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Follicular lymphoma

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Follicular lymphoma is the second most common B-cell NHL, accounting for approximately 35% of all cases. Follicular lymphoma is composed of both small centrocytes (cleaved follicle center cells) and large centroblasts (noncleaved follicle center cells). Follicular lymphoma is assigned a grade based upon the percentage of centroblasts present. Follicular lymphoma is classified as grade I when there are 5 or fewer centroblasts per high-power field (HPF), grade II when there are 6 to 15 centroblasts per HPF, and grade III when there are more than 15 centroblasts per HPF.

Most cases of follicular lymphoma exhibit a t(14;18) chromosomal translocation, which results in deregulation of expression of the BCL2 proto-oncogene on chromosome 18.

Immunophenotyping:

Positive for CD10, CD19, CD20 (strong), CD79a, BCL2 within follicles, BCL6 , CD30+ cells in 30% , CD10 frequently is weak / negative in interfollicular infiltrates and in grade III follicular lymphomas , CD10 is sensitive and specific for follicular lymphoma among small B cell lymphomas, positivity may vary (CD11c, CD23, CD25, CD43) and Negative for CD5 , cyclin D1

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Case-1

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Above case shows positivity for kappa,CD20, CD10, CD19 dim and negativity for CD5, CD23, CD3

 

 

 

 

Reference:

  • Armitage JO, Weisenburger DD. New approach to classifyingnon-Hodgkin's lymphomas: clinical features of the majorhistologic subtypes. Non-Hodgkin's Lymphoma ClassificationProject. J Clin Oncol. 1998;16(8):2780-95.

  • Freedman A. Follicular lymphoma: 2011 update on diagnosis andmanagement. Am J Hematol. 2011;86(9):768-75.

  • Fisher RI, LeBlanc M, Press OW, Maloney DG, Unger JM, MillerTP. New treatment options have changed the survival of patientswith follicular lymphoma. J Clin Oncol. 2005;23(33):8447-52.

  • Liu Q, Fayad L, Cabanillas F, Hagemeister FB, Ayers GD, Hess M,et al. Improvement of overall and failure-free survival in stageIV follicular lymphoma: 25 years of treatment experience atThe University of Texas M.D. Anderson Cancer Center. J ClinOncol. 2006;24(10):1582-9.

  • van Oers MH, Kersten MJ. Treatment strategies in advancedstage follicular lymphoma. Best Pract Res Clin Haematol. 2011;24(2):187-201.

  • Federico M, Vitolo U, Zinzani PL, Chisesi T, Clò V, Bellesi G, etal. Prognosis of follicular lymphoma: a predictive model basedon a retrospective analysis of 987 cases. Intergruppo ItalianoLinfomi. Blood. 2000;95(3):783-9.

  • Solal-Celigny P, Roy P, Colombat P, White J, Armitage JO,Arranz-Saez R, et al. Follicular lymphoma internationalprognostic index. Blood. 2004;104(5):1258-65. Comment in:Blood. 2005;105(12):4892; author reply 4892-3.

  • Luminari S, Cox MC, Montanini A, Federico M. Prognostic tools infollicular lymphomas. Expert Rev Hematol. 2009;2(5):549-62.

  • Federico M, Bellei M, Marcheselli L, Luminari S, Lopez-GuillermoA, Vitolo U, et al. Follicular lymphoma international prognosticindex 2: a new prognostic index for follicular lymphoma developedby the international follicular lymphoma prognostic factorproject. J Clin Oncol. 2009;27(27):4555-62.

  • Pugh TJ, Ballonoff A, Newman F, Rabinovitch R. Improvedsurvival in patients with early stage low-grade follicular lymphomatreated with radiation: a Surveillance, Epidemiology, and EndResults database analysis. Cancer. 2010;116(16):3843-51.

  • Advani R, Rosenberg SA, Horning SJ. Stage I and II follicularnon-Hodgkin's lymphoma: long-term follow-up of no initialtherapy. J Clin Oncol. 2004;22(8):1454-9.

  • Brice P, Bastion Y, Lepage E, Brousse N, Haïoun C, Moreau P, etal. Comparison in low-tumor-burden follicular lymphomasbetween an initial no-treatment policy, prednimustine, orinterferon alfa: a randomized study from the Groupe d'Etude desLymphomes Folliculaires. Groupe d'Etude des Lymphomes del'Adulte. J Clin Oncol. 1997;15(3):1110-7.

  • Young RC, Longo DL, Glatstein E, Ihde DC, Jaffe ES, DeVita VTJr. The treatment of indolent lymphomas: watchful waiting vaggressive combined modality treatment. Semin Hematol. 1988;25(2 Suppl 2):11-6

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