Lymphoblastic Transformation of Follicular Lymphoma: A Case Report and Review of the Literature

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AJSP-Reviews and Reports Pub Date : 2019-09-01 DOI:10.1097/PCR.0000000000000330

Julie A. Rosser, Cody A. Thomas

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Abstract

Follicular lymphoma (FL) is one of the most common B-cell non-Hodgkin lymphomas in adults in the Western world. Prognosis is correlated with the clinical stage and histologic grade and, increasingly, the tumor genetic profile. A subset of patients with FL experiences histologic disease progression (ie, histologic transformation), of which the majority will demonstrate diffuse large B-cell lymphoma. We describe a patient initially diagnosed with low-grade FL with relapsed disease presenting as acute renal failure due to diffuse abdominal lymphadenopathy. Excisional biopsy of an inguinal lymph node at relapse showed high-grade areas with sheets of immature-appearing lymphoid cells adjacent to nodular areas characteristic of low-grade FL. Cells of both components were positive for BCL2 and CD19. The cells of the high-grade component were positive for CD99 and TdT and negative for CD20, whereas cells of the low-grade component were positive for CD20 and negative for CD99 and TdT. Fluorescence in situ hybridization studies demonstrated the IGH/BCL2 rearrangement in addition to an MYC rearrangement in both low- and high-grade components.

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滤泡性淋巴瘤淋巴母细胞转化1例报告及文献复习

滤泡性淋巴瘤(滤泡性淋巴瘤)是西方成人中最常见的b细胞非霍奇金淋巴瘤之一。预后与临床分期和组织学分级有关，并且越来越多地与肿瘤遗传谱有关。一部分FL患者会经历组织学疾病进展(即组织学转化)，其中大多数会表现为弥漫性大b细胞淋巴瘤。我们描述了一个最初诊断为低级别FL的患者，疾病复发，表现为弥漫性腹部淋巴结病引起的急性肾功能衰竭。复发时的腹股沟淋巴结切除活检显示高级别淋巴结附近有片状未成熟的淋巴样细胞，这是低级别FL的特征。这两种成分的细胞都呈BCL2和CD19阳性。高级成分细胞CD99和TdT阳性，CD20阴性，而低级成分细胞CD20阳性，CD99和TdT阴性。荧光原位杂交研究表明，除了MYC重排外，在低和高级成分中还存在IGH/BCL2重排。

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AJSP-Reviews and Reports PATHOLOGY-

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期刊介绍： Each issue of Pathology Case Reviews examines one vital theme in the field with peer-reviewed, clinically oriented case reports that focus on diagnosis, specimen handling and reports generation. Each theme-oriented issue covers both histopathologic and cytopathologic cases, offering a comprehensive perspective that includes editorials and review articles of the newest developments in the field, differential diagnosis hints, applications of new technologies, reviews of current issues and techniques and an emphasis on new approaches.