|Micrograph showing a large B cell lymphoma. Field stain.|
|Symptoms||Swollen lymph nodes, abdominal pain, tiredness, fever, night sweats, weight loss|
|Risk factors||Genetics, environmental factors, viral infections, connective tissue disorders, poor immune function|
|Diagnostic method||Tissue biopsy|
|Treatment||Radiation therapy, chemotherapy, immunotherapy, stem cell transplant|
|Frequency||19 per 100,000 per year (the West)|
B-cell lymphoma are types of lymphoma affecting B cells, a type of white blood cell that makes antibodies. Symptoms may include swollen lymph nodes, abdominal pain, tiredness, fever, night sweats, or weight loss. They generally start within lymph nodes, the spleen, bone marrow, or blood.
Risk factors include certain genetic conditions, environmental factors, viral infections, connective tissue disorders, and poor immune function. They are a type of blood cancer. Subtypes include Hodgkin and over 40 types of non-Hodgkin lymphoma. They are divided into slow-growing (indolent) and aggressive lymphomas. Diagnosis is by tissue biopsy.
Slow growing lymphomas often respond well to treatment, have a survival of many years, but are not generally curable. Aggressive lymphomas on the other hand many be curable but are rapidly fatal when this is not achieved. Treatments may include radiation therapy, chemotherapy, immunotherapy, or stem cell transplant.
In Western countries, B-cell lymphoma affect about 19 per 100,000 people a year and represent about 95% of lymphoma cases. About 80% of non-Hodgkin lymphomas are B-cell lymphomas. While more common in older people, certain types may occur in children.
There are numerous kinds of lymphomas involving B cells. The most commonly used classification system is the WHO classification, a convergence of more than one, older classification systems.
Five account for nearly three out of four patients with non-Hodgkin lymphoma:
- Diffuse large B-cell lymphoma (DLBCL)
- Follicular lymphoma
- Marginal zone B-cell lymphoma (MZL) or mucosa-associated lymphatic tissue lymphoma (MALT)
- Small lymphocytic lymphoma (SLL, also known as chronic lymphocytic leukemia, CLL)
- Mantle cell lymphoma (MCL)
The remaining forms are much less common:
- DLBCL variants or sub-types of
- Primary mediastinal (thymic) large B cell lymphoma
- T cell/histiocyte-rich large B-cell lymphoma
- Primary cutaneous diffuse large B-cell lymphoma, leg type (Primary cutaneous DLBCL, leg type)
- EBV positive diffuse large B-cell lymphoma of the elderly
- Diffuse large B-cell lymphoma associated with chronic inflammation
- Fibrin-associated diffuse large B-cell lymphoma
- Primary testicular diffuse large B-cell lymphoma
- Burkitt's lymphoma
- Lymphoplasmacytic lymphoma, which may manifest as Waldenström's macroglobulinemia
- Nodal marginal zone B cell lymphoma (NMZL)
- Splenic marginal zone lymphoma (SMZL)
- Intravascular lymphomas variants
- Primary effusion lymphoma
- Lymphomatoid granulomatosis
- Primary central nervous system lymphoma
- ALK+ large B-cell lymphoma
- Plasmablastic lymphoma
- Large B-cell lymphoma arising in HHV8-associated multicentric Castleman's disease
- B-cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma
- B-cell lymphoma, unclassifiable with features intermediate between diffuse large B-cell lymphoma and classical Hodgkin lymphoma
When a person appears to have a B-cell lymphoma, the main components of a workup (for determining the appropriate therapy and the person's prognosis) are:
- Establishing the precise subtype: Initially, an incisional or excisional biopsy is preferred. A core needle biopsy is discouraged except in case a lymph node is not easily accessible. Fine-needle aspiration is only acceptable in selected circumstances, in combination with immunohistochemistry and flow cytometry.
- Determining the extent of the disease (localized or advanced; nodal or extranodal)
- The person's general health status.
|Follicular lymphoma||Marginal zone B-cell lymphoma (MZL) or mucosa-associated lymphatic tissue (MALT) lymphoma||Small lymphocytic lymphoma (SLL) / chronic lymphocytic leukemia (CLL)||Mantle cell lymphoma (MCL)|
Associated chromosomal translocations
Chromosomal translocations involving the immunoglobulin heavy locus is a classic cytogenetic abnormality for many B-cell lymphomas, including follicular lymphoma, mantle cell lymphoma and Burkitt's lymphoma. In these cases, the immunoglobulin heavy locus forms a fusion protein with another protein that has pro-proliferative or anti-apoptotic abilities. The enhancer element of the immunoglobulin heavy locus, which normally functions to make B cells produce massive production of antibodies, now induces massive transcription of the fusion protein, resulting in excessive pro-proliferative or anti-apoptotic effects on the B cells containing the fusion protein.
In Burkitt's lymphoma and mantle cell lymphoma, the other protein in the fusion is c-myc (on chromosome 8) and cyclin D1 (on chromosome 11), respectively, which gives the fusion protein pro-proliferative ability. In follicular lymphoma, the fused protein is Bcl-2 (on chromosome 18), which gives the fusion protein anti-apoptotic abilities.
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