Follicular Lymphoma of the Gallbladder in an Octogenarian: A Case Report and Literature Review

Abstract

Primary follicular lymphoma (PFL) is an indolent subtype of non-Hodgkin lymphoma that typically involves lymphoid tissues. Gallbladder involvement is exceedingly rare and poses significant diagnostic challenges. Few cases in the literature describe gallbladder follicular lymphoma, particularly in elderly male patients, leaving notable gaps in clinical understanding and management. Herein, we present the case of an 82-year-old male who presented with acute abdominal pain and unintentional weight loss. Initial imaging, including contrast-enhanced computed tomography, ultrasound, and magnetic resonance imaging, revealed a suspicious gallbladder mass with wall thickening and regional lymphadenopathy, raising concern for malignancy. Endoscopic ultrasound-guided fine needle aspiration and subsequent immunophenotyping confirmed a diagnosis of PFL. The patient underwent radical cholecystectomy with lymphadenectomy, and histopathological examination corroborated the diagnosis of gallbladder follicular lymphoma. During follow-up, the patient developed complications, yet no evidence of lymphoma recurrence was observed. A literature review identified 8 similar cases, further emphasizing the rarity of this presentation. Future research should focus on optimizing diagnostic techniques, refining therapeutic strategies, and conducting longer-term follow-up studies to better assess patient outcomes in such a rare disease. This case highlights the need for heightened clinical suspicion and comprehensive evaluation in atypical presentations of extranodal lymphoma.

Keywords: extra nodal lymphoma; follicular lymphoma; gallbladder; gastroenterology; non-Hodgkin lymphoma.

Figure 1.

(a) Abdominal ultrasound reveals thickening of the gallbladder wall and 2.9 cm ill-defined heterogenous mass in the neck of the gallbladder. (b) Computerized tomography abdomen and pelvis with IV contrast showing 3.5 cm × 3.1 cm mass in the gallbladder neck.

Figure 2.

Magnetic resonance imaging the abdomen and pelvis with contrast showing an axial T-weighted image for a 3.8 cm mass that does not involve the cystic duct.

Figure 3.

Histologic sections of the gallbladder with immunohistochemical stains. The atypical lymphoid follicles predominantly comprise CD20 and PAX5 positive B cells and fewer CD3 T-cells. The B-cells coexpress CD10, BCL6, and BCL-2 (strong). CD21 demonstrates follicular dendritic meshworks in the abnormal lymphoid infiltrate. The overall findings demonstrate involvement by follicular lymphoma, grade 1 to 2 (classic follicular lymphoma). Sheets of large cells diagnostic of transformation to diffuse large B-cell lymphoma are not identified. (a) CD21 100×; (b) CD3 100×; (c) BCL6 100×; (d) PAX5 100×; (e) BCL2100×; (f) CD10 100×; (h) CD5 100×.

Figure 4.

Histologic sections of the gallbladder demonstrate unremarkable biliary mucosa and muscular propria with multiple scattered small lymphoid follicles in the perimucosal connective tissue. The follicles predominately comprise small lymphocytes, often with small cleaved cells and a few scattered large cells. (a) H&E 100×; (b) H&E 400×.