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{{Follicular lymphoma}}
{{Follicular lymphoma}}
{{CMG}}
{{CMG}}; {{AE}} {{AS}}
==Overview==
==Overview==
 
According to the [[World Health Organization|World Health Organization (WHO)]], follicular lymphoma may be classified into 3 subtypes: low-grade follicular lymphoma, high-grade follicular lymphoma, and diffuse large B cell lymphoma. Three variants of follicular lymphoma include [[pediatric]] follicular lymphoma, primary intestinal follicular lymphoma, and other extranodal follicular lymphoma.
==Classification==
==Classification==
According to the WHO criteria, the disease is morphologically graded into:<ref name="urlFollicular Lymphomas">{{cite web |url=http://pleiad.umdnj.edu/hemepath/follicular/follicular.html |title=Follicular Lymphomas |work= |accessdate=2008-07-26}}</ref>
===1- Morphological Classification===
* Grade 1 (<5 centroblasts per high-power field (hpf))
The [[World Health Organization|World Health Organization (WHO)]] classifies follicular lymphoma as follows:<ref name="urlFollicular Lymphomas">{{cite web |url=http://pleiad.umdnj.edu/hemepath/follicular/follicular.html |title=Follicular Lymphomas |work= |accessdate=2008-07-26}}</ref><ref name="pmid7139563">{{cite journal| author=Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM et al.| title=Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute. | journal=Cancer | year= 1982 | volume= 50 | issue= 12 | pages= 2699-707 | pmid=7139563 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7139563  }} </ref>
* Grade 2 (6–15 centroblasts/hpf)
:* Grades 1 and 2 also known as low-grade follicular lymphoma  
* Grade 3 (>15 centroblasts/hpf).
:* Grade 3A as high-grade follicular lymphoma
:* Grade 3A (centrocytes still present)
:* Grade 3B as diffuse large B cell lymphoma
:* Grade 3B (the follicles consist almost entirely of centroblasts)
 
The WHO 2008 update classifies
*Grades 1 and 2 now as low grade follicular lymphoma  
*Grade 3A as high grade follicular lymphoma
*Grade 3B as Diffuse Large B Cell Lymphoma.
 
Follicular lymphoma is graded according to the proportion of large cells (centroblasts). Studies suggest this histologic grading predicts clinical outcome, with more large cells behaving more aggressively and having a higher likelihood of transformation to diffuse large cell lymphoma. When any area of diffuse large-B-cell lymphoma is present in a Follicular lymphoma the disease should be reported as diffuse large B-cell lymphoma (9680/3) (See PH rules).<ref name="seer">National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015. http://seer.cancer.gov</ref>


There are three variants of Follicular Lymphoma:
===2- Variants of Follicular Lymphoma===
* Pediatric follicular lymphoma (mostly grade 3) involves cervical lymph nodes, other peripheral lymph nodes, or Waldeyer ring. Other extranodal involvement may occur. Children with follicular lymphoma typically have early stage disease. Pediatric follicular lymphoma typically lacks BCL2 protein expression and t(14;18).  
Follicular lymphoma has 3 variants that include the following:<ref name="”seer”">National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015. http://seer.cancer.gov</ref><ref name="pmid16948815">{{cite journal| author=Kojima M, Yamanaka S, Yoshida T, Shimizu K, Murayama K, Ohno Y et al.| title=Histological variety of floral variant of follicular lymphoma. | journal=APMIS | year= 2006 | volume= 114 | issue= 9 | pages= 626-32 | pmid=16948815 | doi=10.1111/j.1600-0463.2006.apm_424.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16948815  }} </ref>
* Primary intestinal follicular lymphoma in the GI tract occurs most commonly in the small intestine, and frequently involves the duodenum.  
* Duodenal follicular lymphoma is predominantly found in the second portion of the duodenum, presenting as multiple polyps. The diagnosis is most often an incidental finding. Most patients have localized disease and prognosis is excellent even without treatment.


Other extranodal follicular lymphomas occur in almost any extranodal site. Patients usually have localized extranodal disease and systemic relapses are rare. Testicular follicular lymphoma are reported with increased frequency in children, but also are reported in adults.
'''''A. Pediatric follicular lymphoma'''''
:*Involves [[cervical lymph nodes]], other peripheral lymph nodes, or [[Waldeyer's ring]]
:*Patients typically have early-stage disease
:*Lacks [[bcl-2]] protein expression and t(14;18)
'''''B. Primary intestinal follicular lymphoma'''''
:*Occurs most commonly in the [[small intestine]], and frequently involves the [[duodenum]].
*[[Duodenal]] follicular lymphoma
:*Found in the second portion of the [[duodenum]]
:*Present as multiple [[polyps]]
:*Diagnosis is most often an incidental finding
:*Most patients have localized disease 
:*Prognosis is excellent even without treatment
'''''C. Other extranodal follicular lymphomas'''''
:*Usually have localized extranodal disease.
:*Systemic relapses are rare.  
:*[[Testicular]] follicular lymphoma are reported with increased frequency in children, but also are reported in adults.


==References==
==References==

Latest revision as of 16:18, 22 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

According to the World Health Organization (WHO), follicular lymphoma may be classified into 3 subtypes: low-grade follicular lymphoma, high-grade follicular lymphoma, and diffuse large B cell lymphoma. Three variants of follicular lymphoma include pediatric follicular lymphoma, primary intestinal follicular lymphoma, and other extranodal follicular lymphoma.

Classification

1- Morphological Classification

The World Health Organization (WHO) classifies follicular lymphoma as follows:[1][2]

  • Grades 1 and 2 also known as low-grade follicular lymphoma
  • Grade 3A as high-grade follicular lymphoma
  • Grade 3B as diffuse large B cell lymphoma

2- Variants of Follicular Lymphoma

Follicular lymphoma has 3 variants that include the following:[3][4]

A. Pediatric follicular lymphoma

B. Primary intestinal follicular lymphoma

  • Found in the second portion of the duodenum
  • Present as multiple polyps
  • Diagnosis is most often an incidental finding
  • Most patients have localized disease
  • Prognosis is excellent even without treatment

C. Other extranodal follicular lymphomas

  • Usually have localized extranodal disease.
  • Systemic relapses are rare.
  • Testicular follicular lymphoma are reported with increased frequency in children, but also are reported in adults.

References

  1. "Follicular Lymphomas". Retrieved 2008-07-26.
  2. Anderson T, Chabner BA, Young RC, Berard CW, Garvin AJ, Simon RM; et al. (1982). "Malignant lymphoma. 1. The histology and staging of 473 patients at the National Cancer Institute". Cancer. 50 (12): 2699–707. PMID 7139563.
  3. National Cancer Institute. Surveillance, Epidemiology, and End Results Program 2015. http://seer.cancer.gov
  4. Kojima M, Yamanaka S, Yoshida T, Shimizu K, Murayama K, Ohno Y; et al. (2006). "Histological variety of floral variant of follicular lymphoma". APMIS. 114 (9): 626–32. doi:10.1111/j.1600-0463.2006.apm_424.x. PMID 16948815.