# T-cell/histiocyte-rich large B-cell lymphoma

Source: https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/  
OnCo record `t-cell-histiocyte-rich-large-b-cell-lymphoma` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A lymphoma in which the cancer cells are a tiny minority of what the pathologist sees: scattered large B cells in a dense crowd of normal T cells and macrophages. It is a form of large B-cell lymphoma, it usually presents with disease in the liver, spleen or bone marrow, and it is easy to mistake for a different disease in both directions.

## Summary

What it is. A large B-cell lymphoma in which the malignant cells make up a very small fraction of the tissue. The rest is a reaction: sheets of normal T cells and histiocytes, the tissue form of the macrophage. The diagnosis therefore depends on recognising the scattered large B cells in a background that looks inflammatory, and on the pattern of markers they carry.

How it differs from its family. Ordinary diffuse large B-cell lymphoma is made of sheets of tumour cells. Here the tumour is outnumbered, and the clinical behaviour is different too: it tends to present at an advanced stage with the liver, the spleen and the bone marrow involved rather than with enlarged lymph nodes alone, and it affects men more often and at a younger age than most large B-cell lymphomas.

The boundary problem, which is the most important thing on this page. T-cell/histiocyte-rich large B-cell lymphoma sits at one end of a spectrum whose other end is nodular lymphocyte predominant Hodgkin lymphoma, a condition that usually behaves indolently. WHO-HAEM5 lists six growth patterns of nodular lymphocyte predominant Hodgkin lymphoma, and the last of them, pattern E, is described as diffuse and resembling this disease. The classification states plainly that in some cases a clear distinction may not be possible, and that it is especially difficult on a small biopsy. The International Consensus Classification renamed the Hodgkin disease nodular lymphocyte predominant B-cell lymphoma partly in recognition of that relationship.

The biology agrees that the boundary is soft. In a study that profiled gene expression in the tumour cells themselves, the three conditions did not cluster apart, and only a few genes were consistently different, and those only moderately. What differed was the surrounding tissue, the infiltrating T cells and histiocytes. That is an unusual situation in oncology: two diseases with different names, different stages at presentation and different treatments whose cancer cells look the same at the level of gene expression.

How it is treated. As a diffuse large B-cell lymphoma, with the same immunochemotherapy, which is a reasonable approach for a disease that behaves aggressively and carries CD20. The series are small and no randomised trial has been confined to it. The regimens are on the diffuse large B-cell lymphoma page and in the treatment layer of this family.

## Fields

- Kind: Cancer
- Last checked: 2026-09-29
- Also known as: THRLBCL; T-cell/histiocyte-rich large B-cell lymphoma; T-cell-rich B-cell lymphoma; T-cell/histiocyte rich large B cell lymphoma
- Tags: heme; lymphoma; subtype-page
- Group: haematologic
- Burden: In the United Kingdom population series that reports lymphoma by subtype, 32 of 5,796 lymphomas (0.6 per cent) diagnosed between 2004 and 2012, a crude incidence of 0.30 and a European age-standardised rate of 0.10 per 100,000 a year, with a median age at diagnosis of 65.5 years. Five-year relative survival in that series was 67.9 per cent, with a wide confidence interval (46.8 to 82.0 per cent) because of the small number of patients.
- Biomarkers: Scattered large B cells, fewer than about one in ten of the cells present, in a background of small T cells and histiocytes; The large cells express CD20 and BCL6; nuclear BCL6 was positive in 26 of 29 cases in one series; A background rich in CD8-positive T cells and CD68-positive histiocytes, which is part of the diagnosis rather than incidental; Absence of the nodular meshworks of follicular dendritic cells and of the small B cells that mark nodular lymphocyte predominant Hodgkin lymphoma; Epstein-Barr virus, which is characteristically negative

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#overview
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#what-it-is
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#finding-it [5 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#treating-it [2 settings]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#evidence [3 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#science [1 target]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/where-you-are/
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/#living-with-it [10 questions, 4 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/coming/ [1 medicine, 3 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/t-cell-histiocyte-rich-large-b-cell-lymphoma/data/ [16 connected records]

## Standard of care

- Making the diagnosis, and the two ways it goes wrong: Both errors are common and they point in opposite directions. Called inflammatory, the lymphoma is missed, because the tumour cells are a small minority and the tissue looks reactive. Called nodular lymphocyte predominant Hodgkin lymphoma, an aggressive disease is treated as an indolent one. WHO-HAEM5 states that a clear distinction from the diffuse pattern of that disease may not be possible in some cases, and that small biopsies are the hardest. A generous biopsy, read by a haematopathologist, with the surrounding cells examined as carefully as the tumour cells, is the answer the classification gives. ([Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [CD20](https://onco.cc/targets/cd20/), [The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC)](https://onco.cc/terms/lymphoma-classification-2022/))
- Treatment: Treated as diffuse large B-cell lymphoma, with rituximab-containing immunochemotherapy, which is appropriate for a disease that carries CD20 and behaves aggressively. The staging usually finds advanced disease with the liver, spleen or bone marrow involved. No randomised trial has been confined to this entity; the regimens, the cycles and the evidence are on the diffuse large B-cell lymphoma page and in the treatment layer of this family. ([Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Rituximab](https://onco.cc/drugs/rituximab/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/))

## Open problems

- The line between this disease and the diffuse pattern of nodular lymphocyte predominant Hodgkin lymphoma cannot always be drawn, and the two are treated differently.
- The cancer cells of the two conditions are not distinguishable by gene expression. What differs is the immune cells around them, and nobody knows why the same tumour cell produces an indolent disease in one person and an aggressive one in another.
- No trial has been confined to this entity, so the treatment is borrowed from diffuse large B-cell lymphoma on the strength of the shared surface marker.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Diffuse_large_B-cell_lymphoma
- WHO Classification of Haematolymphoid Tumours, 5th edition: lymphoid neoplasms (Alaggio, Leukemia 2022): https://doi.org/10.1038/s41375-022-01620-2
- International Consensus Classification of Mature Lymphoid Neoplasms (Campo, Blood 2022): https://doi.org/10.1182/blood.2022015851
- Nodular lymphocyte predominant Hodgkin lymphoma and T-cell/histiocyte-rich large B-cell lymphoma, endpoints of a spectrum of one disease? (PLoS One 2013): https://doi.org/10.1371/journal.pone.0078812
- Lymphoma incidence, survival and prevalence 2004 to 2014, subtype analyses from the UK Haematological Malignancy Research Network (Smith, Br J Cancer 2015): https://doi.org/10.1038/bjc.2015.94

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Mediastinal grey zone lymphoma](https://onco.cc/cancers/mediastinal-grey-zone-lymphoma/), [Nodular lymphocyte-predominant Hodgkin lymphoma (nodular lymphocyte-predominant B-cell lymphoma)](https://onco.cc/cancers/nodular-lymphocyte-predominant-hodgkin-lymphoma/), [Non-Hodgkin lymphoma (all types)](https://onco.cc/cancers/non-hodgkin-lymphoma/)
- technologies: [FDG PET](https://onco.cc/technologies/fdg-pet/), [Histopathology & immunohistochemistry](https://onco.cc/technologies/histopathology-ihc/)
- targets: [CD20](https://onco.cc/targets/cd20/)
- terms: [B-cell, T-cell and NK-cell lymphoma](https://onco.cc/terms/lymphoma-b-versus-t-cell/), [Indolent and aggressive lymphoma](https://onco.cc/terms/lymphoma-indolent-versus-aggressive/), [International Prognostic Index (IPI)](https://onco.cc/terms/ipi-score/), [R-CHOP (lymphoma chemoimmunotherapy)](https://onco.cc/terms/r-chop/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/), [The two lymphoma classifications of 2022 (WHO-HAEM5 and ICC)](https://onco.cc/terms/lymphoma-classification-2022/)
- drugs: [Rituximab](https://onco.cc/drugs/rituximab/)

---
JSON: https://onco.cc/api/v1/entities/t-cell-histiocyte-rich-large-b-cell-lymphoma.json