have high-grade nuclei. Apoptotic debris and mitotic figures are readily identified.

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