A 55-year-old man is diagnosed with previously untreated diffuse large B-cell lymphoma. Immunohistochemistry shows CD20+, CD10+, BCL6+, MUM1-. Using the Hans algorithm, what cell of origin does this profile indicate, and what is its prognostic implication?
- A Double-expressor lymphoma; requires intensified therapy
- B Non-germinal center B-cell (non-GCB) subtype; adverse prognosis
- C Germinal center B-cell (GCB) subtype; favorable prognosis compared to non-GCB ✓
- D Primary mediastinal large B-cell lymphoma; excellent prognosis with DA-EPOCH-R
Correct answer: C. Germinal center B-cell (GCB) subtype; favorable prognosis compared to non-GCB
Explanation
The Hans algorithm classifies DLBCL as GCB if CD10+ or if CD10-/BCL6+/MUM1-. This case (CD10+, BCL6+, MUM1-) is GCB subtype, which carries a significantly better prognosis than non-GCB (activated B-cell) subtype when treated with R-CHOP. Double-expressor refers to MYC and BCL2 co-expression by IHC, not the Hans algorithm. Primary mediastinal LBCL has different immunophenotype and clinical features.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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