Follicular lymphoma classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sowminya Arikapudi, M.B,B.S. [2]

Overview

According to the World Health Organization (WHO), follicular lymphoma may be classified into 3 subtypes: low grade follicular lymphoma, high grade follicular lymphoma, and diffuse large B cell lymphoma. Three variants of follicular lymphoma include pediatric follicular lymphoma, primary intestinal follicular lymphoma, and other extranodal follicular lymphoma.

Classification

1- Morphological Classification

The World Health Organization (WHO) classifies follicular lymphoma as follows:

• Grades 1 and 2 now as low grade follicular lymphoma
• Grade 3A as high grade follicular lymphoma
• Grade 3B as diffuse large B cell lymphoma

2- Variants of Follicular Lymphoma

Follicular lymphoma has 3 variants that include the following:

A. Pediatric follicular lymphoma

• Involves cervical lymph nodes, other peripheral lymph nodes, or Waldeyer ring
• Typically have early stage disease
• Lacks bcl-2 protein expression and t(14;18)

B. Primary intestinal follicular lymphoma

• Occurs most commonly in the small intestine, and frequently involves the duodenum

• Duodenal follicular lymphoma

• Found in the second portion of the duodenum
• Present as multiple polyps
• Diagnosis is most often an incidental finding
• Most patients have localized disease
• Prognosis is excellent even without treatment

C. Other extranodal follicular lymphomas

• Usually have localized extranodal disease
• Systemic relapses are rare
• Testicular follicular lymphoma are reported with increased frequency in children, but also are reported in adults.