Follicular Large B-Cell Lymphoma

Siba El Hussein, MD
2 min readOct 16, 2022

Lesson From the Friday Unknowns

The patient has a history of low grade follicular lymphoma with progression to grade 3.

Histologic sections show needle shaped fragments of lymph node involved by lymphoma. The neoplasm has a vaguely nodular pattern with the follicles composed of a mixture of centrocytes and centroblasts supporting grade 3A. A diffuse component with large lymphoma cells are seen (representing at least 30% of the biopsy specimen).

Ki67

Immunohistochemical studies show that the tumor cells are positive for CD20, CD10, BCL6, CD23 and BCL2 and are negative for CD3. The proliferation index measured by Ki-67 is up to 30%. CD21 highlights residual networks of follicular dendritic cells.

In summary, the findings are those of follicular lymphoma grade 3A with areas of diffuse large B cell lymphoma. FISH studies to assess for MYC, BCL2 and BCL6 gene rearrangements are in progress.

Link to digital slides: https://bit.ly/3rRwQ9F | Case 5

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Siba El Hussein, MD

Hematopathology | Cytopathology | Molecular pathology | Digital pathology | Data science | Machine learning