STEPTRACKERHEMATOLOGY + ONCOLOGY | PATHOLOGY | HIGH-YIELD REVIEW

Non-Hodgkin Lymphoma II — Aggressive & T-Cell

Fast-growing B-cell lymphomas (DLBCL, Burkitt) and the T/NK-cell lymphomas with their viral and skin clues.

FOCUS ON
DLBCL is the most common NHL: sheets of large B cells, aggressive but curable. Burkitt is t(8;14) MYC, a "starry sky", near-100% proliferation and tumor lysis risk. Link each viral lymphoma to its virus: EBV (Burkitt, CNS lymphoma, NK/T), HHV-8 (effusion lymphoma), HTLV-1 (ATLL). Mycosis fungoides is the skin T-cell lymphoma.
LYMPHOMA
CELL · MARKERS
GENETICS · VIRUS
CLUE · COURSE
Diffuse large B-cell
most common NHL
Sheets of large B cells: CD20⁺ (± BCL6, BCL2).
De novo, or transformed from follicular/CLL; BCL6 rearrangement common
Older adult, rapidly enlarging node or extranodal mass · R-CHOP, often curable
Burkitt lymphoma
fastest-growing tumor
Medium B cells, CD10⁺ CD20⁺, BCL2⁻; "starry sky" (tingible-body macrophages); Ki-67 ≈ 100%.
t(8;14) MYC; EBV in endemic and HIV forms
Endemic (Africa): jaw mass · sporadic: ileocecal/abdominal mass · tumor lysis risk
Primary CNS lymphoma
DLBCL confined to the brain.
EBV in AIDS (CD4 < 50)
Single ring-enhancing lesion (vs multiple in toxoplasmosis); EBV DNA in CSF
Primary effusion lymphoma
Lymphoma cells floating in body cavities.
HHV-8; HIV
Pleural or peritoneal effusion, no solid mass
Mycosis fungoides / Sézary
cutaneous T cell
CD4⁺ T cells with cerebriform nuclei; Pautrier microabscesses in epidermis.
—
Patches → plaques → tumors on trunk/buttocks · Sézary: erythroderma + circulating cells
Anaplastic large cell lymphoma
Large "hallmark" cells with horseshoe nuclei; CD30⁺.
ALK⁺ t(2;5) in children/young adults (good prognosis); ALK⁻ breast-implant type
Seroma around an implant years later
Adult T-cell leukemia/lymphoma
CD4⁺ CD25⁺ "flower" cells.
HTLV-1
Hypercalcemia, lytic bones, skin lesions
Enteropathy-associated T-cell
Intraepithelial T-cell lymphoma of small bowel.
Long-standing celiac disease
Celiac patient with pain and weight loss despite diet
Extranodal NK/T-cell, nasal type
Angiodestructive NK/T cells.
EBV; Asia, Latin America
Destructive midline facial/nasal lesion

Mechanism — survival vs speed

BCL2 ↑Cells don't die
→
Slow build-upFollicular (indolent)
MYC ↑Cells divide nonstop
→
Doubling in ~1 dayBurkitt
→
Chemo-sensitiveBut tumor lysis

EBV, HHV-8 and HTLV-1 drive lymphomas mostly when T-cell surveillance is weak (HIV, transplant).

Signature findings

LYMPHOMA
GENE / VIRUS
SIGNATURE
Burkitt
MYC t(8;14), EBV
Starry sky
DLBCL
BCL6 / BCL2
Sheets of large cells
Primary CNS
EBV (AIDS)
Solitary ring-enhancing mass
Primary effusion
HHV-8
Effusion, no mass
ALCL
ALK t(2;5)
CD30 hallmark cells
Mycosis fungoides
CD4 T cell
Pautrier microabscesses
NK/T nasal
EBV
Midline destruction

How it's tested

COMMON CONFUSIONEndemic Burkitt hits the jaw; sporadic Burkitt hits the abdomen (ileocecal). Both carry MYC translocations.
THE TRAPAn AIDS patient with a brain lesion that persists after empiric toxoplasmosis treatment, and EBV DNA in the CSF, has primary CNS lymphoma.
YOUR APPROACHLarge or fast-growing → B or T → the virus, skin, gut or implant clue → the named entity.

If you see… think…

African child with a rapidly growing jaw mass → endemic Burkitt (EBV, t(8;14))
US teen with an ileocecal mass and starry-sky pattern → sporadic Burkitt
Older adult, fast-growing node, sheets of CD20⁺ large cells → DLBCL — R-CHOP
AIDS, single ring-enhancing lesion, EBV in CSF → primary CNS lymphoma
HIV patient with lymphomatous pleural effusion → primary effusion lymphoma (HHV-8)
Years of scaly plaques on the buttocks, Pautrier microabscesses → mycosis fungoides
Red skin all over + cerebriform CD4 cells in blood → Sézary syndrome
Young patient, CD30⁺ horseshoe-nucleus cells, ALK⁺ → ALCL t(2;5)
Celiac patient losing weight on a strict diet → EATL
Destructive nasal midline lesion, EBV⁺ → extranodal NK/T-cell lymphoma