Understanding LBCL: Presentation, Diagnosis, and Prognostic Indicators

Lymphoma, a diverse group of cancers affecting the lymphatic system, can present in various ways, making early detection and diagnosis critical. Patients may notice self-palpated adenopathy during daily activities like showering, while others experience deep intra-abdominal or intra-pelvic disease, leading to abdominal discomfort and non-specific complaints. Lymphomas can emerge in lymphoid tissues, lymph nodes, the spleen, and even the liver, presenting a wide spectrum of symptoms and locations. Unexplained intermittent fevers, night sweats, and unintended weight loss can serve as constitutional symptoms suggestive of lymphoma.

Medical evaluation becomes necessary when patients exhibit these symptoms, often revealing lymphadenopathy, enlarged spleens, and occasionally palpable abdominal or pelvic masses. Laboratory tests, including complete blood counts, are conducted to assess potential bone marrow involvement. In some cases, lymphomas manifest with cytopenias or abnormal circulating cells, while a rare subset enters a leukemic phase. Further evaluation includes imaging studies such as CT scans and PET scans, which aid in determining the extent and aggressiveness of the disease. Additionally, laboratory studies, like LDH, help gauge cell turnover and disease propagation. The International Prognostic Index, based on age, LDH, nodal sites, and extra nodal disease, provides valuable prognostic insights.

For precise diagnosis, excisional biopsies of lymph nodes, bone marrow, or bone lesions are performed. The specific subtype of non-Hodgkin's lymphoma is identified, with common types including marginal zone, follicular lymphoma, mantle cell lymphoma, and diffuse large B-cell lymphoma (DLBCL). DLBCL, a B-cell lymphoma, represents the most prevalent non-Hodgkin lymphoma in adult US patients. Molecular studies, like c-MYC translocation and BCL2/BCL6 genetic rearrangements, provide further prognostic information. Lymphoma patients undergo staging through bone marrow biopsies, CT scans, and PET scans. Some lymphomas can manifest in sanctuary sites like the testes and the central nervous system, causing specific clinical manifestations that require investigation. Lymphoma patients can be categorized into subgroups, such as germinal center B-cell lymphoma (GCB) and activated B-cell phenotype, which carry prognostic significance. Recent research focuses on understanding the diverse genetic profiles and their response to various therapeutic agents in these entities.

In conclusion, lymphoma's clinical presentations are broad, and diagnosing the specific subtype is crucial for planning treatment. Prognostic indicators like genetic rearrangements and the International Prognostic Index provide valuable insights into the course of the disease. Tailoring treatment strategies to these factors is essential for improved outcomes in patients with lymphoma.

Video synopsis is AI-generated and reviewed by OncLive editorial staff.