Large-cell lymphoma

Large-cell lymphoma is a type of non-Hodgkin lymphoma (NHL) characterized by large malignant lymphocytes with prominent nuclei. It encompasses several subtypes, including Diffuse large B-cell lymphoma (DLBCL), the most common form of NHL in adults, and Primary mediastinal B-cell lymphoma (PMBCL), a subtype that typically arises in the thymus. Large-cell lymphomas are aggressive malignancies that require prompt diagnosis and treatment.

Etiology and Risk Factors

The exact cause of large-cell lymphoma is not fully understood, but it is believed to involve a combination of genetic and environmental factors. Risk factors may include:

• Age, with a higher incidence in older adults
• Immune system deficiencies or disorders
• Exposure to certain chemicals or radiation
• A history of certain infections, such as Epstein-Barr virus (EBV) associated with DLBCL

Pathophysiology

Large-cell lymphomas originate from the transformation of either B-cell lymphocytes or T-cell lymphocytes, leading to the uncontrolled proliferation of large, abnormal lymphocytes. These malignant cells can accumulate in lymphoid tissues, such as lymph nodes, the spleen, and the bone marrow, and may spread to other organs, causing a wide range of symptoms.

Clinical Features

Symptoms of large-cell lymphoma can vary depending on the subtype and the organs involved but may include:

• Painless swelling of lymph nodes in the neck, armpits, or groin
• Unexplained weight loss
• Fever and night sweats
• Fatigue
• Difficulty breathing or chest pain (in cases where the mediastinum is involved)

Diagnosis

Diagnosis of large-cell lymphoma typically involves a combination of:

• Physical examination
• Laboratory tests, including complete blood count (CBC) and lactate dehydrogenase (LDH) levels
• Imaging studies, such as CT scans or PET scans
• Biopsy of affected tissue, which is essential for confirming the diagnosis and determining the specific subtype of lymphoma

Treatment

Treatment for large-cell lymphoma varies depending on the subtype, stage, and patient's overall health but may include:

• Chemotherapy, often combined with the monoclonal antibody rituximab for B-cell lymphomas
• Radiation therapy, particularly for localized disease
• Stem cell transplantation in cases of relapse or refractory disease
• Targeted therapy and immunotherapy for certain subtypes and situations

Prognosis

The prognosis for large-cell lymphoma depends on a variety of factors, including the subtype, stage at diagnosis, patient's age, and response to treatment. The International Prognostic Index (IPI) is commonly used to help predict outcomes. Despite being aggressive, many cases of large-cell lymphoma, especially DLBCL, can be cured with appropriate treatment.

Prevention

There are no specific measures to prevent large-cell lymphoma. However, maintaining a healthy immune system and avoiding known risk factors may reduce the risk.