An Insight into Clinicopathological Parameters and Prognostic Significance of Double Expressor Diffuse Large B-Cell Lymphoma in a Tertiary Care Center.

Introduction Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma (NHL). A distinct, high-risk subset-double expressor DLBCL shows immunohistochemical (IHC) co-expression of BCL2 and c-MYC. Objective To evaluate the clinicopathological spectrum and prognostic significance of double expressor DLBCL. Methods This retrospective study included 49 patients diagnosed with DLBCL over a four-year period at a tertiary care center. IHC analysis using a non-Hodgkin lymphoma panel was performed, and subtyping was done using the Hans algorithm to classify cases as germinal center B-cell-like (GCB) or non-germinal center B. Double expressor status was defined by IHC expression thresholds for BCL2 and c-MYC. Results Of the 49 cases, 27 (55.1%) were GCB and 22 (44.8%) were non-GCB. Twenty-three patients (46.9%) met criteria for double expressor DLBCL-11 GCB (47.8%) and 12 non-GCB (52.2%). Follow-up data from 27 patients revealed a significantly higher early mortality rate among double expressor cases, particularly within the first six months, suggesting an unfavorable prognosis. Histopathology showed diffuse effacement of lymph node architecture with proliferation of medium- to large-sized atypical lymphoid cells. Conclusion Double expressor DLBCL represents a clinically aggressive variant with a distinctly worse prognosis than DLBCL-not otherwise specified (NOS). Double expressor DLBCL poses a significant prognostic challenge within DLBCL-NOS and must be recognized as a key determinant in patient stratification and management.