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'''Follicular lymphoma''', abbreviated '''FL''', is a very common non-Hodgkin lymphoma. It is a [[small cell lymphoma]] | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Follicular lymphoma -- low mag.jpg | |||
| Width = | |||
| Caption = Follicular lymphoma. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = Lymph node: abundant abnormally-shaped lymphoid follicles with some of the following: non-polarized mantle zone, non-polarized germinal center, loss of tingible body macrophages, sinuses effaced (lost) | |||
| Subtypes = | |||
| LMDDx = [[diffuse large B-cell lymphoma]], other [[small cell lymphomas]], reactive follicular hyperplasia | |||
| Stains = | |||
| IHC = CD20 +ve, CD10 +ve, BCL-6 +ve, BCL-2 +ve | |||
| EM = | |||
| Molecular = t(14;18)(q32;q21) / IGH-BCL2 | |||
| IF = | |||
| Gross = white lesions +/-subtle fine nodularity (fish flesh-like appearance) | |||
| Grossing = | |||
| Site = [[lymph node]], [[spleen]], [[bone marrow]], others | |||
| Assdx = | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = common | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = moderate to good | |||
| Other = | |||
| ClinDDx = other causes of lymphadenopathy - other [[lymphoma]]s, metastatic carcinoma | |||
| Tx = | |||
}} | |||
'''Follicular lymphoma''', abbreviated '''FL''', is a very common [[non-Hodgkin lymphoma]]. It is a [[small cell lymphoma]]. | |||
==General== | ==General== | ||
*A very common type of lymphoma. | *A very common type of lymphoma. | ||
*Moderate prognosis - overall five year survival ~ 66% in one cohort without transformation.<ref name=pmid23897955>{{Cite journal | last1 = Link | first1 = BK. | last2 = Maurer | first2 = MJ. | last3 = Nowakowski | first3 = GS. | last4 = Ansell | first4 = SM. | last5 = Macon | first5 = WR. | last6 = Syrbu | first6 = SI. | last7 = Slager | first7 = SL. | last8 = Thompson | first8 = CA. | last9 = Inwards | first9 = DJ. | title = Rates and outcomes of follicular lymphoma transformation in the immunochemotherapy era: a report from the University of Iowa/MayoClinic Specialized Program of Research Excellence Molecular Epidemiology Resource. | journal = J Clin Oncol | volume = 31 | issue = 26 | pages = 3272-8 | month = Sep | year = 2013 | doi = 10.1200/JCO.2012.48.3990 | PMID = 23897955 }} | |||
</ref> | |||
*May transform to a more aggressive lymphoma, e.g. [[diffuse large B-cell lymphoma]]. | |||
**Prognosis after transformation significantly worse - five year survival ~ 22%.<ref name=pmid23897955/> | |||
**Approximately 2% transform per year, or 10.7% in five years.<ref name=pmid23897955/> | |||
==Gross== | |||
*Lymph node enlargement. | |||
*Classically white and uniform - usually described as ''fish flesh-like''. | |||
**May have a vague nodularity. | |||
===Images=== | |||
<gallery> | |||
Image:Lymphoma_macro.jpg | FL in a lymph node. (WC) | |||
Image:Follicular_lymphoma,_spleen.jpg | FL in the [[spleen]]. (WC) | |||
</gallery> | |||
==Microscopic== | ==Microscopic== | ||
| Line 21: | Line 68: | ||
===Images=== | ===Images=== | ||
<gallery> | |||
Image: Follicular lymphoma -- very low mag.jpg | FL - very low mag. | |||
Image: Follicular lymphoma -- low mag.jpg | FL - low mag. | |||
Image: Follicular lymphoma -- intermed mag.jpg | FL - intermed. mag. | |||
Image: Follicular lymphoma -- high mag.jpg | FL - high mag. | |||
Image: Follicular lymphoma -- very high mag.jpg | FL - very high mag. | |||
</gallery> | |||
<gallery> | |||
Image:Follicular_Lymphoma,_Paratrabecular_Involvement_of_Bone_Marrow_(5691578596).jpg | FL - bone marrow. (WC/euthman) | |||
</gallery> | |||
www: | |||
*[http://www.flickr.com/photos/euthman/3311641845/ Follicular lymphoma - bone marrow (flickr.com)]. | *[http://www.flickr.com/photos/euthman/3311641845/ Follicular lymphoma - bone marrow (flickr.com)]. | ||
*[http://library.med.utah.edu/WebPath/HEMEHTML/HEME034.html Follicular lymphoma (utah.edu)]. | *[http://library.med.utah.edu/WebPath/HEMEHTML/HEME034.html Follicular lymphoma (utah.edu)]. | ||
| Line 42: | Line 100: | ||
==IHC== | ==IHC== | ||
Features:<ref name=pmid18359244/> | Features:<ref name=pmid18359244/> | ||
*CD10 +ve. | *[[CD10]] +ve. | ||
*BCL6 +ve. | *BCL6 +ve. | ||
| Line 55: | Line 113: | ||
*CD21 -ve in tumour cells; highlights follicular dendritic cells. | *CD21 -ve in tumour cells; highlights follicular dendritic cells. | ||
*BCL2 +ve<ref name=pmid18359244>{{cite journal |author=Vitolo U, Ferreri AJ, Montoto S |title=Follicular lymphomas |journal=Crit. Rev. Oncol. Hematol. |volume=66 |issue=3 |pages=248–61 |year=2008 |month=June |pmid=18359244 |doi=10.1016/j.critrevonc.2008.01.014 |url=}}</ref> - like many other small cell lymphomas. | *BCL2 +ve<ref name=pmid18359244>{{cite journal |author=Vitolo U, Ferreri AJ, Montoto S |title=Follicular lymphomas |journal=Crit. Rev. Oncol. Hematol. |volume=66 |issue=3 |pages=248–61 |year=2008 |month=June |pmid=18359244 |doi=10.1016/j.critrevonc.2008.01.014 |url=}}</ref> - like many other small cell lymphomas. | ||
**Usually negative in germinal centres | **Usually negative in benign germinal centres. | ||
A panel to work-up: | A panel to work-up: | ||
*BCL2, BCL6, CD3, CD5, CD10, CD20, CD23, cyclin D1. | *BCL2, BCL6, CD3, CD5, CD10, CD20, CD23, cyclin D1. | ||
===Images=== | |||
<gallery> | |||
Image: Follicluar lymphoma - bcl2 -- low mag.jpg | FL - BCL2 - low mag. | |||
Image: Follicular lymphoma - control bcl2 -- low mag.jpg | FL - BCL2 control - low mag. | |||
</gallery> | |||
www: | |||
*[http://www.pathpedia.com/education/eatlas/histopathology/lymph_node/follicular_lymphoma/follicular-lymphoma-%5B16-ln021_cd21%5D.jpeg Follicular lymphoma - CD21 (pathpedia.com)]. | |||
==Molecular== | ==Molecular== | ||