Concurrent or subsequent lymphomatous effusion in large B-cell lymphoma portends a dismal prognosis: A multi-institutional study

Savanah D Gisriel; Ji Yuan; Haiming Tang; Jie Xu; Hong Fang; Shaoying Li; Jenna McCracken; Peng Li; Ryan C Braunberger; Zijun Y Xu-Monette; Xiaojun Wu; Endi Wang; Qian-Yun Zhang; Lorinda A Soma; Samuel G Katz; Jing Jing Zhang; Nana P Matsumoto; Ken H Young; Mina L Xu; Zenggang Pan

doi:10.1093/ajcp/aqaf057

Concurrent or subsequent lymphomatous effusion in large B-cell lymphoma portends a dismal prognosis: A multi-institutional study

Am J Clin Pathol. 2025 Jun 29:aqaf057. doi: 10.1093/ajcp/aqaf057. Online ahead of print.

Authors

Savanah D Gisriel^{1

2}, Ji Yuan³, Haiming Tang¹, Jie Xu⁴, Hong Fang⁴, Shaoying Li⁴, Jenna McCracken⁵, Peng Li⁶, Ryan C Braunberger⁷, Zijun Y Xu-Monette⁵, Xiaojun Wu⁸, Endi Wang^{5

9}, Qian-Yun Zhang⁷, Lorinda A Soma¹⁰, Samuel G Katz¹, Jing Jing Zhang¹¹, Nana P Matsumoto¹², Ken H Young⁵, Mina L Xu¹, Zenggang Pan^{1

11}

Affiliations

¹ Department of Pathology, Yale University School of Medicine, New Haven, CT, United States.
² Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States.
³ Department of Pathology, Mayo Clinic, Rochester, MN, United States.
⁴ Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, United States.
⁵ Department of Pathology, Duke University Medical Center, Durham, NC, United States.
⁶ ARUP Laboratories and Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States.
⁷ Department of Pathology, University of New Mexico, Albuquerque, NM, United States.
⁸ Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
⁹ Department of Pathology, University of Southern California, Los Angeles, CA, United States.
¹⁰ Department of Pathology, City of Hope National Medical Center, Duarte, CA, United States.
¹¹ Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States.
¹² Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.

PMID: 40581918
DOI: 10.1093/ajcp/aqaf057

Abstract

Objective: Rare large B-cell lymphomas (LBCLs) present with concurrent or subsequent lymphomatous effusion (solid-effusion LBCL, SE-LBCL), which may have an inferior prognosis compared with their noneffusion counterpart. In addition, the relationship between SE-LBCL and human herpesvirus 8-negative effusion-based LBCL (EB-LBCL) remains unclear.

Methods: We collected 141 cases of SE-LBCL and a control cohort of 101 cases of stage IV solid-only LBCL. The clinicopathologic features were analyzed and compared between SE-LBCL and solid-only LBCL.

Results: Patients with SE-LBCL had a median age of 67 years with a male-to-female ratio of 1.3:1. Eighty-six patients had concurrent solid lymphoma and lymphomatous effusion, whereas 55 developed lymphomatous effusion subsequently. Most cases involved the pleural cavities (79%, 112/141), followed by the peritoneal (21%, 29/141) and pericardial (11%, 16/141) cavities. BCL6, CD10, and MUM1 were expressed in 77% (90/117), 46% (60/130), and 61% (58/95) of cases, respectively, and 58% (71/123) were subclassified into the germinal center B-cell (GCB) subtype. Rearrangements of BCL2, BCL6, and MYC were detected in 42% (31/73), 35% (22/63), and 40% (35/88), respectively, and 22% (19/87) had both MYC and BCL2 rearrangements. The patients with SE-LBCL had a dismal prognosis, with a median survival of 5.7 months, which was significantly worse than solid-only LBCL (147.5 months; P < .0001).

Conclusions: The pathologic features of SE-LBCL were similar to those of solid-only LBCL but distinct from those of EB-LBCL; in particular, lymphomatous effusion was an independently adverse prognostic factor in LBCL. Our study underscores the need for surveillance of lymphomatous effusion during LBCL staging and development of effective therapeutic regimens for SE-LBCL.

Keywords: large B-cell lymphoma; lymphomatous effusion; malignant effusion; prognosis.

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