Diffuse large B cell lymphoma (DLBCL) is a malignancy of medium or large B lymphoid cells. Bone marrow involvement in DLBCL is indicative of stage 4 disease. There may be asynchronous low-grade involvement or high-grade involvement. Occasionally, DLBCL may exclusively affect the bone marrow – this is known as primary bone marrow DLBCL.
Peripheral Blood Features
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Patients with marrow involvement may present with cytopaenias. There may be teardrop cells, circulating atypical lymphoid cells or a background of a leukoerythroblastic picture. The lactate dehydrogenase is typically raised, and the patient may also have a pyrexia of unknown origin.
Bone Marrow Features
- Medium-large atypical lymphoid cells
- Loosely-clumped chromatin, often with prominent nucleoli
- Deeply basophilic cytoplasm
- Vacuolations may be present
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- Unlike what is seen in Burkitt lymphoma, the atypical lymphoid infiltrate in DLBCL is not monotonous. Cells are often large, with prominent mitotic figures and nucleoli. The infiltrate is typically diffuse.
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