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Blood, 15 May 2002, Vol. 99, No. 10, pp. 3806-3812
NEOPLASIA
Cytomorphologic, immunohistochemical, and cytogenetic profiles of
follicular lymphoma: 2 types of follicular lymphoma grade 3
German Ott,
Tiemo Katzenberger,
Andreas Lohr,
Steffi Kindelberger,
Thomas Rüdiger,
Martin Wilhelm,
Jörg Kalla,
Andreas Rosenwald,
Justus G. Müller,
M. Michaela Ott, and
Hans Konrad Müller-Hermelink
From the Pathologisches Institut and Poliklinik
für Innere Medizin, University of Würzburg,
Germany.
Follicular lymphoma (FL) grades 1 and 2 are regarded as a distinct
disease entity, whereas data suggest that FL grade 3 might be an
inhomogeneous tumor category. To define the biologic spectrum of FL, 89 follicular lymphomas were studied for their cytologic composition,
antigen expression, mitotic and proliferation indices, cytogenetics,
and clinical data. In contrast to the homogeneous appearance of FL
grades 1 and 2 (29 and 33 cases, respectively), 2 types of FL grade 3 were recognized. Eleven cases of FL 3a displayed structural features
similar to those of FL 1 and 2 and were composed of centroblasts and
centrocytes, whereas 16 cases of FL 3b, with (n = 4) or without
(n = 12) a diffuse large B-cell lymphoma component (DLBL) (FL 3b ± DLBL), consisted exclusively of blasts. In contrast to FL 3a, FL
3b ± DLBL were CD10+ in only 50% of cases and
displayed plasmacytoid differentiation in 44% of cases. Although
FL3a was t(14;18)+ in 8 of 11 (73%) cases, only 2 of 16 (13%)
FL3b ± DLBLs harbored this translocation. In contrast,
chromosomal breaks at 3q27 were encountered in 7 of 16 (44%) FL
3b ± DLBL in contrast to only 2 of 11 (18%) FL 3a, and the
spectrum of secondary aberrations in FL 3b ± DLBL was similar to
that of diffuse large B-cell lymphoma. We conclude, therefore, that FL
grade 3 is a heterogeneous disease group and that the distinction
proposed in the new World Health Organization classification between FL
3a (with centrocytes) and FL3b (without centrocytes) is of biologic,
and possibly clinical, importance.
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