Abstract

The World Health Organization classification of lymphoma recommends the subdivision of follicular lymphoma (FL) into 3 grades (FL1-3) based on the average number of centroblasts per high-power field in the neoplastic follicles, but does not recognize a form of FL characterized by a predominance of large cleaved cells (centrocytes) without enough centroblasts to meet the World Health Organization criteria for FL3. We have classified such cases as follicular large cleaved cell lymphoma (FLC) and, herein, describe the pathologic and clinical features of 72 cases of this entity. The features of FLC include a follicular growth pattern with pale follicles at low magnification and frequent follicular and/or interfollicular fibrosis. Cytologically, the cells are predominantly large cleaved cells with moderately coarse to fine chromatin, absent or inconspicuous nucleoli, and small to moderate amounts of pale cytoplasm. The mean nuclear diameter of the large cleaved cells was 10.1 μ approximately twice that of small lymphocytes and similar to centroblasts. The t(14;18) was present in 83% of the cases, and a high proportion expressed BCL2 (84%), BCL6 (100%), and CD10 (88%) and had high Ki67 proliferation (81%). The clinical features of patients with FLC were similar to those with other types of FL, and survival was excellent with anthracycline-based chemotherapy plus rituximab. FLC is a variant of follicular lymphoma, which should be recognized in future lymphoma classifications because the diagnosis of FLC may be important for the selection of therapy.

Original languageEnglish (US)
Pages (from-to)180-190
Number of pages11
JournalHuman Pathology
Volume72
DOIs
StatePublished - Feb 2018

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Follicular Lymphoma
Lymphoma
Anthracyclines
Chromatin
Cytoplasm
Fibrosis
Lymphocytes
Drug Therapy
Survival
Growth

Keywords

  • Follicular large cleaved cell lymphoma
  • Follicular lymphoma
  • Large centrocyte
  • Large cleaved cell
  • Non-Hodgkin lymphoma

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Follicular large cleaved cell (centrocytic) lymphoma : an unrecognized variant of follicular lymphoma. / El Behery, Radwa; Laurini, Javier A.; Weisenburger, Dennis D.; Smith, Lynette M; Dave, Bhavana J; Yuan, Ji; Fu, Kai; Chan, Wing C.; Nathwani, Bharat N.; Bierman, Philip Jay; Bociek, Robert G; Vose, Julie Marie; Armitage, James Olen; Greiner, Timothy Charles; Aoun, Patricia.

In: Human Pathology, Vol. 72, 02.2018, p. 180-190.

Research output: Contribution to journalArticle

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title = "Follicular large cleaved cell (centrocytic) lymphoma: an unrecognized variant of follicular lymphoma",
abstract = "The World Health Organization classification of lymphoma recommends the subdivision of follicular lymphoma (FL) into 3 grades (FL1-3) based on the average number of centroblasts per high-power field in the neoplastic follicles, but does not recognize a form of FL characterized by a predominance of large cleaved cells (centrocytes) without enough centroblasts to meet the World Health Organization criteria for FL3. We have classified such cases as follicular large cleaved cell lymphoma (FLC) and, herein, describe the pathologic and clinical features of 72 cases of this entity. The features of FLC include a follicular growth pattern with pale follicles at low magnification and frequent follicular and/or interfollicular fibrosis. Cytologically, the cells are predominantly large cleaved cells with moderately coarse to fine chromatin, absent or inconspicuous nucleoli, and small to moderate amounts of pale cytoplasm. The mean nuclear diameter of the large cleaved cells was 10.1 μ approximately twice that of small lymphocytes and similar to centroblasts. The t(14;18) was present in 83{\%} of the cases, and a high proportion expressed BCL2 (84{\%}), BCL6 (100{\%}), and CD10 (88{\%}) and had high Ki67 proliferation (81{\%}). The clinical features of patients with FLC were similar to those with other types of FL, and survival was excellent with anthracycline-based chemotherapy plus rituximab. FLC is a variant of follicular lymphoma, which should be recognized in future lymphoma classifications because the diagnosis of FLC may be important for the selection of therapy.",
keywords = "Follicular large cleaved cell lymphoma, Follicular lymphoma, Large centrocyte, Large cleaved cell, Non-Hodgkin lymphoma",
author = "{El Behery}, Radwa and Laurini, {Javier A.} and Weisenburger, {Dennis D.} and Smith, {Lynette M} and Dave, {Bhavana J} and Ji Yuan and Kai Fu and Chan, {Wing C.} and Nathwani, {Bharat N.} and Bierman, {Philip Jay} and Bociek, {Robert G} and Vose, {Julie Marie} and Armitage, {James Olen} and Greiner, {Timothy Charles} and Patricia Aoun",
year = "2018",
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T1 - Follicular large cleaved cell (centrocytic) lymphoma

T2 - an unrecognized variant of follicular lymphoma

AU - El Behery, Radwa

AU - Laurini, Javier A.

AU - Weisenburger, Dennis D.

AU - Smith, Lynette M

AU - Dave, Bhavana J

AU - Yuan, Ji

AU - Fu, Kai

AU - Chan, Wing C.

AU - Nathwani, Bharat N.

AU - Bierman, Philip Jay

AU - Bociek, Robert G

AU - Vose, Julie Marie

AU - Armitage, James Olen

AU - Greiner, Timothy Charles

AU - Aoun, Patricia

PY - 2018/2

Y1 - 2018/2

N2 - The World Health Organization classification of lymphoma recommends the subdivision of follicular lymphoma (FL) into 3 grades (FL1-3) based on the average number of centroblasts per high-power field in the neoplastic follicles, but does not recognize a form of FL characterized by a predominance of large cleaved cells (centrocytes) without enough centroblasts to meet the World Health Organization criteria for FL3. We have classified such cases as follicular large cleaved cell lymphoma (FLC) and, herein, describe the pathologic and clinical features of 72 cases of this entity. The features of FLC include a follicular growth pattern with pale follicles at low magnification and frequent follicular and/or interfollicular fibrosis. Cytologically, the cells are predominantly large cleaved cells with moderately coarse to fine chromatin, absent or inconspicuous nucleoli, and small to moderate amounts of pale cytoplasm. The mean nuclear diameter of the large cleaved cells was 10.1 μ approximately twice that of small lymphocytes and similar to centroblasts. The t(14;18) was present in 83% of the cases, and a high proportion expressed BCL2 (84%), BCL6 (100%), and CD10 (88%) and had high Ki67 proliferation (81%). The clinical features of patients with FLC were similar to those with other types of FL, and survival was excellent with anthracycline-based chemotherapy plus rituximab. FLC is a variant of follicular lymphoma, which should be recognized in future lymphoma classifications because the diagnosis of FLC may be important for the selection of therapy.

AB - The World Health Organization classification of lymphoma recommends the subdivision of follicular lymphoma (FL) into 3 grades (FL1-3) based on the average number of centroblasts per high-power field in the neoplastic follicles, but does not recognize a form of FL characterized by a predominance of large cleaved cells (centrocytes) without enough centroblasts to meet the World Health Organization criteria for FL3. We have classified such cases as follicular large cleaved cell lymphoma (FLC) and, herein, describe the pathologic and clinical features of 72 cases of this entity. The features of FLC include a follicular growth pattern with pale follicles at low magnification and frequent follicular and/or interfollicular fibrosis. Cytologically, the cells are predominantly large cleaved cells with moderately coarse to fine chromatin, absent or inconspicuous nucleoli, and small to moderate amounts of pale cytoplasm. The mean nuclear diameter of the large cleaved cells was 10.1 μ approximately twice that of small lymphocytes and similar to centroblasts. The t(14;18) was present in 83% of the cases, and a high proportion expressed BCL2 (84%), BCL6 (100%), and CD10 (88%) and had high Ki67 proliferation (81%). The clinical features of patients with FLC were similar to those with other types of FL, and survival was excellent with anthracycline-based chemotherapy plus rituximab. FLC is a variant of follicular lymphoma, which should be recognized in future lymphoma classifications because the diagnosis of FLC may be important for the selection of therapy.

KW - Follicular large cleaved cell lymphoma

KW - Follicular lymphoma

KW - Large centrocyte

KW - Large cleaved cell

KW - Non-Hodgkin lymphoma

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