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Case Reports
. 2022 Jun 16;10(17):5877-5883.
doi: 10.12998/wjcc.v10.i17.5877.

Follicular lymphoma presenting like marginal zone lymphoma: A case report

Hao-Yu Peng  1 , Ying-Jie Xiu  2 , Wei-Hong Chen  1 , Qing-Li Gu  1 , Xin Du  3
Affiliations
Case Reports

Follicular lymphoma presenting like marginal zone lymphoma: A case report

Hao-Yu Peng et al. World J Clin Cases. .

Abstract

Background: Follicular lymphoma (FL), a common type of indolent lymphoma, carries markers of the germinal center, and the rearrangement of the BCL-2 gene is regarded as an initiating event and a hallmark of the neoplasm. When FL has marginal zone differentiation, some marginal zone features are carried by the neoplasm.

Case summary: A 54-year-old male with lymphadenopathy, splenomegaly and hyperlymphocytosis was diagnosed with FL with marginal zone differentiation. The tumor demonstrated different features in the bone marrow (BM) compared with the follicle of the lymph node (LN). Some component of the neoplasm mimicked marginal zone lymphoma, such as infiltrating the marginal zone of the LN, displaying a monocytoid shape and lacking the expression of CD10 in the BM. The diagnosis of FL was made due to the concurrent detection of BCL-2 rearrangement in the LN and BM.

Conclusion: Discordant pathological features in LN and BM could mislead diagnosis. When clinical and pathological manifestations are confusing in diagnosis, typical genetic abnormalities are decisive.

Keywords: Case report; Discordant immunophenotypes; Follicular lymphoma; Gene rearrangement; Marginal zone differentiation.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Morphology and flow cytometry analysis of the bone marrow. A and B: The bone marrow (BM) was mainly infiltrated by monocytoid cells, accompanied with a few cells with cleaved or notched nuclei (pointed by arrows) [400 × (A) and 400 × (B)]; C: Flow cytometry revealed that the neoplastic cells (the red group) in BM were positive for CD19 and CD20 but negative for CD5 and CD10.
Figure 2
Figure 2
Morphology of the bone marrow and lymph node. A and B: Hematoxylin and eosin (HE) stain displayed that the bone marrow was infiltrated by neoplastic lymphocytes in a paratrabecular pattern [100 × (A) and 200 × (B)]; C and D: HE stain showed that expanded follicles were infiltrated by neoplastic centroblasts and centrocytes, and serried monocytoid cells (arrows) [100 × (C) and 200 × (D)] surrounded them.
Figure 3
Figure 3
Fluorescence in situ hybridization analysis of the bone marrow and lymph node. A-D: A and C were the control groups [1000 × (A) and 1000 × (B), 400 × (C) and 400 × (D)], the rearrangement of BCL-2/IGH (fusion of the red light and the green light) (B) was detected in the bone marrow and in the lymph node (fusion of the red light and the green light) (D) shown by fluorescence in situ hybridization.
Figure 4
Figure 4
Immunohistochemical examination of the lymph node. A-D: The follicular cells were positive for CD10 [100 × (A) and 200 × (B)] and CD20 [100 × (C) and 200 × (D)], and the proliferative marginal component was negative for CD10 (A and B) and positive for CD20 (C and D).
See this image and copyright information in PMC

References

    1. Küppers R. Mechanisms of B-cell lymphoma pathogenesis. Nat Rev Cancer. 2005;5:251–262. - PubMed
    1. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD, Jaffe ES. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127:2375–2390. - PMC - PubMed
    1. Chapman JR, Alvarez JP, White K, Sanchez S, Khanlari M, Algashaamy K, Cassidy D, Peng JH, Fan YS, Alencar A, Alderuccio JP, Lossos IS, Vega F. Unusual Variants of Follicular Lymphoma: Case-based Review. Am J Surg Pathol. 2020;44:329–339. - PubMed
    1. Abou-Elella A, Shafer MT, Wan XY, Velanker M, Weisenburger DD, Nathwani BN, Gascoyne RD, Greiner TC, Chan WC. Lymphomas with follicular and monocytoid B-cell components. Evidence for a common clonal origin from follicle center cells. Am J Clin Pathol. 2000;114:516–522. - PubMed
    1. Schmid U, Cogliatti SB, Diss TC, Isaacson PG. Monocytoid/marginal zone B-cell differentiation in follicle centre cell lymphoma. Histopathology. 1996;29:201–208. - PubMed

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