10. Histopathological features and immunohistochemical characteristics of large B-cell non-Hodgkin lymphomas according to the who 2022 classification at K Hospital
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Abstract
A retrospective descriptive study was conducted on 180 patients diagnosed with diffuse large B-cell lymphoma (DLBCL) at K Hospital between December 2019 and December 2024. Histopathological evaluation included hematoxylin-eosin (H&E) staining, immunohistochemistry (IHC), and Epstein-Barr virus (EBV) detection via in situ hybridization (EBER-ISH). In selected cases with suspected high-grade features on H&E, fluorescence in situ hybridization (FISH) was performed to assess c-Myc and Bcl2 gene rearrangements. Subclassification of DLBCL followed the 2022 WHO classification. According to WHO 2022, the most common subtype was DLBCL-not otherwise specified (DLBCL-NOS),representing 64% of all cases, followed by EBV-positive DLBCL (12%) and high-grade B-cell lymphoma, NOS (14%). Histologically, a diffuse growth pattern was observed in 95% of all cases, with pleomorphic cytology in 69%, monomorphic in 25%, and anaplastic features in 6%. 17% of all cases have “starry-sky” pattern, predominantly in EBV-positive DLBCL (33%) and MYC/BCL2 rearrangements (100%). Tumor necrosis was noted in 13%, primarily among EBV-positive (9.5%) and high-grade NOS (19%) subtypes. Immunophenotypically, BCL6 expression was observed in 68.9%, mostly with high intensity (> 30%). MYC and BCL2 were positive in 7.2% and 14.4% of all cases, respectively, while co-expression of MYC and BCL2 was rare. In the EBV-positive DLBCL group, MUM1 was expressed in 66.7%, CD30 in 19%, and the Ki-67 index exceeded 70% in most cases. The 2022 WHO classification enabled clear distinction among DLBCL subtypes in the Vietnamese cohort, based on both histopathological and immunophenotypic profiles, thereby informing diagnostic strategies and therapeutic planning.
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Keywords
DLBCL, World Health Organization (WHO) 2022, Prognostic factor, EBER (Epstein-Barr encoded RNA), Molecular subtypes, Imunohistochemistry
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