Page 85 - The lraternational Journal of the Royal Society of Thailand.indd

The International Journal of the Royal Society of Thailand
Volume XV-2023

Table 2 Diffuse growth pattern and list of some specific entities of lymphoma
Diffuse large B-cell lymphoma (DLBCL): Diffuse growth of medium, medium to large,

or large-sized lymphoma cells (Figures 4A & 4B); varying degree of vascularity;
sometimes with remaining reactive lymphoid follicle(s); large cells may colonize in the
reactive lymphoid follicles (follicular colonization); sometimes replace the normal
structure of the underlying tissue; sometimes infiltrate the normal structure in or near
the lymphomatous areas (epitheliotropism); sometimes infiltrate the vascular wall with/
without angiodestruction and with/without tissue necrosis or ulceration; sometimes
with admixed small lymphoid cells with/without admixed epithelioid histiocytes;

sometimes with admixed plasma cells (polyclonal in reactive plasma cells but
monoclonal in plasmacytic differentiation); sometimes with fibrotic changes of
various thickness.

Burkitt lymphoma: Starry-sky pattern within diffuse growth of medium-sized
lymphoma cells with some discernible cytoplasm (vacuoles better appreciated under
60x objective lens or oil immersion); note predominance of lymphoma cells as dark
blue sky with scattered tangible body macrophages (apoptotic bodies containing)
as stars (Figures 4C & 4D).

Nodal T follicular helper cell lymphoma, angioimmunoblastic-type (the so-called
“angioimmunoblastic T-cell lymphoma”): Hypervascularity within diffuse growth
of polymorphous lymphoid cells varying from small, medium, to large in size with
more medium-sized lymphoma cells having clear cytoplasm, usually along the
blood vessels with high endothelium (the so-called “high endothelium venules” or

“postcapillary venules”) with arborization (branching vasculature); occasional
large activated/transformed lymphoid cells or immunoblasts, some with larger size
resembling Hodgkin cells or Reed-Sternberg cells (Hodgkin-Reed-Sternberg, HRS
cells); common to see admixed plasma cells and eosinophils; subcapsular lymph node
sinuses can be patent (Figures 4E to 4G).

Peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS): Diffuse growth
of lymphoma cells, varying from predominantly small pleomorphic cells, mixed small
to medium and large-sized lymphoma cells, or large pleomorphic cells; common to
see admixed epithelioid histiocytes; sometimes with admixed eosinophils; sometimes
with plasma cell infiltration; sometimes with interfollicular growth pattern (T-cell zone

distribution) by monotonous medium-sized lymphoma cells (Figures 4H & 4I).

Follicular lymphoma with predominantly diffuse growth pattern: Diffuse growth of
small to medium-sized lymphoma cells with cleaved nuclei (centrocytes); occasional
larger cells (centroblasts) but not in sheet; may have delicate interstitial fibrotic
changes but sometimes with sclerosis (thick fibrous tissue); should not diagnose in
core needle biopsy

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