How is follicular lymphoma diagnosed?

Updated: Mar 03, 2020
  • Author: Lauren C Pinter-Brown, MD; Chief Editor: Emmanuel C Besa, MD  more...
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During the physical evaluation, all lymph node areas and the reticuloendothelial system should be examined. Involved nodes typically are nontender, firm, and rubbery in consistency. The throat, liver, and spleen should also be examined. Splenomegaly is present in approximately 50% of patients at presentation, and hepatosplenomegaly may occur.

A complete blood cell count (CBC) with differential should be obtained, including examination of the peripheral blood smear if the differential is abnormal. A chemistry panel and lactate dehydrogenase (LDH) level should be obtained.

A computed tomography (CT) scan of the chest, abdomen, and pelvis can determine whether abdominal or pelvic adenopathy is present. Positron emission tomography (PET) scanning may also be useful in certain clinical settings, such as localized disease or when transformed disease is suspected. [5]

Biopsy is essential to establish a diagnosis of lymphoma. Obtain an excisional biopsy (or, if that is not possible, a core biopsy) of an involved node. If the disease is extranodal, a surgical biopsy sample should be obtained from the involved organ.

Because the chromosomal t(14;18) translocation is found in the majority of patients with follicular lymphoma, bone marrow aspiration and chromosome analysis can also help establish the diagnosis.

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