T cell/histiocyte rich B-cell lymphoma: A difficult diagnosis to make

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin lymphoma. Rarely, DLBCL appears on a background of T-cell and histiocyte-rich stroma, referred to as T-cell/histiocyte rich large B cell lymphoma (T/HRBCL). It is distinguished by its aggressive clinical course and high rates of extranodal malignancy. It is a difficult diagnosis to make.We present a case of a 55-year-old male who presented with an upper gastrointestinal bleed and septic shock. CT imaging of the abdomen revealed a mass arising from the fundus of the stomach infiltrating the spleen. He underwent an exploratory laparotomy, splenectomy, gastric wedge resection of the fundus, and a distal pancreatectomy, with pathological specimens revealing T-cell rich B cell lymphoma. He is being treated with R-CHOP therapy. This case illustrates the importance of understanding the clinical presentations, immunohistochemical analysis, and the diagnostic and therapeutic challenges of a patient with T-cell/histiocyte rich large B cell lymphoma.

Keywords

• T-cell rich B-cell lymphoma
• Large B-cell lymphoma
• R-CHOP therapy