What is the WHO classification of follicular lymphoma?

Answer

More recently, the WHO classification of lymphoid neoplasms adopted the REAL classification and proposed several changes, such as the following^{[21, 22, 23]}:

The WHO classification changed the nomenclature from follicle center cell lymphoma to follicular lymphoma.
The WHO classification calls for grading of the follicular lymphoma from grades 1-3 based on the number of centroblasts per high-power field (hpf) and recognizes the importance of reporting on the presence of diffuse areas.
The WHO classification recognizes two variants of follicular lymphomas: cutaneous follicle center cell lymphoma and diffuse follicle center lymphoma. Nodal follicular lymphoma, according to the WHO classification, is staged as grade 1 (0-5 centroblasts per hpf), grade 2 (6-15 centroblasts per hpf), and grade 3 (>15 centroblasts). Variants include cutaneous follicle center cell lymphoma and diffuse follicle center cell lymphoma.
WHO classification further classifies grade 3 into grades 3A and 3B. ^[6]Grade 3A has centrocytes present whereas grade 3B has follicles composed of centroblasts. Clinically, grade 3B follicular lymphoma is treated like diffuse large B cell lymphoma.

Importantly, progression to diffuse large-cell lymphoma occurs in 10-50% of patients depending on the duration of disease presence. Transformation to diffuse large-cell lymphoma frequently is associated with rapid progression of the disease, including increasing adenopathy, development of systemic symptoms, and infiltration of extranodal sites.

Progression to large-cell lymphoma can be a poor prognostic factor. Many patients who experience transformation succumb to the disease, especially those who have received many lines of previous therapy. See the following image.

A patient with follicular lymphoma who was diagnosed 6 years earlier presents to his hematologist's office because of rapidly growing lymphadenopathy and onset of fever, severe night sweats, and weight loss. In the past, he had been treated with chlorambucil and prednisone when his submandibular lymph nodes became large enough to make him uncomfortable. This treatment had worked well, and he has not required any treatment recently. A biopsy of an involved lymph node is obtained. The diagnosis is transformation to diffuse non-Hodgkin lymphoma.

View Media Gallery

Xerri et al have demonstrated that high levels of MUM1 positivity are associated with shorter progression-free survival, based on analysis of the patient samples from the PRIMA study and correlating the patient outcomes.^[24]Another study of 46 cases of follicular lymphoma was also able to correlate high levels of MUM1 expression with high-grade subtype and poorer outcome because of the propensity for transformation.^[25]

The 2016 WHO classification includes three variants of follicular lymphoma: in situ follicular neoplasia (ISFN), duodenal-type follicular lymphoma, and pediatric-type follicular lymphoma. ISFN replaces the term in situ follicular lymphoma, reflecting the low risk of progression to lymphoma. In a long- term follow-up of ISFN, only one out of 21 patients progressed to overt follicular lymphpoma.^[26]In ISFN, lymph nodes (or other lymphoid proliferations) have an intact architecture but scattered germinal centers with variably dense populations of BCL2-positive and CD10-positive lymphoid cells that are usually predominantly centrocytes, are monoclonal, and have a t(14;18) IGH/BCL2translocation.

Pediatric follicular lymphoma was confirmed as a definite entity, but named pediatric-type follicular lymphoma, as cases may rarely occur in older individuals. Pediatric-type follicular lymphoma is a localized clonal proliferation characterized by large, expansile, highly proliferative follicles that often have prominent blastoid follicular center cells rather than classic centroblasts (or centrocytes); BCL2 rearrangements must not be present, but there may be some BCL2 protein expression. Common sites of involvement are the cervical lymph nodes and tonsils.^[27]Less likely sites of disease include the testis, gastrointestinal tract, salivary duct, kidney, and skin. Pediatric-type follicular lymphoma carries an excellent prognosis; a conservative therapeutic approach may be sufficient.^[28]

Finally, the intestines, especially the duodenum, are a frequent site of extranodal follicular lymphoma. These cases are frequently found in the second part of the duodenum as polyps. Survival appears to be excellent even without treatment. The majority of gastrointestinal follicular lymphoma are low grade (grade 1 or 2). However, 85% of duodenal lymphomas can spread to the jejunum and ileum.^[27]

Did this answer your question?

Yes No

Additional feedback? (Optional)

Thank you for your feedback!

American Cancer Society. Cancer Facts & Figures 2020. Available at https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2020/cancer-facts-and-figures-2020.pdf. Accessed: March 3, 2020.
Adult Non-Hodgkin Lymphoma Treatment–Health Professional Version (PDQ®). National Cancer Institute. Available at http://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq#link/_552_toc. September 18, 2019; Accessed: March 3, 2020.
Swenson WT, Wooldridge JE, Lynch CF, Forman-Hoffman VL, Chrischilles E, Link BK. Improved survival of follicular lymphoma patients in the United States. J Clin Oncol. 2005 Aug 1. 23 (22):5019-26. [Medline].
Tan D, Horning SJ, Hoppe RT, Levy R, Rosenberg SA, Sigal BM, et al. Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience. Blood. 2013 Aug 8. 122 (6):981-7. [Medline]. [Full Text].
Juweid ME, Cheson BD. Role of positron emission tomography in lymphoma. J Clin Oncol. 2005 Jul 20. 23(21):4577-80. [Medline].
Harris NL, Swerdlow SH, Jaffe ES, et al. Follicular Lymphoma. In: Swerdlow SH, Cmapo E, Harris NL, et al, eds. WHO Classification of Tumours of Hematopoietic and Lymphoma Tissues. 4th ed. Lyon, France: International Agency for Research on Cancer; 2008. 158-66.
Marcus R, Imrie K, Belch A, Cunningham D, Flores E, Catalano J, et al. CVP chemotherapy plus rituximab compared with CVP as first-line treatment for advanced follicular lymphoma. Blood. 2005 Feb 15. 105(4):1417-23. [Medline].
Hiddemann W, Kneba M, Dreyling M, Schmitz N, Lengfelder E, Schmits R, et al. Frontline therapy with rituximab added to the combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) significantly improves the outcome for patients with advanced-stage follicular lymphoma compared with therapy with CHOP alone: results of a prospective randomized study of the German Low-Grade Lymphoma Study Group. Blood. 2005 Dec 1. 106(12):3725-32. [Medline].
Press OW, Unger JM, Rimsza LM, Friedberg JW, Leblanc M, Czuczman MS, et al. Phase III Randomized Intergroup Trial of CHOP Plus Rituximab Compared With CHOP Chemotherapy Plus 131Iodine-Tositumomab for Previously Untreated Follicular Non-Hodgkin Lymphoma: SWOG S0016. J Clin Oncol. 2012 Dec 10. [Medline].
Rummel MJ, Niederle N, Maschmeyer G, Banat GA, von Grünhagen U, Losem C, et al. Bendamustine plus rituximab versus CHOP plus rituximab as first-line treatment for patients with indolent and mantle-cell lymphomas: an open-label, multicentre, randomised, phase 3 non-inferiority trial. Lancet. 2013 Apr 6. 381 (9873):1203-10. [Medline].
Fowler NH, Davis RE, Rawal S, Nastoupil L, Hagemeister FB, et al. Safety and activity of lenalidomide and rituximab in untreated indolent lymphoma: an open-label, phase 2 trial. Lancet Oncol. 2014 Nov. 15 (12):1311-8. [Medline].
Leonard JP, Trneny M, Izutsu K, et al. AUGMENT: A Phase III Study of Lenalidomide Plus Rituximab Versus Placebo Plus Rituximab in Relapsed or Refractory Indolent Lymphoma. J Clin Oncol. 2019 May 10. 37 (14):1188-1199. [Medline]. [Full Text].
Roulland S, Kelly RS, Morgado E, Sungalee S, Solal-Celigny P, et al. t(14;18) Translocation: A predictive blood biomarker for follicular lymphoma. J Clin Oncol. 2014 May 1. 32 (13):1347-55. [Medline]. [Full Text].
Ekström Smedby K, Vajdic CM, Falster M, et al. Autoimmune disorders and risk of non-Hodgkin lymphoma subtypes: a pooled analysis within the InterLymph Consortium. Blood. 2008 Apr 15. 111 (8):4029-38. [Medline].
Nabhan C, Byrtek M, Taylor MD, Friedberg JW, Cerhan JR, Hainsworth JD, et al. Racial differences in presentation and management of follicular non-Hodgkin lymphoma in the United States: report from the National LymphoCare Study. Cancer. 2012 Oct 1. 118 (19):4842-50. [Medline]. [Full Text].
Vitolo U, Ferreri AJ, Montoto S. Follicular lymphomas. Crit Rev Oncol Hematol. 2008 Jun. 66(3):248-61. [Medline].
Rosenberg SA. Follicular lymphoma revisited. J Clin Oncol. 2008 Feb 1. 26(4):515-6. [Medline].
Hehn ST, Grogan TM, Miller TP. Utility of fine-needle aspiration as a diagnostic technique in lymphoma. J Clin Oncol. 2004 Aug 1. 22(15):3046-52. [Medline].
[Guideline] NCCN Clinical Practice Guidelines in Oncology: B-Cell Lymphomas. National Comprehensive Cancer Network. Available at https://www.nccn.org/professionals/physician_gls/pdf/b-cell.pdf. Version 1.2020 — January 22, 2020; Accessed: March 3, 2020.
Bordeleau L, Berinstein NL. Molecular diagnostics in follicular non-Hodgkin's lymphoma: a review. Semin Oncol. 2000 Dec. 27(6 Suppl 12):42-52. [Medline].
Harris NL, Jaffe ES, Stein H, Banks PM, Chan JK, Cleary ML, et al. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group. Blood. 1994 Sep 1. 84(5):1361-92. [Medline]. [Full Text].
Armitage JO, Weisenburger DD. New approach to classifying non-Hodgkin's lymphomas: clinical features of the major histologic subtypes. Non-Hodgkin's Lymphoma Classification Project. J Clin Oncol. 1998 Aug. 16(8):2780-95. [Medline].
Harris NL, Jaffe ES, Diebold J, Flandrin G, Muller-Hermelink HK, Vardiman J, et al. The World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues. Report of the Clinical Advisory Committee meeting, Airlie House, Virginia, November, 1997. Ann Oncol. 1999 Dec. 10(12):1419-32. [Medline].
Xerri L, Bachy E, Fabiani B, et al. Identification of MUM1 as a prognostic immunohistochemical marker in follicular lymphoma using computerized image analysis. Human Pathology. 2014. 45:2085-2093.
Naresh KN. MUM1 expression dichotomizes follicular lymphoma into predominantly MUM1-negative low grade and MUM1-positive High grade subtypes. Haematologica. 2007 Feb. 92(2):267-8.
Jegalian AG, Eberle FC, Pack SD, et al. Follicular lymphoma in situ: clinical implications and comparisions with partial involvement by follicular lymphoma. Blood. 2011. 118:2976-2984.
Takata K, Miyata-Takata T, Sato Y, et al. Pathology of follicular lymphoma. J Clin Exp Hematopathology. 2014. 54(1):3-9.
Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016 May 19. 127 (20):2375-90. [Medline]. [Full Text].
Sehn LH, Chua N, Mayer J, Dueck G, Trněný M, Bouabdallah K, et al. Obinutuzumab plus bendamustine versus bendamustine monotherapy in patients with rituximab-refractory indolent non-Hodgkin lymphoma (GADOLIN): a randomised, controlled, open-label, multicentre, phase 3 trial. Lancet Oncol. 2016 Aug. 17 (8):1081-1093. [Medline].
Sweetenham JW, Goldman B, LeBlanc ML, Cook JR, Tubbs RR, Press OW, et al. Prognostic value of regulatory T cells, lymphoma-associated macrophages, and MUM-1 expression in follicular lymphoma treated before and after the introduction of monoclonal antibody therapy: a Southwest Oncology Group Study. Ann Oncol. 2010 Jun. 21(6):1196-202.
Friedberg JW, Byrtek M, Link BK, Flowers C, Taylor M, Hainsworth J, et al. Effectiveness of First-Line Management Strategies for Stage I Follicular Lymphoma: Analysis of the National LymphoCare Study. J Clin Oncol. 2012 Aug. 20:
Solal- Celigny P, Bellei M, Marcheselli L, et al. Watchful waiting in low-tumor burden follicular lymphoma in rituximab era: results of an F2 database. J Clin Oncol. 2012. 30:3848-3853.
Ardeshna KM, Smith P, Norton A, Hancock BW, Hoskin PJ, MacLennan KA, et al. Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: a randomised controlled trial. Lancet. 2003 Aug 16. 362(9383):516-22.
Schulz H, Bohlius JF, Trelle S, Skoetz N, Reiser M, Kober T, et al. Immunochemotherapy with rituximab and overall survival in patients with indolent or mantle cell lymphoma: a systematic review and meta-analysis. J Natl Cancer Inst. 2007 May 2. 99(9):706-14.
Ternant D, Hénin E, Cartron G, Tod M, Paintaud G, Girard P. Development of a drug-disease simulation model for rituximab in follicular non-Hodgkin's lymphoma. Br J Clin Pharmacol. 2009 Oct. 68(4):561-73.
Ghielmini M, Schmitz SF, Cogliatti SB, Pichert G, Hummerjohann J, Waltzer U, et al. Prolonged treatment with rituximab in patients with follicular lymphoma significantly increases event-free survival and response duration compared with the standard weekly x 4 schedule. Blood. 2004 Jun 15. 103(12):4416-23.
Hainsworth JD, Litchy S, Shaffer DW, Lackey VL, Grimaldi M, Greco FA. Maximizing therapeutic benefit of rituximab: maintenance therapy versus re-treatment at progression in patients with indolent non-Hodgkin's lymphoma--a randomized phase II trial of the Minnie Pearl Cancer Research Network. J Clin Oncol. 2005 Feb 20. 23(6):1088-95.
Martinelli G, Schmitz SF, Utiger U, et al. Long-term follow-up of patients with follicular lymphoma receiving single-agent rituximab at two different schedules in trial SAKK 35/98. J Clin Oncol. 2010 Oct 10. 28(29):4480-4.
Vidal L, Gafter-Gvili A, Salles G, et al. Rituximab maintenance for the treatment of patients with follicular lymphoma: an updated systematic review and meta-analysis of randomized trials. J Natl Cancer Inst. 2011 Dec 7. 103(23):1799-806.
Davies A, Merli F, Mihaljević B, Mercadal S, Siritanaratkul N, Solal-Céligny P, et al. Efficacy and safety of subcutaneous rituximab versus intravenous rituximab for first-line treatment of follicular lymphoma (SABRINA): a randomised, open-label, phase 3 trial. Lancet Haematol. 2017 Jun. 4 (6):e272-e282. [Medline].
Gopal AK, Kahl BS, de Vos S, Wagner-Johnston ND, Schuster SJ, Jurczak WJ, et al. PI3Kδ inhibition by idelalisib in patients with relapsed indolent lymphoma. N Engl J Med. 2014 Mar 13. 370 (11):1008-18. [Medline]. [Full Text].
Dreyling M, Santoro A, Mollica L, Leppä S, Follows GA, et al. Phosphatidylinositol 3-Kinase Inhibition by Copanlisib in Relapsed or Refractory Indolent Lymphoma. J Clin Oncol. 2017 Dec 10. 35 (35):3898-3905. [Medline].
Zinzani PL, Wagner-Johnston N, Miller C, Ardeshna K, Tertreault S, Assouline S, et al. A phase 2 study demonstrating the clinical activity of duvelisib in patients with double-refractory follicular lymphoma (abstract S777). Presented at the 22nd Congress of the European Hematology Association. Madrid, Spain. 2017 June 25.
Schulz H, Bohlus J, Skoetz N, et al. Chemotherapy plus rituximab versus chemotherapy alone for B cell non-Hodgkins lymphoma. Cochrane Database Systemic review. 2007 Oct 7. 4:CD003805.
Casulo C, Byrtek M, Dawson KL, Zhou X, Farber CM, Flowers CR, et al. Early Relapse of Follicular Lymphoma After Rituximab Plus Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone Defines Patients at High Risk for Death: An Analysis From the National LymphoCare Study. J Clin Oncol. 2015 Aug 10. 33 (23):2516-22. [Medline].
Salles G, Seymour JF, Offner F, et al. Rituximab maintenance for 2 years in patients with high tumour burden follicular lymphoma responding to rituximab plus chemotherapy (PRIMA): a phase 3, randomised controlled trial. Lancet. 2011 Jan 1. 377(9759):42-51.
Cheah CY, Chihara D, Ahmed M, Davis RE, Nastoupil LJ, Phansalkar K, et al. Factors influencing outcome in advanced stage, low-grade follicular lymphoma treated at MD Anderson Cancer Center in the rituximab era. Ann Oncol. 2016 May. 27 (5):895-901. [Medline].
Fowler NH, Morschhauser F, Feugier P, et al. Relevance: Phase III randomized study of lenalidomide plus rituximab (R2) versus chemotherapy plus rituximab, followed by rituximab maintenance, in patients with previously untreated follicular lymphoma. J Clin Oncol. 2018. 36:(suppl; abstr 7500). [Full Text].
Russell P. NICE Approval for Targeted Lymphoma Drug. Medscape Medical News. Available at https://www.medscape.com/viewarticle/925814. February 27, 2020; Accessed: March 3, 2020.
Marcus R, Davies A, Ando K, Klapper W, Opat S, Owen C, et al. Obinutuzumab for the First-Line Treatment of Follicular Lymphoma. N Engl J Med. 2017 Oct 5. 377 (14):1331-1344. [Medline]. [Full Text].
Freedman AS, Neuberg D, Mauch P, Soiffer RJ, Anderson KC, Fisher DC, et al. Long-term follow-up of autologous bone marrow transplantation in patients with relapsed follicular lymphoma. Blood. 1999 Nov 15. 94(10):3325-33.
van Besien K, Sobocinski KA, Rowlings PA, Murphy SC, Armitage JO, Bishop MR, et al. Allogeneic bone marrow transplantation for low-grade lymphoma. Blood. 1998 Sep 1. 92(5):1832-6.
van Besien K, Loberiza FR Jr, Bajorunaite R, Armitage JO, Bashey A, Burns LJ, et al. Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood. 2003 Nov 15. 102(10):3521-9.
Al Khabori M, de Almeida JR, Guyatt GH, Kuruvilla J, Crump M. Autologous stem cell transplantation in follicular lymphoma: a systematic review and meta-analysis. J Natl Cancer Inst. 2012 Jan 4. 104(1):18-28.
Lunning MA, Migliacci JC, Hilden P, Devlin SM, Castro-Malaspina H, Giralt S, et al. The potential benefit of allogeneic over autologous transplantation in patients with very early relapsed and refractory follicular lymphoma with prior remission duration of ≤12 months. Br J Haematol. 2016 Apr. 173 (2):260-4. [Medline]. [Full Text].
Hilchey SP, Kobie JJ, Cochran MR, Secor-Socha S, Wang JC, Hyrien O, et al. Human follicular lymphoma CD39+-infiltrating T cells contribute to adenosine-mediated T cell hyporesponsiveness. J Immunol. 2009 Nov 15. 183(10):6157-66.
Delaloye AB, Antonescu C, Louton T, Kuhlmann J, Hagenbeek A. Dosimetry of 90Y-ibritumomab tiuxetan as consolidation of first remission in advanced-stage follicular lymphoma: results from the international phase 3 first-line indolent trial. J Nucl Med. 2009 Nov. 50(11):1837-43.
Fisher RI, Kaminski MS, Wahl RL, Knox SJ, Zelenetz AD, Vose JM, et al. Tositumomab and iodine-131 tositumomab produces durable complete remissions in a subset of heavily pretreated patients with low-grade and transformed non-Hodgkin's lymphomas. J Clin Oncol. 2005 Oct 20. 23(30):7565-73.
Kaminski MS, Tuck M, Estes J, Kolstad A, Ross CW, Zasadny K, et al. 131I-tositumomab therapy as initial treatment for follicular lymphoma. N Engl J Med. 2005 Feb 3. 352(5):441-9.
Witzig TE, Gordon LI, Cabanillas F, Czuczman MS, Emmanouilides C, Joyce R, et al. Randomized controlled trial of yttrium-90-labeled ibritumomab tiuxetan radioimmunotherapy versus rituximab immunotherapy for patients with relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma. J Clin Oncol. 2002 May 15. 20(10):2453-63.
Tan D, Horning SJ, Hoppe RT, Levy R, Rosenberg SA, Sigal BM, et al. Improvements in observed and relative survival in follicular grade 1-2 lymphoma during 4 decades: the Stanford University experience. Blood. 2013 Aug 8. 122 (6):981-7. [Medline]. [Full Text].
Provencio M, et al; GOTEL (Spanish Lymphoma Oncology Group). Impact of treatment in long-term survival patients with follicular lymphoma: A Spanish Lymphoma Oncology Group registry. PLoS One. 2017. 12 (5):e0177204. [Medline]. [Full Text].
Solal-Céligny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R, et al. Follicular lymphoma international prognostic index. Blood. 2004 Sep 1. 104(5):1258-65.
Kelly JL, Salles G, Goldman B, Fisher RI, Brice P, Press O, et al. Low Serum Vitamin D Levels Are Associated With Inferior Survival in Follicular Lymphoma: A Prospective Evaluation in SWOG and LYSA Studies. J Clin Oncol. 2015 May 1. 33 (13):1482-90. [Medline]. [Full Text].
Tracy SI, Maurer MJ, Witzig TE, Drake MT, Ansell SM, Nowakowski GS, et al. Vitamin D insufficiency is associated with an increased risk of early clinical failure in follicular lymphoma. Blood Cancer J. 2017 Aug 25. 7 (8):e595. [Medline]. [Full Text].
National Cancer Institute sponsored study of classifications of non-Hodgkin's lymphomas: summary and description of a working formulation for clinical usage. The Non-Hodgkin's Lymphoma Pathologic Classification Project. Cancer. 1982 May 15. 49 (10):2112-35. [Medline].
Swerdlow SH, et al, eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. 4th edition. Lyon, France: International Agency for Research on Cancer; 2008.
[Guideline] Dreyling M, Ghielmini M, Rule S, Salles G, Vitolo U, Ladetto M, et al. Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2017 Dec 1. 28 (12):3109. [Medline]. [Full Text].
Brice P, Bastion Y, Lepage E, Brousse N, Haïoun C, Moreau P, et al. Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: a randomized study from the Groupe d'Etude des Lymphomes Folliculaires. Groupe d'Etude des Lymphomes de l'Adulte. J Clin Oncol. 1997 Mar. 15 (3):1110-7. [Medline].
Federico M, Bellei M, Marcheselli L, Luminari S, Lopez-Guillermo A, Vitolo U, et al. Follicular lymphoma international prognostic index 2: a new prognostic index for follicular lymphoma developed by the international follicular lymphoma prognostic factor project. J Clin Oncol. 2009 Sep 20. 27 (27):4555-62. [Medline].

Media Gallery

Follicular lymphoma, low-power view. Note the nodular pattern reminiscent of germinal centers. Photograph courtesy of Aamir Ehsan, MD.
Diffuse lymphoma. Note the absence of the nodular pattern observed in follicular lymphomas. Photograph courtesy of Aamir Ehsan, MD.
A patient with follicular lymphoma who was diagnosed 6 years earlier presents to his hematologist's office because of rapidly growing lymphadenopathy and onset of fever, severe night sweats, and weight loss. In the past, he had been treated with chlorambucil and prednisone when his submandibular lymph nodes became large enough to make him uncomfortable. This treatment had worked well, and he has not required any treatment recently. A biopsy of an involved lymph node is obtained. The diagnosis is transformation to diffuse non-Hodgkin lymphoma.

of 3

Author

Lauren C Pinter-Brown, MD Director of Lymphoma Program, Clinical Professor of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, University of California, Los Angeles, Medical Center

Lauren C Pinter-Brown, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Hematology, SWOG

Disclosure: Nothing to disclose.

Coauthor(s)

Deepa Jeyakumar, MD Assistant Clinical Professor of Medicine, Division of Hematology/Oncology, UC Irvine Medical Center

Deepa Jeyakumar, MD is a member of the following medical societies: American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, SWOG

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Emmanuel C Besa, MD Professor Emeritus, Department of Medicine, Division of Hematologic Malignancies and Hematopoietic Stem Cell Transplantation, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University

Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American Society of Clinical Oncology, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Cesar O Freytes, MD, FACP Director of Bone Marrow Transplant Program, Professor, Department of Internal Medicine, Division of Hematology, University of Texas Health Science Center at San Antonio

Cesar O Freytes, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American Society for Blood and Marrow Transplantation, International Society for Experimental Hematology, American Association for the Advancement of Science, American Association for Cancer Research, American Association of Blood Banks, American College of Physicians, American Society of Hematology, New York Academy of Sciences

Disclosure: Received honoraria from Sanofi for speaking and teaching; Received honoraria from Spectrum for review panel membership; Received grant/research funds from Merck for research funds; Received grant/research funds from Otskuka for research funds.

Koyamangalath Krishnan, MD, FRCP, FACP Dishner Endowed Chair of Excellence in Medicine, Professor of Medicine, James H Quillen College of Medicine at East Tennessee State University

Koyamangalath Krishnan, MD, FRCP, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, American Society of Hematology, Royal College of Physicians

Disclosure: Nothing to disclose.

Francisco J Hernandez-Ilizaliturri, MD Professor of Medicine, Department of Medical Oncology, Associate Professor of Immunology, Department of Immunology, Chief, Lymphoma and Myeloma Section, Director, The Lymphoma Translational Research Program, Roswell Park Cancer Institute, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Francisco J Hernandez-Ilizaliturri, MD is a member of the following medical societies: American Association for Cancer Research, American Society of Hematology

Disclosure: Nothing to disclose.

Julianna A Merten, PharmD, BCOP, BCPS (AQ-ID) Clinical Pharmacy Specialist in Hematology/Oncology, Mayo Clinic

Julianna A Merten, PharmD, BCOP, BCPS (AQ-ID) is a member of the following medical societies: American Society of Health-System Pharmacists, Hematology/Oncology Pharmacy Association

Disclosure: Nothing to disclose.

Priyank P Patel, MD Hematology/Oncology Fellow, Roswell Park Cancer Institute, University

Priyank P Patel, MD is a member of the following medical societies: American Society of Hematology, American Society of Clinical Oncology, European Society for Medical Oncology, American College of Physicians

Disclosure: Nothing to disclose.

What is the WHO classification of follicular lymphoma?

Answer

Related Questions:

References

Tables

Contributor Information and Disclosures