What Is a Follicular Neoplasm?

Follicular lymphoma (FL): An inert B-cell tumor derived from cells derived from the follicular germinal center. FL accounts for about 50% of all NHL in Western countries, and FL accounts for about 13% of NHL in China. The histological feature of FL is the obvious nodular growth of tumor cells under low magnification. Tumor follicles are mainly composed of different proportions of central cells and central mother cells. The nucleus of the central cell has a fissure, which is called a small nuclear fission cell. The central mother cell has a large nucleus, and the nucleus is round or leaf-shaped.

Follicular lymphoma

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Follicular lymphoma (FL): An inert B-cell tumor derived from cells derived from the follicular germinal center. FL accounts for about 50% of all NHL in Western countries, and FL accounts for about 13% of NHL in China. The histological feature of FL is the obvious nodular growth of tumor cells under low magnification. Tumor follicles are mainly composed of different proportions of central cells and central mother cells. The nucleus of the central cell has a fissure, which is called a small nuclear fission cell. The central mother cell has a large nucleus, and the nucleus is round or leaf-shaped.

Chinese name

Follicular lymphoma

Foreign name

follicular lymphoma

Types of

Inert B-cell tumor

Histological characteristics

Obvious nodular growth

Main composition

Central cell and central mother cell

treatment method

Conservative treatment

In most follicular lymphomas, the central cells account for the vast majority and the number of central blasts increases, indicating an increase in the malignancy of the tumor.

Approximately 10% of patients have increased total leukocytes due to the involvement of peripheral blood (but often less than 20 × 108 / L). About 85% of patients have bone marrow involvement. Tumor cells infiltrate the white pulp of the spleen and the manifold area of the liver. The immunophenotypic test showed that the tumor cells of FL had the immunophenotype of normal germinal center cells and expressed CD19, CD20, CD10 and monoclonal surface immunoglobulin. In approximately 90% of cases, tumor cells express BCL2, while normal follicular germinal center B cells are BCL2-negative; almost all tumor cells express BCL6. The characteristic cytogenetic change of FL is t (14; 18). The result is the splicing of the lgH gene on chromosome 14 and the BCL2 gene on chromosome 18, leading to the activation of BCL2 gene and high expression of BCL2 protein. Therefore, BCL2 protein is also a useful marker to distinguish between reactive hyperplasia follicles and FL tumor follicles.

In terms of treatment, conservative treatment is the main treatment. The response to chemotherapy is good, but it cannot be cured, the disease course is long, and the recurrence or metastasis is invasive.

This disease is more common in elderly men. Skin nodules and plaques occur on the trunk, especially the back, followed by the scalp. Most of them are single or scattered, with a diameter of 2.5 to 15cm, and the surface is smooth and papillary, with little flaking and ulceration. Typical cases are surrounded by smaller pimples, mildly infiltrated plaques, and / or graphical erythema. Mild invasive plaques can occur months or 20 years before a rapidly growing skin tumor. Some patients have pimples, nodules, and / or mildly infiltrated plaques that last only a few months.

The lesions are non-scaly, solitary or clustered pimples, plaques, and / or tumors, surrounded by erythema. In most cases, skin lesions are confined to a certain location. About two thirds of the cases occur in the trunk, and one fifth occur in the head and neck. This disease is twice as many as men. Without treatment, the damage gradually increases over the years, and the number increases, but it is rare that the skin is affected. The prognosis of head and trunk damage is good, and the 5-year survival rate after treatment is 100%.

According to clinical manifestations, skin lesion characteristics, and histopathological characteristics can be diagnosed.

The dermis was nodular or diffusely infiltrated, and was characterized by intact epidermis. Early damage can be seen in central cells, a small number of central blasts and reactive T cells are mixed. As the disease progresses, tumor B cells increase in number.

The histological classification of FCCL, according to the new work classification, includes: follicular small fissure cells, follicular mixed cells, and follicular large cells. The relationship between these types and the Rappaport and Kiel classifications is shown in Table 1. The infiltrating cells of this tumor are mainly distributed in the superficial part of the dermal reticular layer and even in the deep and subcutaneous tissues, and they are even distributed in a continuous band. The cell is infiltrated with a cell-free zone at an interval from the epidermis, and there are early slices along the blood vessels and / or appendages Shaped, lumpy infiltration. 10% of the damaged specimens showed a follicular type, most of which were diffuse in the late stage, and the common type was both types (mixed type). The components of infiltrating cells are different, but no matter what cell type they are, some cells that differentiate into plasma cells are common and are often limited to the cloning of a single light chain. In some cases, transitional shapes between plasma cells and tumor cells can be seen. It is prominent that no large neoplasmic follicular structure typical in the lymph node FCCL is seen as the aggregation of larger lymphoid cells, the boundaries are unclear, and the small lymphocytes are irregularly distributed around the periphery. According to the new work classification and the time of damage, although tissues may show small clea red cell (SCC) lymphomas at an early stage, mixed small cell and large cell (MC) lymphomas are common; in the late stages Even in old tumors, although it may show obvious MC lymphoma, it often shows large cell (LC) lymphoma. The number of inflammatory response cells varies, mainly small lymphocytes, plasma cells, and macrophages. In about 10% of the damaged specimens, it can be seen that there is a fully developed reactive lymphoid follicle and / or structure (immunolabeling indicates B cell polyclonality) in the germinal center. Immunolabeling showed that in addition to the expression of whole B cell antigens (CD19, C1320, and CD22) and HLA-DR, tumor cells often showed the conversion of immunoglobulin heavy chains, lost IgD, and obtained IRC or IRA.

Tumor B cell markers CD19, CD20, CD22, and CD79 were positive. A single type of immunoglobulin product, the kappa or lambda light chain, can be found on the cell surface, while small is positive for both. Tumor-stage immunoglobulin staining was negative. Skin follicular central cell lymphoma does not express CD5 or CD10. In contrast to lymph node follicular central cell lymphomas, primary skin follicular centers generally also do not express bcl-2 protein. Clonal rearrangement of immunoglobulin genes can be seen in most cases. ^[1]

(A) treatment

The total amount of radiation therapy is 30-40Gy, which is a better therapy. For generalized damage, CHOP combined with chemotherapy can be considered. A single lesion can be removed surgically.

(B) the prognosis

Marzano et al. Pointed out that subcutaneous T-cell lymphoma can be classified as primary or secondary, and the presence or absence of hemophagocytic syndrome, tumor subtypes, and immunophenotypes is related to prognosis. The prognosis of head and trunk damage is good, and the 5-year survival rate after treatment is 100%.