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Vageli DP, Doukas PG, Batrakouli O, Tsangari V, Zacharouli K, Pouliou E, Tzika S, Ioannou M. Head and neck follicular lymphoma with marginal zone differentiation and BCL2 translocation t(14;18) in both nodular and extranodular sites: a case report with mini-review. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:e139-e148. [PMID: 37516620 DOI: 10.1016/j.oooo.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/26/2023] [Accepted: 05/10/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Head and neck follicular lymphoma (FL) with marginal zone (MZ) differentiation is a rare high-risk B-cell composite variant that has been reported in nodular but not extranodular sites in the parotid glands. Here we summarize the literature on FL with MZ differentiation in head and neck nodular sites and describe a rare case of extranodular FL with MZ differentiation in the parotid gland. STUDY DESIGN We examined both the germinal center and MZ components of the parotid and bone-marrow biopsies of a 65-year-old female histologically, immunohistochemically, and molecularly to identify B-cell, germinal center, and follicular dendritic cell markers. RESULTS The immunohistochemical and molecular analysis provided evidence that the FL and the MZ components derived from the same B-cell clone with a similar BCL2/IGH t(14;18) translocation site. The differentiated cells in the MZ did not express germinal center markers BCL6 and CD10. Both the parotid and bone-marrow proliferative B cells showed BCL6, CD2O, and CD79a positivity. CONCLUSIONS Head and neck FL with MZ differentiation can develop in both nodular and extranodular sites and is characterized by BCL2 translocation t(14;18). Although the mechanism of MZ differentiation is unclear, the characterization of this rare histopathologic phenomenon might be clinically important.
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Affiliation(s)
- Dimitra P Vageli
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece; Yale Larynx Laboratory, Department of Surgery (Otolaryngology), Yale School of Medicine, USA.
| | - Panagiotis G Doukas
- Yale Larynx Laboratory, Department of Surgery (Otolaryngology), Yale School of Medicine, USA.
| | - Olga Batrakouli
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Vaya Tsangari
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
| | | | - Evi Pouliou
- Department of Haematopathology, Evangelismos Athens General Hospital, Athens, Greece
| | - Stella Tzika
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
| | - Maria Ioannou
- Department of Pathology, School of Medicine, University of Thessaly, Larissa, Greece
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2
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Ikoma H, Miyaoka M, Hiraiwa S, Yukie Kikuti Y, Shiraiwa S, Hara R, Kojima M, Ohmachi K, Ando K, Carreras J, Nakamura N. Clinicopathological analysis of follicular lymphoma with BCL2, BCL6, and MYC rearrangements. Pathol Int 2022; 72:321-331. [PMID: 35297566 DOI: 10.1111/pin.13223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 02/28/2022] [Indexed: 02/01/2023]
Abstract
Most follicular lymphomas (FL) show t(14;18)/IGH-BCL2 translocation, but rearrangement (R) negative cases exist. A series of 140 FL patients with a BCL2, BCL6, and MYC gene status examined by fluorescence in situ hybridization (FISH) were classified into five groups: (a) BCL2-R group (BCL2-R/BCL6-G/MYC-G) (G, germline), 77 cases; (b) BCL2/BCL6 double-R group (BCL2-R/BCL6-R/MYC-G), 16 cases; (c) BCL6-R group (BCL2-G/BCL6-R/MYC-G), 16 cases; (d) MYC-R group (BCL2-R or G/BCL6-R or G/MYC-R), three cases; (e) Triple-G group (BCL2-G/BCL6-G/MYC-G), 28 cases. The BCL6-R group had different clinicopathological characteristics. It showed lower rates of an advanced clinical stage and bone marrow invasion, less disease progression (p = 0.036), and a 'trend' toward a favorable progression-free survival (PFS) (p = 0.06). It also showed higher rates of grade 3A and MUM1-expression, and when analyzing the interfollicular spread pattern of CD20-positive cells, had fewer cases showing the IF3+ pattern (high interfollicular spread). Moreover, cases with BCL6-R and/or BCL6 gain (with cases of BCL2 rearrangement and/or of copy number gain excluded) correlated with favorable PFS (p = 0.014) and less IF3+ pattern (p = 0.007). We demonstrated that BCL6-R FLs showed unique clinicopathological findings, and FISH of BCL2, BCL6, and MYC is useful for FL diagnosis and clinical management.
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Affiliation(s)
- Haruka Ikoma
- Department of Pathology, School of Medicine, Tokai University, Isehara, Japan
| | - Masashi Miyaoka
- Department of Pathology, School of Medicine, Tokai University, Isehara, Japan
| | - Shinichiro Hiraiwa
- Department of Pathology, School of Medicine, Tokai University, Isehara, Japan
| | - Yara Yukie Kikuti
- Department of Pathology, School of Medicine, Tokai University, Isehara, Japan
| | - Sawako Shiraiwa
- Department of Hematology and Oncology, School of Medicine, Tokai University, Isehara, Japan
| | - Ryujiro Hara
- Department of Hematology and Oncology, School of Medicine, Tokai University, Isehara, Japan
| | - Minoru Kojima
- Department of Hematology and Oncology, School of Medicine, Tokai University, Isehara, Japan
| | - Ken Ohmachi
- Department of Hematology and Oncology, School of Medicine, Tokai University, Isehara, Japan
| | - Kiyoshi Ando
- Department of Hematology and Oncology, School of Medicine, Tokai University, Isehara, Japan
| | - Joaquim Carreras
- Department of Pathology, School of Medicine, Tokai University, Isehara, Japan
| | - Naoya Nakamura
- Department of Pathology, School of Medicine, Tokai University, Isehara, Japan
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3
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Gibson SE, Liu YC, Yatsenko SA, Barasch NJ, Swerdlow SH. Histopathologic, immunophenotypic, and mutational landscape of follicular lymphomas with plasmacytic differentiation. Mod Pathol 2022; 35:60-68. [PMID: 34601504 DOI: 10.1038/s41379-021-00938-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
Follicular lymphomas with plasmacytic differentiation (FL-PCD) include two major subtypes: one with predominantly interfollicular PCD that usually harbors a BCL2 rearrangement (BCL2-R), and a second that has predominantly intrafollicular PCD and the frequent absence of a BCL2-R. It is proposed that these latter cases share some features with marginal zone lymphomas (MZL). To further explore this hypothesis in an expanded cohort of FL-PCD, a clinicopathologic investigation of 25 such cases was undertaken including an analysis of their mutational landscape. The 10 interfollicular FL-PCDs exhibited typical intrafollicular centrocytes/centroblasts (90%), CD10 expression (90%), full PCD including expression of CD138 by the plasma cells (PC) (100%), and PCs with class-switched immunoglobulin heavy chains (70%). These cases were BCL2-R positive (100%), BCL6-R positive in 30%, lacked extra BCL2 copies, and only 22% had extra copies of BCL6. Similar to classic FLs, 80% of interfollicular FL-PCDs harbored mutations in epigenetic regulators KMT2D (70%), CREBBP (40%), and/or EZH2 (30%). In contrast, only 45% of 11 intrafollicular FL-PCDs demonstrated typical intrafollicular centrocytes/centroblasts, 55% were CD10(-), 80% contained IgM+ PCs, and only 27% harbored BCL2-Rs. BCL6-Rs were identified in 27% of intrafollicular FL-PCD, while 60% showed extra copies of BCL2 and 50% extra copies of BCL6, consistent with complete or partial trisomies of chromosomes 18 and 3, respectively. Only 54% of intrafollicular FL-PCDs showed mutations in epigenetic regulators. Both subtypes showed mutational differences compared to classic FL, but only the interfollicular subtype showed differences from what is reported for nodal MZL. Four additional cases showed mixed intra- and interfollicular PCD. These results suggest that FL-PCD has some distinctive features and supports the existence of two major subtypes. The interfollicular PCD subtype shares many features with classic FL. The intrafollicular FL-PCDs are more heterogeneous, have differences from classic FL, and have a greater morphologic, immunophenotypic, and genetic overlap with MZL.
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Affiliation(s)
- Sarah E Gibson
- Mayo Clinic Arizona, Phoenix, AZ, USA. .,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.
| | - Yen-Chun Liu
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.,St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Svetlana A Yatsenko
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
| | - Nicholas J Barasch
- University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA.,Columbia University Medical Center, New York, NY, USA
| | - Steven H Swerdlow
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA, USA
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4
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Xia D, Leon AJ, Yan J, Silva A, Bakhtiari M, Tremblay-LeMay R, Selvarajah S, Sabatini P, Diamandis P, Pugh T, Kridel R, Delabie J. DNA Methylation-Based Classification of Small B-Cell Lymphomas: A Proof-of-Principle Study. J Mol Diagn 2021; 23:1774-1786. [PMID: 34562613 DOI: 10.1016/j.jmoldx.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/15/2022] Open
Abstract
Although most small B-cell lymphomas (SBCLs) can be diagnosed using routine methods, challenges exist. For example, marginal zone lymphomas (MZLs) can be difficult to rule-in, in large part because no widely-used, sensitive, and specific biomarker is available for the marginal zone cell of origin. In this study, it was hypothesized that DNA methylation array profiling can assist with the classification of SBCLs, including MZLs. Extramedullary SBCLs, including challenging cases, were reviewed internally for pathology consensus and profiled. By combining the resulting array data set with data sets from other groups, a set of 26 informative probes was selected and used to train machine learning models to classify 4 common SBCLs: chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, mantle cell lymphoma, and MZL. Prediction probability cutoff was used to separate classifiable from unclassifiable cases, and show that the trained model was able to classify 95% of independent test cases (n = 264/279). The concordance between model predictions and pathology diagnoses was 99.6% (n = 262/263) among classifiable test cases. One validation reference test case was reclassified based on model prediction. The model was also used to predict the diagnoses of two challenging SBCLs. Although the differential examined and data on difficult cases are limited, these results support accurate methylation-based classification of SBCLs. Furthermore, high specificities of predictions suggest that methylation signatures can be used to rule-in MZLs.
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Affiliation(s)
- Daniel Xia
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
| | - Alberto Jose Leon
- Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jiong Yan
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Anjali Silva
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Vector Institute, Toronto, Ontario, Canada
| | | | - Rosemarie Tremblay-LeMay
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shamini Selvarajah
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Peter Sabatini
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Division of Clinical Laboratory Genetics, University Health Network, Toronto, Ontario, Canada
| | - Phedias Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Pugh
- Translational Genomics Laboratory, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Robert Kridel
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jan Delabie
- Division of Hematopathology and Transfusion Medicine, University Health Network, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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5
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Nalbandyan K, Benharroch D, Gurevitch A, Levi I. Transformation of low-grade follicular lymphoma with partial marginal zone differentiation: Two cases. Hematol Rep 2021; 13:8896. [PMID: 34650782 PMCID: PMC8477310 DOI: 10.4081/hr.2021.8896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/02/2021] [Indexed: 11/23/2022] Open
Abstract
Two cases of low-grade follicular lymphoma, with marginal zone differentiation and/or with high proliferation rate in one of them, are reported with transformation into high grade B-cell and B-lymphoblastic lymphomas. The contribution of these features to the transforming process, although previously described, is infrequent, and has not been deciphered to date.
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Affiliation(s)
| | | | - Anna Gurevitch
- Division of Hematology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Levi
- Division of Hematology, Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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6
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Maskey N, Chen Q, Liu F, Liu S, Tian S. A rare face of follicular lymphoma: reverse variant of follicular lymphoma. Diagn Pathol 2020; 15:31. [PMID: 32245492 PMCID: PMC7119098 DOI: 10.1186/s13000-020-00932-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/05/2020] [Indexed: 01/17/2023] Open
Abstract
Background Reverse Variant of Follicular Lymphoma (RVFL) is one of the rare morphological variants of FL, characterized by dark staining small centrocytes in the center and pale staining large centroblasts at the periphery of the neoplastic follicles. Only rare cases of RVFL have been described to date. The histological appearance of this little known variant of FL may be misinterpreted if pathologists are unaware of its existence. The main purpose of this study is to draw pathologists’ attention to such an uncommon growth pattern of FL so that this variant can be correctly recognized and the clinical significance further studied in the future. Methods Four cases of FL with unusual morphologic features were evaluated for the expression pattern of CD20, CD10, BCL6, BCL2, CD21, CD23, CD3, CD5, Cyclin D1, IgD and Ki67 by immunohistochemistry. Fluorescence in situ hybridization (FISH) with break-apart probes was performed to detect BCL2 gene rearrangement. Results All four cases showed distinctive morphologic pattern of RVFL; in addition, each also exemplified unique morphological features. Immunohistochemical stains confirmed the cells in both the central areas and the peripheral cuffs had the same immunophenotypic profiles, contrasting to the FL with marginal zone differentiation in which only the center of the nodules showed expression of CD10. FISH demonstrated BCL2 gene rearrangement in all cases. Conclusion The growth pattern of this rare FL variant may mimic FL with marginal-zone differentiation and other entities including but not limited to marginal zone lymphoma (MZL), progressive transformation of germinal centers (PTGC) and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). Pathologists should be familiar with this unusual morphological variant to avoid diagnostic pitfalls.
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Affiliation(s)
- Ninu Maskey
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China
| | - Qiongrong Chen
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan University Center for Pathology and Molecular Diagnostics, 169 Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China
| | - Fang Liu
- Department of Pathology, Foshan Hospital, Sun Yat-sen University, 81 North Lingnan Avenue, Chancheng District, Foshan, Guangdong Province, People's Republic of China
| | - Shangqin Liu
- Department of Hematology, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuchang District, Wuhan, Hubei, 430071, People's Republic of China.
| | - Sufang Tian
- Department of Pathology, Zhongnan Hospital of Wuhan University, Wuhan University Center for Pathology and Molecular Diagnostics, 169 Donghu Road, Wuchang District, Wuhan, 430071, People's Republic of China.
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7
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Koh J, Jeon YK. Morphologic variant of follicular lymphoma reminiscent of hyaline-vascular Castleman disease. J Pathol Transl Med 2020; 54:253-257. [PMID: 32013324 PMCID: PMC7253963 DOI: 10.4132/jptm.2019.12.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/17/2019] [Indexed: 01/10/2023] Open
Abstract
Follicular lymphoma (FL) with hyaline-vascular Castleman disease (FL-HVCD)-like features is a rare morphologic variant, with fewer than 20 cases in the literature. Herein, we report a case of FL-HVCD in a 37-year-old female who presented with isolated neck lymph node enlargement. The excised lymph node showed features reminiscent of HVCD, including regressed germinal centers (GCs) surrounded by onion skin-like mantle zones, lollipop lesions composed of hyalinized blood vessels penetrating into regressed GCs, and hyalinized interfollicular stroma. In addition, focal areas of abnormally conglomerated GCs composed of homogeneous, small centrocytes with strong BCL2, CD10, and BCL6 expression were observed, indicating partial involvement of the FL. Several other lymphoid follicles showed features of in situ follicular neoplasia. Based on the observations, a diagnosis of FL-HVCD was made. Although FLHVCD is very rare, the possibility of this variant should be considered in cases resembling CD. Identification of abnormal, neoplastic follicles and ancillary immunostaining are helpful for proper diagnosis.
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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul, Korea.,Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
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8
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Fratoni S, Zanelli M, Zizzo M, Sanguedolce F, Aimola V, Cerrone G, Ricci L, Filosa A, Martino G, Ascani S. The broad landscape of follicular lymphoma: Part I. Pathologica 2020; 112:1-16. [PMID: 32031179 PMCID: PMC8138498 DOI: 10.32074/1591-951x-35-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 12/08/2019] [Indexed: 12/12/2022] Open
Abstract
Follicular lymphoma is a neoplasm derived from follicle center B cells, typically both centrocytes and centroblasts, in variable proportions according to the lymphoma grading. The pattern of growth may be entirely follicular, follicular and diffuse, and rarely completely diffuse. It represents the second most common non-Hodgkin lymphoma, after diffuse large B-cell lymphoma and is the most common low-grade mature B-cell lymphoma in western countries. In the majority of cases, follicular lymphoma is a nodal tumor, occurring in adults and frequently associated with the translocation t(14;18)(q32;q21)/IGH-BCL2. However, in recent years the spectrum of follicular lymphoma has expanded and small subsets of follicular lymphoma, which differ from common follicular lymphoma, have been identified and included in the current 2017 WHO classification. The aim of our review is to describe the broad spectrum of follicular lymphoma, pointing out that the identification of distinct clinicopathological variants of follicular lymphoma is relevant for patient outcomes and choice of treatment.
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Affiliation(s)
- Stefano Fratoni
- Department of Anatomic Pathology, St. Eugenio Hospital of Rome, Rome, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria - Ospedali Riuniti di Foggia, Italy
| | | | | | | | | | - Giovanni Martino
- Hematology Unit, CREO, Azienda Ospedaliera di Perugia, University of Perugia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera Santa Maria Terni, University of Perugia, Terni, Italy
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9
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Randall C, Fedoriw Y. Pathology and diagnosis of follicular lymphoma and related entities. Pathology 2019; 52:30-39. [PMID: 31791624 DOI: 10.1016/j.pathol.2019.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023]
Abstract
Follicular lymphoma (FL) is an indolent, mature B-cell neoplasm classically characterised by the t(14;18)(q32;q21) with constitutive overexpression of the anti-apoptotic protein, BCL2. Most cases present in older adults with slowly progressive lymphadenopathy and follow an indolent clinical course. Typical morphology shows an expansile follicular proliferation with tumour expression of germinal centre markers, and bone marrow involvement at diagnosis is frequent. However, in the recent past, efforts to understand the biological and clinical heterogeneity of FL has effected significant change to the diagnostic approach. While morphological grade, assessed by enumerating large 'centroblasts' in the neoplastic follicles, generally correlates with outcome in systemic nodal FL, variants with high-grade morphology but indolent clinical behaviour have been identified. Given the clinical implications of these FL variants, knowledge of their clinical and histopathological defining features is of paramount importance to the pathologist. Furthermore, as with many areas of diagnostic oncology, precursors to FL have been identified and described with measurable rates of progression to bona fide lymphoma. Accurate diagnosis of these early lesions can often prevent unnecessary therapy and guide appropriate monitoring for disease progression. This review aims to summarise these key pathological and diagnostic features of FL. We further highlight the biological underpinnings of FL that will likely affect the classification, diagnosis, and treatment of patients with lymphoma.
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Affiliation(s)
- Cara Randall
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, University of North Carolina, NC Cancer Hospital, Chapel Hill, NC, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, Division of Hematopathology, University of North Carolina, NC Cancer Hospital, Chapel Hill, NC, USA.
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10
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Choi SM, Betz BL, Perry AM. Follicular Lymphoma Diagnostic Caveats and Updates. Arch Pathol Lab Med 2018; 142:1330-1340. [PMID: 30221980 DOI: 10.5858/arpa.2018-0217-ra] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Follicular lymphoma is a common small B-cell lymphoma, likely to be encountered by any practicing pathologist, regardless of specialty. Although the features of typical follicular lymphoma are well known and in most instances easily identifiable, there are lesser-appreciated morphologic appearances that can raise alternative diagnostic possibilities. The limited tissue available in core needle biopsies can make it additionally challenging to thoroughly evaluate those features in the context of architecture. Furthermore, ancillary testing including immunohistochemistry and molecular/genetic analysis do not always show classic findings and may pose additional challenges to interpretation. OBJECTIVES.— To review the morphologic features of follicular lymphoma with a discussion of morphologic variants and mimics; to discuss pitfalls of ancillary testing and provide the practicing pathologist with an appropriate context for interpretation of immunohistochemical and molecular/genetic studies when follicular lymphoma is part of the differential diagnosis; and to propose diagnostic strategies when there is limited tissue for evaluation. DATA SOURCES.— We used examples of follicular lymphoma from our institution as well as a review of the literature, with a focus on the diagnostic aspects that are broadly relevant to a general pathology practice. CONCLUSIONS.— Follicular lymphoma can occasionally present with atypical morphologic, immunohistochemical, or molecular/genetic features. In particular, those findings can be difficult to interpret in the setting of a limited tissue sample. Awareness of those possibilities will help guide the pathologist to a more accurate and precise diagnosis.
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Affiliation(s)
- Sarah M Choi
- From the Department of Pathology, University of Michigan, Ann Arbor
| | - Bryan L Betz
- From the Department of Pathology, University of Michigan, Ann Arbor
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11
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Glazyrin A, Patel C, Kujtan L, Madhusudhana S. Two for One: B-Cell Lymphomas with Features of Marginal and Follicular Lymphomas. Acta Haematol 2018; 139:84-88. [PMID: 29408811 DOI: 10.1159/000486360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 12/14/2017] [Indexed: 12/26/2022]
Abstract
Low-grade follicular lymphomas are genetically characterized by the translocation t(14; 18)(q32;q21) with BCL2 gene rearrangements. Marginal zone lymphomas are often associated with translocations or transcriptional deregulations of the MALT gene. We report 2 cases of lymphomas which harbor both the t(14;18)(q32;q21) translocation and MALT gene upregulation. Patients presented with numerous circulating atypical lymphocytes. Lymph node biopsy in both cases on HE staining demonstrated vague nodularity readily highlighted by CD10, CD23, or BCL6. Staining with CD20 and BCL2 demonstrated monotonous diffuse effacement of normal architecture with tumor cells without obvious follicular structures. Morphologically, tumor cells were consistent with centrocytes. Bone marrow biopsy demonstrated a combined peritrabecular and interstitial distribution of the tumor cells. These cases present substantial difficulties for diagnosis and classification. Clinical and morphological features were mostly consistent with follicular lymphoma, with a few features more often seen in marginal zone lymphomas (leukemic presentation, no CD10 in circulating cells, interstitial location of tumor cells in bone marrow); therefore, these cases were finally classified as follicular lymphoma grade I. Both patients were treated with standard chemotherapy regimens for follicular and nongastric MALT lymphomas with a good response to date.
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MESH Headings
- Adult
- Biomarkers
- Biopsy
- Bone Marrow/pathology
- Diagnosis, Differential
- Female
- Humans
- Immunohistochemistry
- In Situ Hybridization, Fluorescence
- Lymph Nodes/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/genetics
- Middle Aged
- Symptom Assessment
- Translocation, Genetic
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Affiliation(s)
- Alexey Glazyrin
- Department of Pathology, Truman Medical Center, University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Chirag Patel
- Department of Pathology, Truman Medical Center, University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Lara Kujtan
- Department of Internal Medicine - Hematology/Oncology, Truman Medical Center, University of Missouri at Kansas City, Kansas City, Missouri, USA
| | - Sheshadri Madhusudhana
- Department of Internal Medicine - Hematology/Oncology, Truman Medical Center, University of Missouri at Kansas City, Kansas City, Missouri, USA
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Koduru PR, Chen W, Garcia R, Fuda F. Acquisition of a t(11;14)(q13;q32) in clonal evolution in a follicular lymphoma with a t(14;18)(q32;q21) and t(3;22)(q27;q11.2). Cancer Genet 2015; 208:303-9. [PMID: 25953460 DOI: 10.1016/j.cancergen.2015.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/25/2015] [Accepted: 03/06/2015] [Indexed: 12/22/2022]
Abstract
Chromosome translocations involving an immunoglobulin (IG) locus and another gene, either BCL or MYC, are common events in B-cell lymphoma. Occasionally, two IG loci, one with BCL and the other with MYC, are simultaneously involved; such cases are classified as double-hit (DH) lymphomas. These tumors often show intermediate histologic features between those of diffuse large B-cell lymphoma and those of Burkitt lymphoma. Patients with DH lymphoma have a poor prognosis. Rarely, lymphomas in which three IG loci are simultaneously involved with two different BCL genes and MYC have been reported. These cases are classified as triple-hit lymphomas; virtually all these are aggressive tumors with an even worse prognosis. We present here a unique case of follicular lymphoma (FL) with rearranged BCL2, BCL6, and BCL1 (also known as CCND1) genes. Lymphoma cells at first clinical relapse had a complex karyotype that included a t(3;22)(q27;q11) and t(14;18)(q32;q21). About 15 years after initial diagnosis, the lymphoma cells showed clonal cytogenetic evolution and acquired a t(11;14)(q13;q32). This article is the first case report of a low grade B-cell lymphoma that had three lymphoma-associated reciprocal translocations not involving MYC and that had a long indolent clinical course.
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MESH Headings
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 22/genetics
- Chromosomes, Human, Pair 3/genetics
- Clonal Evolution
- Cyclin D1/genetics
- DNA-Binding Proteins/genetics
- Humans
- In Situ Hybridization, Fluorescence
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Male
- Middle Aged
- Proto-Oncogene Proteins c-bcl-6
- Translocation, Genetic/genetics
- bcl-Associated Death Protein/genetics
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Affiliation(s)
- Prasad R Koduru
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA.
| | - Weina Chen
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Rolando Garcia
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Franklin Fuda
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, USA
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13
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Wang E, Stoecker M, Burchette J, Rehder C. Follicular lymphoma with prominent Dutcher body formation: a pathologic study of 3 cases in comparison with nodal or splenic lymphoplasmacytic lymphoma and marginal zone lymphoma. Hum Pathol 2012; 43:2001-11. [PMID: 22607703 DOI: 10.1016/j.humpath.2012.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 01/31/2012] [Accepted: 02/02/2012] [Indexed: 12/23/2022]
Abstract
Dutcher bodies have been described in lymphoid neoplasms with plasmacytic differentiation, including plasma cell myeloma, lymphoplasmacytic lymphoma, and marginal zone lymphoma. We report a pathologic study of 3 cases of follicular lymphoma with extensive Dutcher body formation in comparison with lymphoplasmacytic lymphoma and marginal zone lymphoma. Of 3 cases, 1 showed a follicular growth pattern, whereas the other 2 cases demonstrated only a vague nodular appearance highlighted by immunohistochemical analysis. Cells containing Dutcher bodies were counted at 25, 90, or 110 per high-power field in each case, respectively. In 2 cases, cells with Dutcher bodies were clustered in an intrafollicular distribution, a possible histopathologic clue for follicular lymphoma. Immunoglobulin M κ was identified as the component of Dutcher bodies in all 3 cases, implying a possible molecular basis for the formation of Dutcher bodies in B-cell lymphomas. All 3 cases had cytogenetic changes supporting the diagnosis of follicular lymphoma, including dual rearrangement of BCL2 and BCL6, rearrangement of BCL2 with trisomy 3 (BCL6), and isolated BCL6 rearrangement. We emphasize immunohistochemical analyses with anti-κ/λ and anti-immunoglobulin heavy-chain isotypes to characterize Dutcher bodies and document clonality in addition to the routine lymphoma workup and indicated cytogenetic studies in B-cell lymphomas with prominent Dutcher bodies.
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Affiliation(s)
- Endi Wang
- Department of Pathology, Duke University Medical Center Box 3712, Duke Hospital South, Durham, NC 27710, USA.
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14
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15
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Yamada K, Maeshima AM, Taniguchi H, Kawabata Y, Nomoto J, Maruyama D, Kim SW, Watanabe T, Kobayashi Y, Tobinai K, Tsuda H. Follicular lymphoma with marked monocytoid or plasmacytoid differentiation and tiny or indistinct follicles: a case study of four patients. Leuk Lymphoma 2011; 52:804-13. [DOI: 10.3109/10428194.2011.555570] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Tari A, Sato Y, Asaoku H, Kunihiro M, Fukumoto A, Tanaka S, Fujihara M, Yoshino T. A duodenal follicular lymphoma associated with the lesion mimicking MALT lymphoma in terminal ileum and Bauhin valve. Med Mol Morphol 2010; 43:174-7. [DOI: 10.1007/s00795-009-0477-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 09/28/2009] [Indexed: 01/27/2023]
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17
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Genomic alterations reveal potential for higher grade transformation in follicular lymphoma and confirm parallel evolution of tumor cell clones. Blood 2010; 116:1489-97. [DOI: 10.1182/blood-2010-03-272278] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Our aim was to examine the genetics of clonal evolution in follicular lymphoma (FL) and to identify genetic alterations associated with disease progression. A total of 100 biopsies from 44 patients diagnosed with t(14;18)-positive FL were examined by array comparative genomic hybridization. In 20 patients the patterns of somatic hypermutations (SHMs) in the variable region of heavy chain gene were additionally analyzed. Gain of chromosome X in male samples was a marker for poor outcome (P < .01). Gains involving chromosome 2, 3q, and 5 were exclusively present in FL biopsies from cases with higher grade transformation and were among the copy number alterations (CNAs) associated with inferior survival. Although we noted a trend for increasing genomic complexity in initial versus late FL samples, the overall frequencies of CNAs in initial and late FL biopsies showed a surprisingly stable pattern through the course of the disease. In 27 of cases the initial samples harbored CNAs that were absent in relapse samples, indicating that tumor cell clones at relapse were not direct descendants of initially dominating clones. The pattern of SHMs confirmed parallel development of tumor cell clones in 14 cases. Our findings support the hypothesis of common progenitor cells in FL.
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18
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Gitelson E, Al-Saleem T, Robu V, Millenson MM, Smith MR. Pediatric nodal marginal zone lymphoma may develop in the adult population. Leuk Lymphoma 2010; 51:89-94. [PMID: 19863176 PMCID: PMC3572776 DOI: 10.3109/10428190903349670] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pediatric nodal marginal zone lymphoma (NMZL) is described as a separate variant of NMZL in the most recent WHO classification of tumors of hematologic and lymphoid tissues. It has distinctive morphology and clinical presentation and stands out as an indolent disease with remarkably better overall prognosis compared to classic NMZL. Here we report two adult patients with NMZL with clinical and morphologic features consistent with pediatric NMZL (pNMZL) and review available literature describing the clinical and histologic presentation of pNMZL. Two men, ages 44 and 18 years, each presented with localized cervical lymphadenopathy, both demonstrated florid proliferation of the marginal zone and disruption of reactive germinal centers, progressive transformation of germinal centers-like morphologic features typical for pNMZL and clonal disease with immunophenotype consistent with NMZL. This is the first report of pNMZL in a middle-aged person. Distinct histologic features and characteristic benign clinical course will help to distinguish this rare variant from other NMZL in the adults. Clinically, recognition is important to understand the true incidence of this rare form in the adult population and to avoid unnecessary overtreatment of this indolent form.
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MESH Headings
- Adolescent
- Adult
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Flow Cytometry/methods
- Humans
- Immunophenotyping
- Immunotherapy/methods
- Lymphatic Diseases/diagnosis
- Lymphatic Diseases/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Medical Oncology/methods
- Prognosis
- Remission Induction
- Rituximab
- Treatment Outcome
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19
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Gradowski JF, Jaffe ES, Warnke RA, Pittaluga S, Surti U, Gole LA, Swerdlow SH. Follicular lymphomas with plasmacytic differentiation include two subtypes. Mod Pathol 2010; 23:71-9. [PMID: 19838161 PMCID: PMC6349384 DOI: 10.1038/modpathol.2009.146] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Follicular lymphomas with plasmacytic differentiation were described more than two decades ago. However, the possibility that some of these reported cases are marginal zone lymphomas or composite lymphomas must be considered. In addition, it is also uncertain whether follicular lymphomas with plasmacytic differentiation have any unique cytogenetic or other features. Therefore, fluorescence immunophenotypic and interphase cytogenetic analysis of 14 well-characterized follicular lymphomas with plasmacytic differentiation was performed using a CD138 antibody to identify the plasma cells and with BCL2, BCL6, IGH@ and MALT1 break-apart probes and a chromosome 12 centromeric probe. CD10 was expressed in 12/14 cases, BCL6 in 12/12 cases and BCL2 in 12/14 cases. At least one cytogenetic abnormality was identified in 12/14 cases. The same abnormality was present in both the plasmacytic (CD138+) and non-plasmacytic (CD138-) component in all 10 evaluable cases. BCL2 rearrangements were present in seven cases (5 IGH@ rearranged, 1 IGH@-not rearranged, 1 IGH@-not evaluable), BCL6 rearrangement in two (1 also with BCL2/IGH@ rearrangement), +12 in 1, +MALT1 without +18 in 1, IGH@ rearrangement without other abnormalities in 1 and IGH@ rearranged or partially deleted in 1 case. No cases showed +BCL6 (3q27) or a MALT1 rearrangement. All six cases with an isolated BCL2 rearrangement had predominantly interfollicular plasmacytic cells whereas, 6/7 cases without the translocation had concentrations of intrafollicular or perifollicular plasmacytic cells (P<0.005), as did the case with BCL2 and BCL6 translocations. These results support the existence of bona fide follicular lymphomas with plasmacytic differentiation and support the clonal relationship of the neoplastic lymphoid and plasma cells in at least most of these cases. The differential distribution of the plasma cells, specifically in relation to the presence or absence of an isolated BCL2 rearrangement suggests that the latter cases may be distinctive, sharing some features with marginal zone lymphomas.
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Affiliation(s)
- Joel F Gradowski
- Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elaine S Jaffe
- Department of Pathology, National Cancer Institute, Bethesda, MD, USA
| | - Roger A Warnke
- Department of Pathology, Stanford University, Palo Alto, CA, USA
| | | | - Urvashi Surti
- Department of Pathology, University of Pittsburgh School of Medicine and Pittsburgh Cytogenetics Laboratory, UPMC-Magee Womens Hospital, Pittsburgh, PA, USA
| | - Leena A Gole
- Pittsburgh Cytogenetics Laboratory, UPMC-Magee Womens Hospital, Pittsburgh, PA, USA
| | - Steven H Swerdlow
- Department of Pathology, Division of Hematopathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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20
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Naresh KN. Nodal marginal zone B-cell lymphoma with prominent follicular colonization – difficulties in diagnosis: a study of 15 cases. Histopathology 2008; 52:331-9. [DOI: 10.1111/j.1365-2559.2007.02951.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Aamot HV, Torlakovic EE, Eide MB, Holte H, Heim S. Non-Hodgkin lymphoma with t(14;18): clonal evolution patterns and cytogenetic–pathologic–clinical correlations. J Cancer Res Clin Oncol 2007; 133:455-70. [PMID: 17235551 DOI: 10.1007/s00432-006-0188-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 12/13/2006] [Accepted: 12/19/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The pattern and frequency of secondary chromosome abnormalities in t(14;18)-carrying non-Hodgkin lymphomas (NHL) were evaluated for differences in relation to histologic NHL subtype and patients' outcome. METHODS One hundred and forty-nine NHL patients with t(14;18) and complete cytogenetic, morphologic, and clinical information were selected. RESULTS One hundred and twelve cases were follicular lymphoma (FL) and 37 were diffuse large B-cell lymphoma (DLBCL). One hundred and forty cases showed secondary aberrations (94%, median = 6.0). The most frequent were losses from chromosome arms 1p and 6q and +7 (26%). Loss from 1q, +7, and +12 were more frequent in DLBCL than in FL. Loss from 1p, Xp, and -16 were more frequent in FL grade 3 than in FL grades 1 and 2. Patients with <6.0 secondary cytogenetic aberrations had better prognosis than did those with a higher number of aberrations. Trisomy 21 was associated with shorter patient survival. FLIPI score, the number of secondary chromosomal aberrations, and +21 were all of independent prognostic value in Cox multivariate analysis. FL grade 1-3a patients that had received chemotherapy, showed a higher frequency of i(6p) and loss from 6q. CONCLUSION Secondary chromosomal aberrations showed some correlation with the morphologic subgroups of t(14;18)-NHL. Trisomy 21 and the presence of >6.0 secondary cytogenetic aberrations both correlated with shorter overall survival.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Chromosome Aberrations
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 18
- Disease Progression
- Female
- Humans
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/genetics
- Lymphoma, Non-Hodgkin/pathology
- Male
- Middle Aged
- Prognosis
- Survival Rate
- Translocation, Genetic
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Affiliation(s)
- Hege Vangstein Aamot
- Department of Medical Genetics, Rikshospitalet-Radiumhospitalet Medical Centre, Montebello, 0310 Oslo, Norway
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22
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Kojima M, Yamanaka S, Yoshida T, Shimizu K, Murayama K, Ohno Y, Itoh H, Motoori T, Masawa N, Nakamura S. Histological variety of floral variant of follicular lymphoma. APMIS 2006; 114:626-32. [PMID: 16948815 DOI: 10.1111/j.1600-0463.2006.apm_424.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To further clarify the histopathological findings of the floral variant of follicular lymphoma (FVFL), we studied 13 Japanese cases. Two histological subtypes of neoplastic follicles of FVFL have been described: (i) A macrogerminal center pattern where the mantle zone lymphocytes were invaginated into the neoplastic germinal center, often reminiscent of a floral design. (ii) A microgerminal center pattern where the massive invasion of mantle zone lymphocytes resulted in almost complete breakage of the neoplastic follicles. In the former pattern, the neoplastic germinal center usually contained large clusters of tumor cells, whereas in the latter, small clusters of up to 20 tumor cells or isolated tumor cells were observed in the neoplastic germinal centers. Moreover, occasional tumor cells showed a lymphocytic and/or histiocytic Reed-Sternberg cell (L&H cells)-like morphology. Both types of neoplastic follicles were observed to a varying degree in most cases. The macrogerminal center pattern was predominant in nine cases (70%), whilst the microgerminal center pattern was predominant in only four cases (30%). Three lesions (23%) had a marginal zone component. Immunohistochemistry showed that atypical follicular center cells, including L&H cells, were CD3-, CD5-, CD10+, CD20+, CD43-, bcl-2+, cyclinD1-. The overall histological findings of the macrogerminal center are similar to those of florid progressive transformation of germinal center (PTGC), whilst the microgerminal center pattern is similar to that of nodular lymphocyte-predominant Hodgkin lymphoma. Initially, the differential diagnosis between FVFL and florid PTGC was emphasized. However, the present study indicates that nodal marginal zone B-cell lymphoma possessing floral follicles and nodular lymphocyte-predominant Hodgkin lymphoma should be added to the differential diagnosis of FVFL. The germinal center B-cell nature of FVFL is most clearly recognizable by immunohistochemistry, though histological appearance alone may cause some diagnostic problems.
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Affiliation(s)
- Masaru Kojima
- Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, 617-1 Takabayashinishi-cho, Ohta 373-8550, Japan.
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23
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Abstract
The observed variability in the clinical course of follicular lymphoma (FL), along with the diverse range of therapeutic options available, necessitates accurate prognostic stratification of the individual patient. A number of clinical, laboratory, and pathologic parameters have been associated with both good and poor risk disease; in some instances these have been incorporated into readily calculable prognostic indices. With new insights into disease biology and the resulting identification of biomarkers that have arisen from the analysis of both the genome and the transcriptome, more accurate individualization of prognosis will be realized. At present the clinical application of such biomarkers, however, remains largely in its infancy. This review examines the clinical and molecular prognostic features that have been identified as of value in FL.
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Affiliation(s)
- Andrew J Davies
- Department of Medical Oncology, St Bartholomew's Hospital, West Smithfield, London, UK.
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24
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Jourdan F, Molina TJ, Le Tourneau A, Machet MC, De Muret A, Renjard L, Fetissof F. Florid marginal zone differentiation in follicular lymphoma mimicking marginal zone lymphoma of MALT type in the lung. Histopathology 2006; 49:426-9. [PMID: 16978207 DOI: 10.1111/j.1365-2559.2006.02462.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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25
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Torlakovic EE, Aamot HV, Heim S. A marginal zone phenotype in follicular lymphoma with t(14;18) is associated with secondary cytogenetic aberrations typical of marginal zone lymphoma. J Pathol 2006; 209:258-64. [PMID: 16583359 DOI: 10.1002/path.1981] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Marginal zone differentiation of follicular lymphomas (FL), sometimes referred to as monocytoid B-cell differentiation, is a relatively uncommon phenomenon. Recently, this type of differentiation was also linked to secondary cytogenetic aberrations of chromosome 3 in a small number of patients. We have analysed 131 primary nodal FL with t(14;18)(q32;q21) for secondary cytogenetic aberrations previously described as recurrent in marginal zone lymphomas (MZL) to identify their frequency and possible association with morphological evidence of marginal zone differentiation. We searched for trisomy of chromosomes 3, 12, and 18, gains of chromosome arm 3q, deletions of chromosome arm 7p, structural anomalies with break-points in 1q21 and 1p34, as well as the t(1;2)(p22;p12), t(1;14)(p22;q32), t(3;14)(q27;q32), t(6;14)(p21;q32), and t(11;18)(q21;q21) translocations. At least focal morphological evidence of marginal zone differentiation occurred in 35/131 (27%) FL with t(14;18)(q32;q21) as the primary chromosomal abnormality. None of the recurrent balanced translocations characteristic of extranodal MZL were seen secondarily in the nodal FLs with t(14;18)(q32;q21). However, 43/131 (33%) cases had at least one of the above secondary cytogenetic aberrations previously reported as recurrent aberrations in MZL and, when combined, these were significantly more frequent in FL with morphological evidence of marginal zone differentiation (p<0.0001, two-sided Fisher's exact test). Aberrations of chromosome 3 and, in particular, trisomy 3 occurred frequently in FL with marginal zone differentiation (p=0.002 and p<0.0001, respectively, two-sided Fisher's exact test), while chromosome 21, 22, and X chromosome aberrations, which have not been described previously as recurrent in MZL, were also significantly associated with marginal zone differentiation in FL (p=0.002, p=0.037, p=0.039, respectively, two-sided Fisher's exact test).
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MESH Headings
- Cell Differentiation/genetics
- Chromosome Aberrations
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 12/genetics
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 7/genetics
- Cytogenetic Analysis/methods
- Humans
- Immunophenotyping/methods
- Lymphoma, Follicular/genetics
- Lymphoma, Follicular/pathology
- Phenotype
- Translocation, Genetic/genetics
- Trisomy/genetics
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Affiliation(s)
- E E Torlakovic
- Department of Pathology, College of Medicine, University of Saskatchewan, Royal University Hospital, Saskatoon, SK, Canada.
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26
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Baseggio L, Gazzo S, Callet-Bauchu E, Traverse-Glehen A, Thieblemont C, Bryon PA, Magaud JP, Berger F, Felman P. An unusual case of indolent B-cell lymphoma with distinct chronic lymphocytic leukemia and marginal zone differentiation according to the site of involvement. Leuk Lymphoma 2005; 46:1369-74. [PMID: 16109617 DOI: 10.1080/10428190500138039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The immunological profile of lymphoproliferative disorders is usually conserved whatever the involved site, thus allowing a reliable diagnosis from peripheral blood analysis, especially in small lymphocytic lymphoma/chronic lymphocytic lymphoma (SLL/CLL). Here we present a case wherein the cytology and immunophenotype of blood specimen and bone marrow argue in favor of SLL/CLL with a typical Matutes score (5/5), whereas the cyto-histology and immunophenotype of spleen specimen led to the diagnosis of splenic marginal zone B-cell lymphoma (SMZL). Moreover genomic analysis showed that the splenic cells displayed a SMZL signature. Whereas these data suggested the presence of 2 B-cell clones, the study of the mutational status of IgVH gene in blood and spleen demonstrated the presence of a single clone, which likely developed simultaneously along two distinct ways of differentiation according to the anatomic site suggesting here the predominant role of a micro-environmental factor in cell differentiation. Although rare, this kind of event must be kept in mind as a cause of discrepancies between diagnoses from different sites.
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Affiliation(s)
- Lucile Baseggio
- Service d'Hématologie Biologique, Hôpital Edouard Herriot, Lyon, France
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27
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Kojima M, Tanaka H, Matsuda H, Iijima M, Motoori T, Masawa N. Floral variant of follicular lymphoma containing marginal zone B-cell component. Report of two cases. APMIS 2005; 113:638-42. [PMID: 16218941 DOI: 10.1111/j.1600-0463.2005.apm_274.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We here report two unusual cases of floral variant of follicular lymphoma containing marginal zone B-cells. Histologically, the neoplastic follicles consisted of three distinct layers. The inner layer was composed of neoplastic germinal centers exhibiting a floral design and the middle layer had unusually prominent mantle zones. The outer zone of neoplastic follicles was surrounded by a pale cuff of marginal zone B-cells. Immunohistological study demonstrated that both the germinal center and marginal zone component lay within the follicular dendritic cell network. The germinal center component was CD10+ and bcl-2+. However, a portion of the marginal zone component weakly expressed bcl-2 but not CD10. Nodal marginal zone B-cell lymphoma (NMZBL) occasionally possesses "floral" lymphoid follicles. Follicular lymphoma with marginal zone differentiation is a high-risk variant of follicular lymphoma. In diagnostic practice, the differential diagnosis between the floral variant of follicular lymphoma containing marginal zone B-cells and the "floral variant" of NMZBL is important.
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Affiliation(s)
- M Kojima
- Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Japan.
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28
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Karube K, Ohshima K, Tsuchiya T, Yamaguchi T, Kawano R, Suzumiya J, Harada M, Kikuchi M. A “floral” variant of nodal marginal zone lymphoma. Hum Pathol 2005; 36:202-6. [PMID: 15754298 DOI: 10.1016/j.humpath.2004.12.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We describe 6 cases of a specific variant of nodal marginal zone lymphoma with "floral" lymph follicles in patients ranging in age from 18 to 66 years. All 6 patients had lymphadenopathy, either local (n = 5) or systemic (n = 1), and good performance status (0), and none had fever, weight loss, or night sweating. They all underwent excisional biopsy. Histologically, all lesions had a distinctive morphology, with proliferation of medium-sized atypical lymphoid cells in the marginal zone, hyperplastic lymph follicles with enlarged germinal centers, and a thickened mantle zone. In places, folliculolysis was observed. On immunohistochemical staining, the atypical lymphoid cells showed a B-cell phenotype (CD20 +), IgM positivity in 2 of 5 cases, and negativity for CD5, CD10, CD23, CD43, bcl-6, and IgD. Polymerase chain reaction examination for immunoglobulin heavy chain in 5 cases showed monoclonality in all. Five patients did not receive adjuvant chemotherapy and had no recurrences. The patient with systemic lymphadenopathy received chemotherapy and had a complete response without relapse. This variant should be differentiated from the usual nodal marginal zone lymphoma because of its specific clinical and pathological features.
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Affiliation(s)
- Kennosuke Karube
- Department of Pathology, School of Medicine, Fukuoka University, Fukuoka 814-0180, Japan.
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