Follicular lymphoma overview: Difference between revisions
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==Overview== | ==Overview== | ||
Follicular lymphoma is defined as a [[lymphoma]] of [[lymph follicle|follicle]] center [[B-cells]] (centrocytes and centroblasts), which has at least a partially follicular pattern. Follicular lymphoma may be caused by [[translocation]] between [[chromosome]] 14 and 18 that results in the over expression of the [[bcl-2]] gene. The progression to follicular lymphoma involves the microRNAs (miRNAs). Follicular lymphoma may be classified according to WHO criteria into 3 groups: low grade follicular lymphoma, high grade follicular lymphoma and diffuse large B cell lymphoma. Pediatric-type follicular lymphoma, primary intestinal follicular lymphoma, other extranodal follicular lymphomas and follicular lymphoma “in situ” (FLIS) are the other variants that are included under follicular lymphoma. Follicular lymphoma must be differentiated from other diseases such as diffuse large B cell lymphoma, Mucosa-Associated Lymphatic Tissue lymphoma(MALT), small cell lymphocytic lymphoma, and mantle cell lymphoma (MCL). The prevalence of follicular lymphoma increases with age. Women are more commonly affected. | Follicular lymphoma is defined as a [[lymphoma]] of [[lymph follicle|follicle]] center [[B-cells]] (centrocytes and centroblasts), which has at least a partially follicular pattern. Follicular lymphoma may be caused by [[translocation]] between [[chromosome]] 14 and 18 that results in the over expression of the [[bcl-2]] gene. The progression to follicular lymphoma involves the microRNAs (miRNAs). Follicular lymphoma may be classified according to WHO criteria into 3 groups: low grade follicular lymphoma, high grade follicular lymphoma and diffuse large B cell lymphoma. Pediatric-type follicular lymphoma, primary intestinal follicular lymphoma, other extranodal follicular lymphomas and follicular lymphoma “in situ” (FLIS) are the other variants that are included under follicular lymphoma. Follicular lymphoma must be differentiated from other diseases such as diffuse large B cell lymphoma, Mucosa-Associated Lymphatic Tissue lymphoma(MALT), small cell lymphocytic lymphoma, and mantle cell lymphoma (MCL). The prevalence of follicular lymphoma increases with age. Women are more commonly affected. Prognosis of follicular lymphoma is generally poor. The [[median]] survival is around 10 years. According to the Lugano classification, there are four stages of follicular lymphoma based on the number of nodes, and extranodal involvement. The most common symptoms of follicular lymphoma include [[fever]], [[weight loss]], [[night sweats]], [[skin rash]], painless swelling in the neck,under arm, groin, thorax and abdomen, and pain in the chest, abdomen and bones. Patient may experience weight loss, fatigue and night sweats. Common physical examination findings of follicular lymphoma include fever, rash, spleenomegaly, peripheral lymphadenopathy and central lymphadenopathy. Laboratory tests in the diagnosis of follicular lymphoma include histological confirmation, immunophenotyping, immunohistochemistry, molecular genetic analysis and cytogenetics. CT scan may be helpful in the diagnosis of follicular lymphoma. MRI may be helpful in the diagnosis of follicular lymphoma. The optimal therapy for follicular lymphoma depends on the stage at diagnosis, age and prognostic scores. The predominant therapy for follicular lymphoma is chemotherapy. Adjunctive hematopoietic stem cell transplantation, and radioimmunotherapy may be required. There are a large number of recent and current clinical trials for follicular lymphoma. Personalised idiotype vaccines have shown promise, but have still to prove their efficacy in randomized clinical trials. | ||
==Classification== | ==Classification== | ||
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Follicular lymphoma may be caused by [[translocation]] between [[chromosome]] 14 and 18 that results in the over expression of the [[bcl-2]] gene. | Follicular lymphoma may be caused by [[translocation]] between [[chromosome]] 14 and 18 that results in the over expression of the [[bcl-2]] gene. | ||
==Differential diagnosis== | ==Differential diagnosis== | ||
Follicular lymphoma must be differentiated from other diseases such as diffuse large B cell lymphoma, Mucosa-Associated Lymphatic Tissue lymphoma(MALT), small cell lymphocytic lymphoma, and mantle cell lymphoma (MCL). | Follicular lymphoma must be differentiated from other diseases such as diffuse large B cell lymphoma, Mucosa-Associated Lymphatic Tissue lymphoma(MALT), small cell lymphocytic lymphoma, and mantle cell lymphoma (MCL). | ||
==Epidemiology and demographics== | ==Epidemiology and demographics== | ||
The prevalence of follicular lymphoma increases with age. Women are more commonly affected. | |||
==Prognosis== | |||
Prognosis of follicular lymphoma is generally poor. The [[median]] survival is around 10 years. | |||
==Staging== | |||
According to the Lugano classification, there are four stages of follicular lymphoma based on the number of nodes, and extranodal involvement. | |||
==Symptoms== | |||
The | The most common symptoms of follicular lymphoma include [[fever]], [[weight loss]], [[night sweats]], [[skin rash]], painless swelling in the neck,under arm, groin, thorax and abdomen, and pain in the chest, abdomen and bones. | ||
==Physical examination== | |||
Patient may experience weight loss, fatigue and night sweats. Common physical examination findings of follicular lymphoma include fever, rash, spleenomegaly, peripheral lymphadenopathy and central lymphadenopathy. | |||
==Laboratory tests== | |||
Laboratory tests in the diagnosis of follicular lymphoma include histological confirmation, immunophenotyping, immunohistochemistry, molecular genetic analysis and cytogenetics. | |||
==CT== | |||
CT scan may be helpful in the diagnosis of follicular lymphoma. | |||
==MRI== | |||
MRI may be helpful in the diagnosis of follicular lymphoma. | |||
==Medical Therapy== | |||
The optimal therapy for follicular lymphoma depends on the stage at diagnosis, age and prognostic scores. The predominant therapy for follicular lymphoma is chemotherapy. Adjunctive hematopoietic stem cell transplantation, and radioimmunotherapy may be required. | |||
====Future or Investigational therapies== | |||
There are a large number of recent and current clinical trials for follicular lymphoma. Personalised idiotype vaccines have shown promise, but have still to prove their efficacy in randomized clinical trials. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 20:58, 25 August 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Follicular lymphoma is defined as a lymphoma of follicle center B-cells (centrocytes and centroblasts), which has at least a partially follicular pattern. Follicular lymphoma may be caused by translocation between chromosome 14 and 18 that results in the over expression of the bcl-2 gene. The progression to follicular lymphoma involves the microRNAs (miRNAs). Follicular lymphoma may be classified according to WHO criteria into 3 groups: low grade follicular lymphoma, high grade follicular lymphoma and diffuse large B cell lymphoma. Pediatric-type follicular lymphoma, primary intestinal follicular lymphoma, other extranodal follicular lymphomas and follicular lymphoma “in situ” (FLIS) are the other variants that are included under follicular lymphoma. Follicular lymphoma must be differentiated from other diseases such as diffuse large B cell lymphoma, Mucosa-Associated Lymphatic Tissue lymphoma(MALT), small cell lymphocytic lymphoma, and mantle cell lymphoma (MCL). The prevalence of follicular lymphoma increases with age. Women are more commonly affected. Prognosis of follicular lymphoma is generally poor. The median survival is around 10 years. According to the Lugano classification, there are four stages of follicular lymphoma based on the number of nodes, and extranodal involvement. The most common symptoms of follicular lymphoma include fever, weight loss, night sweats, skin rash, painless swelling in the neck,under arm, groin, thorax and abdomen, and pain in the chest, abdomen and bones. Patient may experience weight loss, fatigue and night sweats. Common physical examination findings of follicular lymphoma include fever, rash, spleenomegaly, peripheral lymphadenopathy and central lymphadenopathy. Laboratory tests in the diagnosis of follicular lymphoma include histological confirmation, immunophenotyping, immunohistochemistry, molecular genetic analysis and cytogenetics. CT scan may be helpful in the diagnosis of follicular lymphoma. MRI may be helpful in the diagnosis of follicular lymphoma. The optimal therapy for follicular lymphoma depends on the stage at diagnosis, age and prognostic scores. The predominant therapy for follicular lymphoma is chemotherapy. Adjunctive hematopoietic stem cell transplantation, and radioimmunotherapy may be required. There are a large number of recent and current clinical trials for follicular lymphoma. Personalised idiotype vaccines have shown promise, but have still to prove their efficacy in randomized clinical trials.
Classification
Follicular lymphoma may be classified according to WHO criteria into 3 groups: low grade follicular lymphoma, high grade follicular lymphoma and diffuse large B cell lymphoma. Pediatric-type follicular lymphoma, primary intestinal follicular lymphoma, other extranodal follicular lymphomas and follicular lymphoma “in situ” (FLIS) are the other variants that are included under follicular lymphoma.
Pathophysiology
Follicular lymphoma is defined as a lymphoma of follicle center B-cells (centrocytes and centroblasts), which has at least a partially follicular pattern. Genes involved in the pathogenesis of follicular lymphoma include bcl-2, and bcl-6. The progression to follicular lymphoma involves the microRNAs (miRNAs).
Causes
Follicular lymphoma may be caused by translocation between chromosome 14 and 18 that results in the over expression of the bcl-2 gene.
Differential diagnosis
Follicular lymphoma must be differentiated from other diseases such as diffuse large B cell lymphoma, Mucosa-Associated Lymphatic Tissue lymphoma(MALT), small cell lymphocytic lymphoma, and mantle cell lymphoma (MCL).
Epidemiology and demographics
The prevalence of follicular lymphoma increases with age. Women are more commonly affected.
Prognosis
Prognosis of follicular lymphoma is generally poor. The median survival is around 10 years.
Staging
According to the Lugano classification, there are four stages of follicular lymphoma based on the number of nodes, and extranodal involvement.
Symptoms
The most common symptoms of follicular lymphoma include fever, weight loss, night sweats, skin rash, painless swelling in the neck,under arm, groin, thorax and abdomen, and pain in the chest, abdomen and bones.
Physical examination
Patient may experience weight loss, fatigue and night sweats. Common physical examination findings of follicular lymphoma include fever, rash, spleenomegaly, peripheral lymphadenopathy and central lymphadenopathy.
Laboratory tests
Laboratory tests in the diagnosis of follicular lymphoma include histological confirmation, immunophenotyping, immunohistochemistry, molecular genetic analysis and cytogenetics.
CT
CT scan may be helpful in the diagnosis of follicular lymphoma.
MRI
MRI may be helpful in the diagnosis of follicular lymphoma.
Medical Therapy
The optimal therapy for follicular lymphoma depends on the stage at diagnosis, age and prognostic scores. The predominant therapy for follicular lymphoma is chemotherapy. Adjunctive hematopoietic stem cell transplantation, and radioimmunotherapy may be required.
==Future or Investigational therapies
There are a large number of recent and current clinical trials for follicular lymphoma. Personalised idiotype vaccines have shown promise, but have still to prove their efficacy in randomized clinical trials.