Follicular lymphoma
Description
- Commonest indolent NHL; germinal-centre B-cell origin, follicular (nodular) growth pattern
- Incurable with standard therapy in advanced stage, but compatible with decades of life - the management problem is sequencing, not cure
- Transforms to aggressive lymphoma at ~2-3% per year
Grading and the WHO 5th edition
| Classic FL (grades 1-3A) | Centrocyte-predominant. Treated as indolent |
| Follicular large B-cell lymphoma (old grade 3B) | Sheets of centroblasts, often BCL2-negative and t(14;18)-negative. *Treat as DLBCL* |
| In situ follicular neoplasia | Incidental, BCL2+ cells confined to germinal centres. Very low progression risk - do not treat |
| Duodenal-type FL | Localised to small bowel, excellent prognosis, watch and wait |
| Paediatric-type FL | Localised, BCL2-negative, high grade histology but cured by excision alone |
- Typical presentation: painless, waxing-and-waning lymphadenopathy over months to years, often with no B symptoms
- Marrow involvement in 40-70% at diagnosis - stage IV is common and does not mean urgent treatment
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