Our first major non-Hodgkin
lymphoma that we’ll take a look at
will be follicular lymphoma.
Let’s go straight to the point.
Where is the translocation
taking place in?
This 14;18 is then going
to over express BCL-2.
If we move on, BCL-2 is going to do what
with cytochrome C from the mitochondria?
Our discussion, apoptosis,
remember this is a cancer.
It will do everything in its power to
upregulate anti-apoptotic factors.
So therefore, BCL-2 if upregulated
prevents the release of cytochrome
C from the mitochondria.
You are not going to activate caspase
and you’ve inhibited apoptosis.
Causing increased survival
of your germinal center.
I’ll show you a picture in
which follicular lymphoma
in your lymph node in
a common one by the way,
is involvement of your follicular,
follicular, portion of the lymph node.
And you’ll find this to be extremely,
extremely expanded and active.
And at some point in time, I
wish to mention here as well
that 30 to 40% of time,
may actually then go on to
diffuse large B-cell lymphoma.
We’ll talk about different ways that
you will be responsible for developing
diffuse large B-cell
lymphoma for your boards.
One method might be from
If you find a diffuse large B-cell
lymphoma, having translocation 14;18,
you know for a fact that it
came from follicular lymphoma.
The description of morphology in
follicular lymphoma in the lymph node,
which is where the
you would find enlarged lymph node
consisting of small
If you would take a look at a lymph node
and here, it’s a lower amplification,
you’ll find in the middle there
huge areas of the follicle
that are just about engrossing
this entire follicle.
Quite a bit of increase
in size of the follicle.
Upon closer examination,
here once again, you’ll find in the middle
quite a bit of small cleaved lymphocytes
in which you’ll find follicular
activity to be extremely prevalent.
This is follicular lymphoma
Upregulation in BCL-2.
These cancer cells, these B cells
are going to remain alive forever.
Our topic here,
an important differential is
the fact that you might have
reactive lymphoid hyperplasia
versus follicular lymphoma.
The immunohistochemistry stain,
at least be able to identify
what’s known as spectrin staining.
And your focus here,
I’d like for you to take a look at would be
reactive type of your lymphoid hyperplasia.
Not a cancer per se.
So you would still have increased
activity of your follicle
based on the reaction that’s taking
place, maybe perhaps your infection.
Ands so therefore,
how would you be able to differentiate
this from follicular lymphoma?
would then help you.
And what you’re seeing here would be the
germinal center, which is quite active.
And you have an area,
that’s the mantle.
And then outside of this, you
then have your paracortex.
What you also would find is that,
well, stronger expression of spectrin
and numerous tingible
However, in the middle, do not, do not
appear to be take up your spectrin.
However, the T zone,
paracortex however will.
And this is quite important for you to
differentiate reactive lymphoid hyperplasia
versus what we’ll take a look
at with follicular lymphoma.
And follicular lymphoma,
what you end up finding is going
to be positive spectrin staining
in what kind of cells?
And B-cells are located where?
In the follicle.
Let’s stop here and make sure
that you truly understand
how to differentiate reactive
in which it’s responding to an invader
versus follicular lymphoma,
which is going to be a cancer.
If you remember correctly, if
it’s an acute type of reaction,
the paracortex is going
to come and play
and it’s going to start
activating, well, T-cells.
And you need CD4 and you need CD8.
And because of this, the spectrin
will be taken up by the T-cells
and therefore, the anatomy of the
lymph node now comes in handy.
Your T-cells reside where
in your lymph node?
Next, if you’re thinking
about follicular lymphoma,
what kind of lymphoma is this?
A non-Hodgkin’s lymphoma of the follicle
and what kind of
cells are involved?
So now the B-cells are going to
start taking up your spectrin.
You’d expect this to occur in your
follicle as you’ll see in the picture.
A few more words about
It is a common non-Hodgkin’s lymphoma,
it usually presents in middle
age and fairly indolent
and average survival
age of eight years.
Chemotherapy works quite well
and as I mentioned earlier,
about 30 to 50% of your patients
who have a translocation 14;18
may then go onto diffuse
aggressive large B-cell lymphoma.
Therefore, if you find diffuse large B cell
lymphoma as being your morphologic picture
and they’re giving you
It came from
A possible cause.
We’ll talk about two more
when the time is right.
This is not equivalent
to Richter syndrome.
When we talk about chronic
the oldest of all the leukemias
in terms of your age group.
there’s a fixed population
or small population
in which that CLL goes on to become
diffuse large B-cell lymphoma.
That is going to be
your Richter syndrome.
So right off the bat,
I’m giving you two major possibilities of
developing diffuse large B-cell lymphoma.
Number one here,
you’d focus upon follicular lymphoma
and when we discuss together CLL,
at that point, I will
mention Richter syndrome.
I will refer to de novo type of development
of your diffuse large B-cell lymphoma.