Follicular large cleaved cell (centrocytic) lymphoma: an unrecognized variant of follicular lymphoma

Behery, Radwa El; Laurini, Javier A.; Weisenburger, Dennis D.; Smith, Lynette M.; Davé, Bhavana J.; Yuan, Jane; Fu, Kai; Chan, Wing C.; Nathwani, Bharat N.; Bierman, PJ; Bociek, R. Gregory; Vose, Julie M.; Armitage, Jamés O.; Greiner, Timothy C.; Aoun, Patricia

doi:10.1016/j.humpath.2017.11.002

Cited by 11 publications

(9 citation statements)

References 16 publications

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“…However, in the remaining 51/1921 cases (2.7%) a clear distinction between FL3A and FL3B could not be established although high-grade features were present, prompting us to consider a category of "unconventional high-grade" FL (FL3U). The shared morphological characteristics of FL3U cases included: (1) a nodular growth pattern evidenced by a CD21 + and/or CD23 + FDC network of variable density; (2) a predominant cell population (more than 15/hpf) of small-sized to mediumsized blasts or LCC with open fine chromatin and inconspicuous nucleoli as previously defined; 9 (3) scarcity or absence of any centrocytic component (Figs. 2C-F and 3).…”

Section: Resultsmentioning

confidence: 88%

“…Several previous studies have suggested that the LCC cytologic pattern, including fine chromatin and pale cytoplasm with somewhat blastoid appearance, should be considered as a high-grade feature in FL. 9,10,34 Patients with LCC FL had a clinical presentation and survival similar to those with FL3A and FL3B, suggesting that LCC could be a FL3 variant. 34 LCC FLs were also shown to display a higher Ki67 than FL1-2, 4,9 and a frequency of DH similar to FL3B.…”

Section: Discussionmentioning

confidence: 96%

“…The reliability of this method based on a mere centroblast count appears indeed debatable, especially its ability to handle particular variants such as so-called "large cleaved cell" (LCC) FL, that is, FL in which the neoplastic follicles are predominantly composed of large centrocytes with high proliferation rates. 9 One could consider that a high content of LCC in FL may represent a high-grade feature since a well-known pioneering report about FL grading states that the count of large cells should include both cleaved and noncleaved cells. 10 The reason why only large noncleaved cells should be counted according to the current WHO system may be that this count was considered as a more reliable method, with approaching results in term of survival correlations.…”

Section: Introductionmentioning

confidence: 99%

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High-grade Follicular Lymphomas Exhibit Clinicopathologic, Cytogenetic, and Molecular Diversity Extending Beyond Grades 3A and 3B

Laurent

Adélaı̈de

Guillé

et al. 2021

American Journal of Surgical Pathology

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Although follicular lymphoma (FL) is usually graded as FL1-2, FL3A, and FL3B, some borderline cases can be observed and led us to investigate the clinicopathologic diversity of grade 3 FL (FL3). Among 2449 FL patients enrolled in Lymphoma Study Association (LYSA) trials, 1921 cases with sufficient material underwent a central pathologic review. The resulting diagnoses comprised 89.6% FL1-2 (n=1723), 7.2% FL3A (n=138), and 0.5% purely follicular FL3B (n=9). The remaining 51 unclassifiable cases (2.7%) exhibited high-grade features but did not meet WHO criteria for either FL3A or FL3B; and were considered as “unconventional” high-grade FL (FL3U). FL3U morphological pattern consisted of nodular proliferation of large cleaved cells or small-sized to medium-sized blast cells. Compared with FL3A, FL3U exhibited higher MUM1 and Ki67 expression, less BCL2 breaks and more BCL6 rearrangements, together with a higher number of cases without any BCL2, BCL6 or MYC rearrangement. FL3U harbored less frequent mutations in BCL2, KMT2D, KMT2B, and CREBBP than FL3A. MYC and BCL2 were less frequently mutated in FL3U than FL3B. Rituximab cyclophosphamide, doxorubicin, vincristine, and prednisone treated FL3U patients had a worse survival than FL1-2 patients with similar follicular lymphoma international prognostic index and treatment. These results suggest that high-grade FLs encompass a heterogeneous spectrum of tumors with variable morphology and genomic alterations, including FL3U cases that do not strictly fit WHO criteria for either FL3A or FL3B, and display a worse outcome than FL1-2. The distinction of FL3U may be useful to allow a better comprehension of high-grade FLs and to design clinical trials.

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Section: Resultsmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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High-grade Follicular Lymphomas Exhibit Clinicopathologic, Cytogenetic, and Molecular Diversity Extending Beyond Grades 3A and 3B

Laurent

Adélaı̈de

Guillé

et al. 2021

American Journal of Surgical Pathology

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“…Nevertheless, latest discoveries are changing the impression that FL is a disease entity that can be easily diagnosed and classified. Cases of FL with a range of unusual features have been described [8][9][10]. The morphologic variants of FL were reviewed by Choi and colleagues [11].…”

Section: Discussionmentioning

confidence: 99%

A rare face of follicular lymphoma: reverse variant of follicular lymphoma

et al. 2020

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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,

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“…The second most common type of NHL is follicular lymphoma (FL). FL has been described as a heterogeneous malignancy that includes tumors often derived from germinal center B-cells, centrocytes, and occasionally centroblasts [ 2 ]. There are 3.18 cases of FL per 100,000 people seen in the United States with a greater predilection (2X) in Caucasian than African-American or Asian populations [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Follicular lymphoma presenting as scalp mass deformity: Case Report and Review of the literature

Nwafor

Radwan

Lucke‐Wold

et al. 2017

Biomed Res Clin Prac

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Lymphoma presenting as a scalp mass is a rare but serious medical condition mandating aggressive treatment and neurosurgical intervention. We report a case of 53-year-old male who presented with a large right sided frontal scalp mass and a smaller mass located on the left frontal scalp. After discussion with the patient, it was decided to resect the larger mass for definitive diagnosis. After subtotal resection of the mass, biopsy revealed WHO grade 1 follicular lymphoma (FL), diffuse pattern stage IV. The patient was subsequently treated with 4 grays (Gy) of palliative radiotherapy over 2 fractions to the right frontal scalp and systemic chemo-immunotherapy (6 cycles) followed by rituximab maintenance. Lumbar puncture to obtain cerebrospinal fluid was done a month after therapy began and the results were negative for spread of malignant cells. Approximately 3 months after initiation of therapy, PET/CT showed no evidence of active malignancy and MRI revealed a complete internal resolution of the enlarged right frontal scalp mass. We use this case to provide a detailed discussion regarding disease pathophysiology, early diagnosis, and management

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Follicular large cleaved cell (centrocytic) lymphoma: an unrecognized variant of follicular lymphoma

Cited by 11 publications

References 16 publications

High-grade Follicular Lymphomas Exhibit Clinicopathologic, Cytogenetic, and Molecular Diversity Extending Beyond Grades 3A and 3B

High-grade Follicular Lymphomas Exhibit Clinicopathologic, Cytogenetic, and Molecular Diversity Extending Beyond Grades 3A and 3B

A rare face of follicular lymphoma: reverse variant of follicular lymphoma

Follicular lymphoma presenting as scalp mass deformity: Case Report and Review of the literature

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