An update on high grade B-cell lymphoma

The new WHO 2017 revised fourth edition details updates on several large B-cell entities, the most important including separation of cases of large B-cell lymphomas with the so called “double-hit” or “triple-hit” phenotype that harbor rearrangements of MYC in conjunction with rearrangements of BCL2 and/or BCL6. In addition, the knowledge of several EBV-driven B-cell lymphoproliferations has led to the firm establishment of the entity called EBV+ diffuse large B-cell lymphoma, not otherwise specified which can mimic several other Hodgkin-like lymphoproliferations including classical Hodgkin lymphoma and T-cell/histiocyte rich large B-cell lymphoma. Certain other newer provisional entities with unique molecular alterations including Burkitt-like lymphoma with 11q aberration which do not harbor MYC alterations occurring mostly in the paediatric population as well as large B-cell lymphoma with IRF4 rearrangement are also discussed in this review although these may not necessarily exhibit aggressive clinical behavior.