Abstract
Lymphomas with plasmablastic features are a heterogeneous group of aggressive and mostly uncommon neoplasms of varied aetiologies, presenting in immunocompetent individuals as well as in immunodeficiency, associated with EBV and Kaposi sarcoma virus infections, and some as progression from indolent B-cell lymphomas. They show overlapping diagnostic features and pose a differential diagnosis with other aggressive B-cell lymphomas that can downregulate the B-cell expression programme. The spectrum of rare reactive proliferations and all lymphomas defined by plasmablastic features, together with an expanding range of poorly characterised, uncommon conditions at the interface between reactive lymphoid proliferations and neoplasia submitted to the session V of the 20th European Association for Haematopathology/Society for Hematopathology lymphoma workshop are summarised and discussed in this paper.
Similar content being viewed by others
References
Stein H, Bonk A, Tolksdorf G, Lennert K, Rodt H, Gerdes J (1980) Immunohistologic analysis of the organization of normal lymphoid tissue and non-Hodgkin’s lymphomas. J Histochem Cytochem 28(8):746–760
Greipp PR, Raymond NM, Kyle RA, O’Fallon WM (1985) Multiple myeloma: significance of plasmablastic subtype in morphological classification. Blood 65(2):305–310
Delecluse HJ, Anagnostopoulos I, Dallenbach F, Hummel M, Marafioti T, Schneider U et al (1997) Plasmablastic lymphomas of the oral cavity: a new entity associated with the human immunodeficiency virus infection. Blood 89(4):1413–1420
Borenstein J, Pezzella F, Gatter KC (2007) Plasmablastic lymphomas may occur as post-transplant lymphoproliferative disorders. Histopathology 51(6):774–777
Leopold G, Dotlic S, Mahdi A, Pugh M, Dojcinov S (2020) Differential diagnosis of aggressive neoplasms with plasmablastic and late post-follicular differentiation. Diagn Histopathol 26(9):421–439
Dupin N, Diss TL, Kellam P, Tulliez M, Du MQ, Sicard D et al (2000) HHV-8 is associated with a plasmablastic variant of Castleman disease that is linked to HHV-8-positive plasmablastic lymphoma. Blood 95(4):1406–1412
Moreaux J (2021) The origin of preplasmablastic cells. Blood 137(9):1134–1135
Colomo L, Loong F, Rives S, Pittaluga S, Martínez A, López-Guillermo A et al (2004) Diffuse large B-cell lymphomas with plasmablastic differentiation represent a heterogeneous group of disease entities. Am J Surg Pathol 28(6):736–747
Simonitsch-Klupp I, Hauser I, Ott G, Drach J, Ackermann J, Kaufmann J et al (2004) Diffuse large B-cell lymphomas with plasmablastic/plasmacytoid features are associated with TP53 deletions and poor clinical outcome. Leukemia 18(1):146–155
Montes-Moreno S, Montalbán C, Piris MA (2012) Large B-cell lymphomas with plasmablastic differentiation: a biological and therapeutic challenge. Leuk Lymphoma 53(2):185–194
Balague O, Mozos A, Martinez D, Hernandez L, Colomo L, Mate JL et al (2009) Activation of the endoplasmic reticulum stress-associated transcription factor x box-binding protein-1 occurs in a subset of normal germinal-center B cells and in aggressive B-cell lymphomas with prognostic implications. Am J Pathol 174(6):2337–2346
Song JY, Dirnhofer S, Piris MA, Quintanilla-Martinez L, Pileri S, Campo E (2023) Diffuse large B-cell lymphomas, not otherwise specified, and emerging entities. Virchows Arch 482(1):179–192
Alaggio R, Amador C, Anagnostopoulos I, Attygalle AD, Araujo IBO, Berti E et al (2022) The 5th edition of the World Health Organization classification of haematolymphoid tumours: lymphoid neoplasms. Leukemia 36(7):1720–48
Campo E, Jaffe ES, Cook JR, Quintanilla-Martinez L, Swerdlow SH, Anderson KC et al (2022) The international consensus classification of mature lymphoid neoplasms: a report from the clinical advisory committee. Blood 140(11):1229–1253
Vrzalikova K, Vockerodt M, Leonard S, Bell A, Wei W, Schrader A et al (2011) Down-regulation of BLIMP1alpha by the EBV oncogene, LMP-1, disrupts the plasma cell differentiation program and prevents viral replication in B cells: implications for the pathogenesis of EBV-associated B-cell lymphomas. Blood 117(22):5907–5917
DeFalco J, Harbell M, Manning-Bog A, Baia G, Scholz A, Millare B et al (2018) Non-progressing cancer patients have persistent B cell responses expressing shared antibody paratopes that target public tumor antigens. Clin Immunol 187:37–45
Morscio J, Dierickx D, Nijs J, Verhoef G, Bittoun E, Vanoeteren X et al (2014) Clinicopathologic comparison of plasmablastic lymphoma in HIV-positive, immunocompetent, and posttransplant patients: single-center series of 25 cases and meta-analysis of 277 reported cases. Am J Surg Pathol 38(7):875–886
Martinez D, Valera A, Perez NS, Sua Villegas LF, Gonzalez-Farre B, Sole C et al (2013) Plasmablastic transformation of low-grade B-cell lymphomas: report on 6 cases. Am J Surg Pathol 37(2):272–281
Castillo J, Pantanowitz L, Dezube BJ (2008) HIV-associated plasmablastic lymphoma: lessons learned from 112 published cases. Am J Hematol 83(10):804–809
Harmon CM, Smith LB (2016) Plasmablastic lymphoma: a review of clinicopathologic features and differential diagnosis. Arch Pathol Lab Med 140(10):1074–1078
Carbone A, Gloghini A (2008) Plasmablastic lymphoma: one or more entities? Am J Hematol 83(10):763–764
Taddesse-Heath L, Meloni-Ehrig A, Scheerle J, Kelly JC, Jaffe ES (2010) Plasmablastic lymphoma with MYC translocation: evidence for a common pathway in the generation of plasmablastic features. Mod Pathol 23(7):991–999
Chapman J, Gentles AJ, Sujoy V, Vega F, Dumur CI, Blevins TL et al (2015) Gene expression analysis of plasmablastic lymphoma identifies downregulation of B-cell receptor signaling and additional unique transcriptional programs. Leukemia 29(11):2270–2273
Garcia-Reyero J, Martinez Magunacelaya N, Gonzalez de Villambrosia S, Loghavi S, Gomez Mediavilla A, Tonda R et al (2021) Genetic lesions in MYC and STAT3 drive oncogenic transcription factor overexpression in plasmablastic lymphoma. Haematologica 106(4):1120–8
Ramis-Zaldivar JE, Gonzalez-Farre B, Nicolae A, Pack S, Clot G, Nadeu F et al (2021) MAPK and JAK-STAT pathways dysregulation in plasmablastic lymphoma. Haematologica 106(10):2682–2693
Maeshima AM, Taniguchi H, Ida H, Hosoba R, Fujino T, Saito Y et al (2020) Non-diffuse large B-cell lymphoma transformation from follicular lymphoma: a single-institution study of 19 cases. Hum Pathol 102:33–43
Ouansafi I, He B, Fraser C, Nie K, Mathew S, Bhanji R et al (2010) Transformation of follicular lymphoma to plasmablastic lymphoma with c-myc gene rearrangement. Am J Clin Pathol 134(6):972–981
Pan Z, Xie Q, Repertinger S, Richendollar BG, Chan WC, Huang Q (2013) Plasmablastic transformation of low-grade CD5+ B-cell lymphoproliferative disorder with MYC gene rearrangements. Hum Pathol 44(10):2139–2148
Ronchi A, Marra L, Frigeri F, Botti G, Franco R, De Chiara A (2017) Richter syndrome with plasmablastic lymphoma at primary diagnosis: a case report with a review of the literature. Appl Immunohistochem Mol Morphol 25(6):e40–e45
Robak T, Urbanska-Rys H, Strzelecka B, Krykowski E, Bartkowiak J, Blonski JZ et al (2001) Plasmablastic lymphoma in a patient with chronic lymphocytic leukemia heavily pretreated with cladribine (2-CdA): an unusual variant of Richter’s syndrome. Eur J Haematol 67(5–6):322–327
Evans AG, Rothberg PG, Burack WR, Huntington SF, Porter DL, Friedberg JW et al (2015) Evolution to plasmablastic lymphoma evades CD19-directed chimeric antigen receptor T cells. Br J Haematol 171(2):205–209
Gasljevic G, Grat M, Kloboves Prevodnik V, Grcar Kuzmanov B, Gazic B, Lovrecic L et al (2020) Chronic lymphocytic leukemia with divergent Richter’s transformation into a clonally related classical Hodgkin’s and Plasmablastic lymphoma: a case report. Case Rep Oncol 13(1):120–129
Hatzimichael E, Papathanasiou K, Zerdes I, Flindris S, Papoudou-Bai A, Kapsali E (2017) Plasmablastic lymphoma with coexistence of chronic lymphocytic leukemia in an immunocompetent patient: a case report and mini-review. Case Rep Hematol 2017:2861596
Holderness BM, Malhotra S, Levy NB, Danilov AV (2013) Brentuximab vedotin demonstrates activity in a patient with plasmablastic lymphoma arising from a background of chronic lymphocytic leukemia. J Clin Oncol 31(12):e197–e199
Chan KL, Blombery P, Jones K, Lade S, Carney D, Tran H et al (2017) Plasmablastic Richter transformation as a resistance mechanism for chronic lymphocytic leukaemia treated with BCR signalling inhibitors. Br J Haematol 177(2):324–328
Gango A, Kiss R, Farkas P, Hanna E, Demeter J, Deak B et al (2022) Morphologic and molecular analysis of Richter syndrome in chronic lymphocytic leukaemia patients treated with ibrutinib or venetoclax. Pathology 54(1):95–103
Montes-Moreno S, Gonzalez-Medina AR, Rodriguez-Pinilla SM, Maestre L, Sanchez-Verde L, Roncador G et al (2010) Aggressive large B-cell lymphoma with plasma cell differentiation: immunohistochemical characterization of plasmablastic lymphoma and diffuse large B-cell lymphoma with partial plasmablastic phenotype. Haematologica 95(8):1342–1349
Hsi ED, Lorsbach RB, Fend F, Dogan A (2011) Plasmablastic lymphoma and related disorders. Am J Clin Pathol 136(2):183–194
Sailer M, Vykoupil KF, Peest D, Coldewey R, Deicher H, Georgii A (1995) Prognostic relevance of a histologic classification system applied in bone marrow biopsies from patients with multiple myeloma: a histopathological evaluation of biopsies from 153 untreated patients. Eur J Haematol 54(3):137–146
Bartl R, Frisch B, Fateh-Moghadam A, Kettner G, Jaeger K, Sommerfeld W (1987) Histologic classification and staging of multiple myeloma. A retrospective and prospective study of 674 cases. Am J Clin Pathol 87(3):342–55
Chang ST, Liao YL, Lu CL, Chuang SS, Li CY (2007) Plasmablastic cytomorphologic features in plasma cell neoplasms in immunocompetent patients are significantly associated with EBV. Am J Clin Pathol 128(2):339–344
Moller HE, Preiss BS, Pedersen P, Kristensen IB, Hansen CT, Frederiksen M et al (2015) Clinicopathological features of plasmablastic multiple myeloma: a population-based cohort. APMIS 123(8):652–658
Greipp PR, Leong T, Bennett JM, Gaillard JP, Klein B, Stewart JA et al (1998) Plasmablastic morphology–an independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group. Blood 91(7):2501–2507
Rajkumar SV, Fonseca R, Lacy MQ, Witzig TE, Therneau TM, Kyle RA et al (1999) Plasmablastic morphology is an independent predictor of poor survival after autologous stem-cell transplantation for multiple myeloma. J Clin Oncol 17(5):1551–1557
Chen BJ, Yuan CT, Yang CF, Ho CH, Lin YK, Su YZ et al (2022) Plasmablastic myeloma in Taiwan frequently presents with extramedullary and extranodal mass mimicking plasmablastic lymphoma. Virchows Arch 481(2):283–293
Fend F, Dogan A, Cook JR (2023) Plasma cell neoplasms and related entities-evolution in diagnosis and classification. Virchows Arch 482(1):163–177
Chng WJ, Santana-Davila R, Van Wier SA, Ahmann GJ, Jalal SM, Bergsagel PL et al (2006) Prognostic factors for hyperdiploid-myeloma: effects of chromosome 13 deletions and IgH translocations. Leukemia 20(5):807–813
Fonseca R, Barlogie B, Bataille R, Bastard C, Bergsagel PL, Chesi M et al (2004) Genetics and cytogenetics of multiple myeloma: a workshop report. Cancer Res 64(4):1546–1558
Bink K, Haralambieva E, Kremer M, Ott G, Beham-Schmid C, de Leval L et al (2008) Primary extramedullary plasmacytoma: similarities with and differences from multiple myeloma revealed by interphase cytogenetics. Haematologica 93(4):623–626
Valera A, Balague O, Colomo L, Martinez A, Delabie J, Taddesse-Heath L et al (2010) IG/MYC rearrangements are the main cytogenetic alteration in plasmablastic lymphomas. Am J Surg Pathol 34(11):1686–1694
Chesi M, Bergsagel PL (2015) Advances in the pathogenesis and diagnosis of multiple myeloma. Int J Lab Hematol 37(Suppl 1):108–114
Chesi M, Bergsagel PL (2013) Molecular pathogenesis of multiple myeloma: basic and clinical updates. Int J Hematol 97(3):313–323
Xiao R, Cerny J, Devitt K, Dresser K, Nath R, Ramanathan M et al (2014) MYC protein expression is detected in plasma cell myeloma but not in monoclonal gammopathy of undetermined significance (MGUS). Am J Surg Pathol 38(6):776–783
Dib A, Gabrea A, Glebov OK, Bergsagel PL, Kuehl WM (2008) Characterization of MYC translocations in multiple myeloma cell lines. J Natl Cancer Inst Monogr 39:25–31
Liu Y, Jelloul F, Zhang Y, Bhavsar T, Ho C, Rao M et al (2020) Genetic basis of extramedullary plasmablastic transformation of multiple myeloma. Am J Surg Pathol 44(6):838–848
Weh HJ, Bartl R, Seeger D, Selbach J, Kuse R, Hossfeld DK (1995) Correlations between karyotype and cytologic findings in multiple myeloma. Leukemia 9(12):2119–2122
Gong S, Crane GM, McCall CM, Xiao W, Ganapathi KA, Cuka N et al (2018) Expanding the spectrum of EBV-positive marginal zone lymphomas: a lesion associated with diverse immunodeficiency settings. Am J Surg Pathol 42(10):1306–1316
Lenze D, Leoncini L, Hummel M, Volinia S, Liu CG, Amato T et al (2011) The different epidemiologic subtypes of Burkitt lymphoma share a homogenous micro RNA profile distinct from diffuse large B-cell lymphoma. Leukemia 25(12):1869–1876
Loghavi S, Khoury JD, Medeiros LJ (2015) Epstein-Barr virus-positive plasmacytoma in immunocompetent patients. Histopathology 67(2):225–234
Zhou T, Cheng J, Karrs J, Davies-Hill T, Pack SD, Xi L et al (2022) Clinicopathologic and molecular characterization of Epstein-Barr Virus-positive plasmacytoma. Am J Surg Pathol 46(10):1364–1379
Chen YB, Rahemtullah A, Hochberg E (2007) Primary effusion lymphoma. Oncologist 12(5):569–576
Gaidano G, Carbone A (2001) Primary effusion lymphoma: a liquid phase lymphoma of fluid-filled body cavities. Adv Cancer Res 80:115–146
Hu Z, Pan Z, Chen W, Shi Y, Wang W, Yuan J, et al. (2021) Primary effusion lymphoma: a clinicopathological study of 70 cases. Cancers (Basel) 13(4)
Carbone A, Gloghini A (2008) PEL and HHV8-unrelated effusion lymphomas: classification and diagnosis. Cancer 114(4):225–227
Song JY, Jaffe ES (2013) HHV-8-positive but EBV-negative primary effusion lymphoma. Blood 122(23):3712
Carbone A, Gloghini A, Vaccher E, Marchetti G, Gaidano G, Tirelli U (2005) KSHV/HHV-8 associated lymph node based lymphomas in HIV seronegative subjects. Report of two cases with anaplastic large cell morphology and plasmablastic immunophenotype. J Clin Pathol 58(10):1039–45
Nador RG, Cesarman E, Chadburn A, Dawson DB, Ansari MQ, Sald J et al (1996) Primary effusion lymphoma: a distinct clinicopathologic entity associated with the Kaposi’s sarcoma-associated herpes virus. Blood 88(2):645–656
Guillet S, Gerard L, Meignin V, Agbalika F, Cuccini W, Denis B et al (2016) Classic and extracavitary primary effusion lymphoma in 51 HIV-infected patients from a single institution. Am J Hematol 91(2):233–237
Pan ZG, Zhang QY, Lu ZB, Quinto T, Rozenvald IB, Liu LT et al (2012) Extracavitary KSHV-associated large B-Cell lymphoma: a distinct entity or a subtype of primary effusion lymphoma? Study of 9 cases and review of an additional 43 cases. Am J Surg Pathol 36(8):1129–1140
Chen BJ, Wang RC, Ho CH, Yuan CT, Huang WT, Yang SF et al (2018) Primary effusion lymphoma in Taiwan shows two distinctive clinicopathological subtypes with rare human immunodeficiency virus association. Histopathology 72(6):930–944
Vega F, Miranda RN, Medeiros LJ (2020) KSHV/HHV8-positive large B-cell lymphomas and associated diseases: a heterogeneous group of lymphoproliferative processes with significant clinicopathological overlap. Mod Pathol 33(1):18–28
Boshoff C, Weiss RA (2001) Epidemiology and pathogenesis of Kaposi’s sarcoma-associated herpesvirus. Philos Trans R Soc Lond B Biol Sci 356(1408):517–534
Oksenhendler E, Boulanger E, Galicier L, Du MQ, Dupin N, Diss TC et al (2002) High incidence of Kaposi sarcoma-associated herpesvirus-related non-Hodgkin lymphoma in patients with HIV infection and multicentric Castleman disease. Blood 99(7):2331–2336
Bower M, Pria AD, Coyle C, Nelson M, Naresh K (2014) Diagnostic criteria schemes for multicentric Castleman disease in 75 cases. J Acquir Immune Defic Syndr 65(2):e80–e82
Gonzalez-Farre B, Martinez D, Lopez-Guerra M, Xipell M, Monclus E, Rovira J et al (2017) HHV8-related lymphoid proliferations: a broad spectrum of lesions from reactive lymphoid hyperplasia to overt lymphoma. Mod Pathol 30(5):745–760
Nakaya Y, Ishii N, Kasamatsu Y, Shimizu K, Tatsumi N, Tsutsumi M et al (2020) Human herpesvirus 8-positive multicentric Castleman disease with germinotropic plasmablastic aggregates: overlapping spectrum of human herpesvirus 8-associated lymphoproliferative disorder. Pathol Int 70(8):574–580
Zanelli M, Zizzo M, Bisagni A, Froio E, De Marco L, Valli R et al (2020) Germinotropic lymphoproliferative disorder: a systematic review. Ann Hematol 99(10):2243–2253
Boyer DF, McKelvie PA, de Leval L, Edlefsen KL, Ko YH, Aberman ZA et al (2017) Fibrin-associated EBV-positive Large B-Cell lymphoma: an indolent neoplasm with features distinct from diffuse large B-cell lymphoma associated with chronic inflammation. Am J Surg Pathol 41(3):299–312
Aguilar C, Beltran B, Quiñones P, Carbajal T, Vilcapaza J, Yabar A et al (2015) Large B-cell lymphoma arising in cardiac myxoma or intracardiac fibrinous mass: a localized lymphoma usually associated with Epstein-Barr virus? Cardiovasc Pathol 24(1):60–64
Dojcinov SD, Venkataraman G, Raffeld M, Pittaluga S, Jaffe ES (2010) EBV positive mucocutaneous ulcer–a study of 26 cases associated with various sources of immunosuppression. Am J Surg Pathol 34(3):405–417
Dojcinov SD, Quintanilla-Martinez L (2023) How I diagnose EBV-positive B- and T-cell lymphoproliferative disorders. Am J Clin Pathol 159(1):14–33
Polizzotto MN, Uldrick TS, Wang V, Aleman K, Wyvill KM, Marshall V et al (2013) Human and viral interleukin-6 and other cytokines in Kaposi sarcoma herpesvirus-associated multicentric Castleman disease. Blood 122(26):4189–4198
Uldrick TS, Wang V, O’Mahony D, Aleman K, Wyvill KM, Marshall V et al (2010) An interleukin-6-related systemic inflammatory syndrome in patients co-infected with Kaposi sarcoma-associated herpesvirus and HIV but without Multicentric Castleman disease. Clin Infect Dis 51(3):350–358
Oksenhendler E, Boutboul D, Beldjord K, Meignin V, de Labarthe A, Fieschi C et al (2013) Human herpesvirus 8+ polyclonal IgMlambda B-cell lymphocytosis mimicking plasmablastic leukemia/lymphoma in HIV-infected patients. Eur J Haematol 91(6):497–503
Sanchez S, Veloza L, Wang L, Lopez M, Lopez-Guillermo A, Marginet M et al (2020) HHV8-positive, EBV-positive Hodgkin lymphoma-like large B cell lymphoma: expanding the spectrum of HHV8 and EBV-associated lymphoproliferative disorders. Int J Hematol 112(5):734–740
Ferry JA, Sohani AR, Longtine JA, Schwartz RA, Harris NL (2009) HHV8-positive, EBV-positive Hodgkin lymphoma-like large B-cell lymphoma and HHV8-positive intravascular large B-cell lymphoma. Mod Pathol 22(5):618–626
Acknowledgements
We thank Professor Lorenzo Leoncini and Dr. Lucia Mundo for their help with RNAscope analyses and Dr. Matt Pugh and Ms. Annemarie Moul for assistance with immunostaining. The authors gratefully acknowledge the case submitters for contributing materials and information for the cases in this session and for use of images in this review.
Author information
Authors and Affiliations
Contributions
S. Dotlic and S. Dojcinov chaired the WS session/performed all case reviews and wrote and edited the manuscript; all authors were members of the EA4HP/SH Workshop Panel, performed the case reviews, contributed to the study conception and design, and commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval
All authors declare strict compliance with ethical standards. Any additional studies were conducted with the approval of the Medical Ethical Committee of AmsterdamUMC/VUMC (registration 2020.343).
Conflict of interest
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Dotlic, S., Gibson, S.E., Hartmann, S. et al. Lymphomas with plasmablastic features: a report of the lymphoma workshop of the 20th meeting of the European Association for Haematopathology. Virchows Arch 483, 591–609 (2023). https://doi.org/10.1007/s00428-023-03585-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00428-023-03585-8