A 60-year-old man has experienced vague abdominal discomfort accompanied by bloating and diarrhea for the past 6 months. On physical examination, there is a midabdominal firm mass. The stool is positive for occult blood. An abdominal CT scan shows a 5 × 12 cm mass involving the wall of the distal ileum and adjacent mesentery. A laparotomy is performed, and the mass is removed. Microscopically, the mass is composed of sheets of large lymphoid cells with large nuclei, prominent nucleoli, and frequent mitoses. The neoplastic cells mark with CD19+ and CD20+ and have the BCL6 gene rearrangement. Which of the following prognostic features is most applicable to this case?

• Indolent disease with survival of 7 to 9 years without treatment
• Aggressive disease that can be cured by aggressive chemotherapy
• Aggressive disease that does not respond to chemotherapy and transforms to acute leukemia
• Indolent disease that can be cured by chemotherapy

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