Diffuse Large B-Cell Lymphoma Involving the Central Nervous System

Gualco, Gabriela MD
Weiss, Lawrence M. MD
Barber, Glen N. PhD
Bacchi, Carlos E. MD

¹Consultoria em Patologia, Botucatu, São Paulo, Brazil
²Division of Pathology, City of Hope National Medical Center, Duarte, CA, USA
³University of Miami Miller School of Medicine and Sylvester Cancer Center, Fogarty International Center, Miami, FL, USA

Corresponding Author:

Carlos E. Bacchi, Consultoria em Patologia, Rua Major Leônidas Cardoso 739, Botucatu, SP 18602–010, Brazil

International Journal of Surgical Pathology 19(1):p 44-50, February 2011. | DOI: 10.1177/1066896910386476

Abstract

Lymphomas involving the central nervous system are recognized increasingly in immunocompetent as well as immunosuppressed individuals, and the majority of the cases are diffuse large B-cell lymphoma (DLBCL). The aim of this study was to compare the immunophenotype, clinicopathological features, and association with Epstein-Barr virus (EBV) of DLBCL of the central nervous system (CNS) in 3 different clinical situations: primary, in immunocompetent patients; “primary,” in immunosuppressed patients; and in patients with secondary involvement by systemic lymphoma. The authors reviewed the clinicopathological features, morphology, immunophenotype (according to germinal-center B-cell-like and nongerminal B-cell-like subtypes), and association with EBV in 36 cases of DLBCL of the CNS, including 25 primary cases, 5 associated with immunosuppression, and 6 cases with secondary involvement. Survival was evaluated in 15 cases of primary CNS lymphomas. Of the 36 patients, 19 were male and 18 female. Only 2 cases of lymphomas were EBV-positive; both occurred in immunosuppressed patients. Separation into germinal-center and non-germinal center subtypes by an immunohistochemistry panel showed that 68% of primary, 80% of secondary, and 83% of the cases associated with immunosuppression were of non-germinal-center subtype, respectively. Patients with non-germinal-center immunophenotype showed significantly worse survival than those with CNS lymphomas of the germinal-center subtype.