TAILIEUCHUNG - Chapter 105. Malignancies of Lymphoid Cells (Part 17)

Evaluation of an adequate biopsy by an expert hematopathologist is sufficient to make a diagnosis of follicular lymphoma. The tumor is composed of small cleaved and large cells in varying proportions organized in a follicular pattern of growth (Fig. 105-7). Confirmation of B cell immunophenotype and the existence of the t(14;18) and abnormal expression of BCL-2 protein are confirmatory. The major differential diagnosis is between lymphoma and reactive follicular hyperplasia. The coexistence of diffuse large B cell lymphoma must be considered. Patients with follicular lymphoma are often subclassified into those with predominantly small cells, those with a mixture of. | Chapter 105. Malignancies of Lymphoid Cells Part 17 Evaluation of an adequate biopsy by an expert hematopathologist is sufficient to make a diagnosis of follicular lymphoma. The tumor is composed of small cleaved and large cells in varying proportions organized in a follicular pattern of growth Fig. 105-7 . Confirmation of B cell immunophenotype and the existence of the t 14 18 and abnormal expression of BCL-2 protein are confirmatory. The major differential diagnosis is between lymphoma and reactive follicular hyperplasia. The coexistence of diffuse large B cell lymphoma must be considered. Patients with follicular lymphoma are often subclassified into those with predominantly small cells those with a mixture of small and large cells and those with predominantly large cells. While this distinction cannot be made simply or very accurately these subdivisions do have prognostic significance. Patients with follicular lymphoma with predominantly large cells have a higher proliferative fraction progress more rapidly and have a shorter overall survival with simple chemotherapy regimens. Figure 105-7 Follicular lymphoma. The normal nodal architecture is effaced by nodular expansions of tumor cells. Nodules vary in size and contain predominantly small lymphocytes with cleaved nuclei along with variable numbers of larger cells with vesicular chromatin and prominent nucleoli. The most common presentation for follicular lymphoma is with new painless lymphadenopathy. Multiple sites of lymphoid involvement are typical and unusual sites such as epitrochlear nodes are sometimes seen. However essentially any organ can be involved and extranodal presentations do occur. Most patients do not have fevers sweats or weight loss and an IPI score of 0 or 1 is found in 50 of patients. Fewer than 10 of patients have a high . 4 or 5 IPI score. The staging evaluation for patients with follicular lymphoma should include the studies included in Table 105-11. Follicular Lymphoma Treatment .

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