Lymphoma, small cleaved-cell, follicular

Lymphoma, Small Cleaved-Cell, Follicular

Lymphoma, small cleaved-cell, follicular is a subtype of non-Hodgkin lymphoma (NHL) characterized by the presence of small cleaved cells in a follicular pattern. This type of lymphoma is part of the broader category of follicular lymphoma, which is one of the most common forms of indolent (slow-growing) lymphomas.

Pathophysiology

Follicular lymphoma arises from B cells, a type of white blood cell that plays a crucial role in the immune response. The hallmark of follicular lymphoma is the translocation t(14;18)(q32;q21), which results in the overexpression of the BCL2 gene. This genetic alteration prevents apoptosis, allowing the B cells to survive longer than normal, leading to the accumulation of malignant cells.

The "small cleaved-cell" designation refers to the appearance of the lymphoma cells under the microscope. These cells are typically small with irregular, cleaved nuclei, and they form a follicular pattern in the lymph nodes.

Clinical Presentation

Patients with small cleaved-cell follicular lymphoma often present with painless lymphadenopathy, which is the swelling of lymph nodes. Other symptoms may include fatigue, night sweats, fever, and weight loss, collectively known as B symptoms. Due to its indolent nature, many patients may be asymptomatic at diagnosis.

Diagnosis

Diagnosis of small cleaved-cell follicular lymphoma involves a combination of clinical evaluation, imaging studies, and histopathological examination. A biopsy of the affected lymph node is essential to confirm the diagnosis. Immunohistochemistry is used to identify the expression of specific markers such as CD20, CD10, and BCL2, which are characteristic of follicular lymphoma.

Treatment

The treatment approach for small cleaved-cell follicular lymphoma depends on the stage of the disease and the presence of symptoms. In asymptomatic patients, a "watch and wait" strategy may be employed. For symptomatic patients, treatment options include:

• Rituximab: A monoclonal antibody targeting CD20 on B cells.
• Chemotherapy: Regimens such as CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) may be used.
• Radioimmunotherapy: Combines radiation therapy with monoclonal antibodies.

Prognosis

Follicular lymphoma is generally considered incurable with standard therapies, but it often has a prolonged course with multiple remissions and relapses. The prognosis depends on factors such as age, stage of the disease, and overall health of the patient. The Follicular Lymphoma International Prognostic Index (FLIPI) is commonly used to assess prognosis.

Also see

• Non-Hodgkin Lymphoma
• B-cell Lymphoma
• Rituximab
• Immunohistochemistry