Concurrent or Subsequent Lymphomatous Effusion in Large B-Cell Lymphoma Portends a Dismal Prognosis: A Multi-Institutional Study

Authors

• Savanah D. Gisriel, Department of Pathology, Yale University School of Medicine, New Haven, CT, United States. Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, United States.
• Ji Yuan, Department of Pathology, Mayo Clinic, Rochester, MN, United States.
• Haiming Tang, Department of Pathology, Yale University School of Medicine, New Haven, CT, United States.
• Jie Xu, Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, United States.
• Hong Fang, Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, United States.
• Shaoying Li, Department of Hematopathology, MD Anderson Cancer Center, Houston, TX, United States.
• Jenna McCracken, Department of Pathology, Duke University Medical Center, Durham, NC, United States.
• Peng Li, ARUP Laboratories and Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, United States.
• Ryan C. Braunberger, Department of Pathology, University of New Mexico, Albuquerque, NM, United States.
• Zijun Y. Xu-Monette, 5Department of Pathology, Duke University Medical Center, Durham, NC, United States.
• Xiaojun Wu, Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, United States.
• Endi Wang, Department of Pathology, Duke University Medical Center, Durham, NC, United States. Department of Pathology, University of Southern California, Los Angeles, CA, United States.
• Qian-Yun Zhang, Department of Pathology, University of New Mexico, Albuquerque, NM, United States.
• Lorinda A. Soma, Department of Pathology, City of Hope National Medical Center, Duarte, CA, United States.
• Samuel G. Katz, Department of Pathology, Yale University School of Medicine, New Haven, CT, United States.
• Jing Jing Zhang, Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States.
• Nana P. Matsumoto, Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
• Ken H. Young, 5Department of Pathology, Duke University Medical Center, Durham, NC, United States.
• Mina L. Xu, Department of Pathology, Yale University School of Medicine, New Haven, CT, United States.
• Zenggang Pan, Department of Pathology, Yale University School of Medicine, New Haven, CT, United States. Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States. Department of Pathology, University of Colorado School of Medicine, Aurora, CO, United States.

Document Type

Article

Publication Date

9-9-2025

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.

Recommended Citation

Gisriel SD, Yuan J, Tang H, Xu J, Fang H, Li S, McCracken J, Li P, Braunberger RC, Xu-Monette ZY, Wu X, Wang E, Zhang QY, Soma LA, Katz SG, Zhang JJ, Matsumoto NP, Young KH, Xu ML, Pan Z. Concurrent or subsequent lymphomatous effusion in large B-cell lymphoma portends a dismal prognosis: A multi-institutional study. Am J Clin Pathol. 2025 Sep 9;164(3):390-401. doi: 10.1093/ajcp/aqaf057. PMID: 40581918.