Follicular lymphoma

This article was last reviewed and updated on April 3, 2019

by Philip Berardi, MD PhD FRCPC

Quick facts:

  • Follicular lymphoma is a cancer that comes from immune cells called lymphocytes.

  • Follicular lymphoma can start anywhere in the body although the most common locations are lymph nodes, the gastrointestinal tract, skin, and breast.

  • Follicular lymphoma is the second most common type of lymphoma to affect adults.

 

After you read this article, please complete our patient experience survey.

 

Learn more

Your immune system is made up of many different kinds of cells and each play an important role protecting your body from infections and helping you heal after an injury. Unlike other types of organs, your immune system is spread throughout your body. Most immune cells are found in lymph nodes although many are also found in the blood, skin, gastrointestinal tract, and bones. 

Follicular lymphoma is a type of cancer (a malignant tumour) that comes from a special type of immune cell called a lymphocyte. Follicular lymphoma can start anywhere in the body where lymphocytes gather in large numbers and the most common locations include lymph nodes, the gastrointestinal tract (in particular the stomach and small bowel), the skin, and the breast. Follicular lymphoma is the second most common lymphoma to affect adults.

Patients with lymphoma may notice a painless lump or swelling that slowly increases in size over time. Other symptoms of follicular lymphoma include fatigue, unintentional weight loss, loss of appetite, night sweats, and fever. 

The diagnosis of follicular lymphoma is usually made after a small piece of tissue is removed in a procedure called a biopsy. Depending on the features of the cancer, patients are then typically either followed ('watch and wait') or treated by chemotherapy and/or radiation therapy.  Occasionally and only in specific situations is the tumour removed by surgery. 

Histological grade

Grade is a word pathologists use to describe how different the cancer cells look compared to normal lymphocytes. Follicular lymphoma is given a grade from 1 through 3. Grade 3 follicular lymphoma can be further subdivided into grade 3A and 3B.

The tumour grade depends on how the cancer cells look when examined under the microscope. Pathologists determine the tumour grade by counting the number of large cancer cells called centroblasts in a given area. Tumours with more large cells are given a higher grade. 

Grade 1 and grade 2 tumours are grouped together and are referred to as low-grade or grade 1-2 because they tend to grow and spread very slowly. Tumours that behave in this manner are also referred to as indolent.

Grade 3 tumours are referred to as high-grade because they tend to behave in a more aggressive manner and are associated with a poorer overall outcome.

Over time, low-grade (grade 1 or grade 2) tumours can change into high-grade (grade 3) tumours. If you develop new symptoms and were initially diagnosed with a low-grade follicular lymphoma, your doctor may perform another biopsy to see if the tumour has changed to a higher grade.

Transformation to diffuse large B-cell lymphoma

Over time, some follicular lymphomas will increase in grade (become more aggressive) and the final step in this change is the development of a more serious form of lymphoma called diffuse large B-cell lymphoma.

 
Pathologists call the development of diffuse large B-cell lymphoma from follicular lymphoma transformation.

Your pathologist will carefully examine your tissue for any evidence of diffuse large B-cell lymphoma.

Pattern of growth

Pattern of growth is a term pathologists use to describe the way groups of cancer cells look under the microscope.

When the cancer cells are arranged in small round groups the pattern is called follicular. When the cancer cells grow in very large shapeless groups and there is no space between the groups, the pattern is called diffuse.

The diffuse pattern can be associated with a worse prognosis. If a grade 3B tumour shows a diffuse pattern of growth, the diagnosis changes from follicular lymphoma to diffuse large B-cell lymphoma.

Immunohistochemistry
Immunohistochemistry is a test that allows pathologists to learn more about the types of proteins made by specific cells. Cells that produce a protein are called positive or reactive. Cells that do not produce a protein are called negative or non-reactive.

Immunohistochemistry is commonly performed on cases of follicular lymphoma to confirm the diagnosis and to exclude other diseases that can look similar under the microscope.

Follicular lymphoma commonly shows the following immunohistochemistry results:

  • CD20 – Positive.

  • CD10 – Positive.

  • BCL2 – Positive.

  • BCL6 – Positive.

  • CD23 – Negative.

  • CD3 – Negative.

  • CD5 – Negative.

  • Cyclin D1 – Negative.

The Ki67 labelling index is a way estimating how quickly cells are dividing. Generally, the quicker the cancer cells divide (the higher the Ki67 labelling index), the more concerned your doctor will be that your lymphoma will behave aggressively.

  • Facebook
  • Twitter

Copyright 2017 MyPathologyReport.ca

For more information about this site, contact us at info@mypathologyreport.ca.

Disclaimer: The articles on MyPathologyReport are intended for general informational purposes only and they do not address individual circumstances. The articles on this site are not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the MyPathologyReport site. The articles on MyPathologyReport.ca are intended for use within Canada by residents of Canada only.

Droits d'auteur 2017 MyPathologyReport.ca
Pour plus d'informations sur ce site, contactez-nous à info@mypathologyreport.ca.
Clause de non-responsabilité: Les articles sur MyPathologyReport ne sont destinés qu’à des fins d'information et ne tiennent pas compte des circonstances individuelles. Les articles sur ce site ne remplacent pas les avis médicaux professionnels, diagnostics ou traitements et ne doivent pas être pris en compte pour la prise de décisions concernant votre santé. Ne négligez jamais les conseils d'un professionnel de la santé à cause de quelque chose que vous avez lu sur le site de MyPathologyReport. Les articles sur MyPathologyReport.ca sont destinés à être utilisés au Canada, par les résidents du Canada uniquement.