L6a

Follicular lymphoma

·         2nd most common NHL (esp in the West) ·         >40 ·         Neoplasm of follicular center B cells ·         14;18 with BCL2 abnormality (~90%) ·         Nodules of small cleaved à large B cells ·         Disseminated at presentation o   Slowly progressive Grade1 Grade 2 Grade 3 Mostly small cleaved cells Small cleaved and a few large B Mostly large B ·         Grades 1,2: median survival 8-10yrs (may progress to higher grade)

Mrs. Schwartz, a 50 year old woman presents to your office for a second opinion. She was diagnosed with cancer a month ago and has come to you for a second opinion.

 She tells you, "I do not feel sick enough to have cancer! I have been tired but also very busy. Yes, I have noticed that the lymph nodes on my neck are quite swollen - but they do not even hurt! There is no way this is cancer. Can you please give me your opinion. I have brought my slides from my biopsy - what do you think?"

·         What type of growth do you see in the above image?

o   Nodular: note the increase in the germinal center

o   Nodules filled with small cleaved – large B cells

·         Which Lymphomas originate from the germinal center?

o   Follicular

o   Burkitt

o   HL

o   +/- diffuse large B (may also originate from marginal zone)

·         What do you see in the image above:

o   Small cells: irregular, elongated, cleaved nucleus with scant cytoplasm

o   Larger cells: round, vesicular chromatin, prominent nucleoli

·         What is your diagnosis? Follicular Lymphoma 

·         What translocation would you expect the person to have?

o   14;18 -- BCL2 (18) – anti-apoptosis

·         How is this type of lymphoma graded?

o   1: mostly small cleaved cells

o   2: mix

o   3: mostly large B cells