Abstract
BackgroundReverse Variant of Follicular Lymphoma (RVFL) is one of the rare morphological variants of FL, characterized by dark staining small centrocytes in the center and pale staining large centroblasts at the periphery of the neoplastic follicles. Only rare cases of RVFL have been described to date. The histological appearance of this little known variant of FL may be misinterpreted if pathologists are unaware of its existence. The main purpose of this study is to draw pathologists’ attention to such an uncommon growth pattern of FL so that this variant can be correctly recognized and the clinical significance further studied in the future.MethodsFour cases of FL with unusual morphologic features were evaluated for the expression pattern of CD20, CD10, BCL6, BCL2, CD21, CD23, CD3, CD5, Cyclin D1, IgD and Ki67 by immunohistochemistry. Fluorescence in situ hybridization (FISH) with break-apart probes was performed to detect BCL2 gene rearrangement.ResultsAll four cases showed distinctive morphologic pattern of RVFL; in addition, each also exemplified unique morphological features. Immunohistochemical stains confirmed the cells in both the central areas and the peripheral cuffs had the same immunophenotypic profiles, contrasting to the FL with marginal zone differentiation in which only the center of the nodules showed expression of CD10. FISH demonstrated BCL2 gene rearrangement in all cases.ConclusionThe growth pattern of this rare FL variant may mimic FL with marginal-zone differentiation and other entities including but not limited to marginal zone lymphoma (MZL), progressive transformation of germinal centers (PTGC) and nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). Pathologists should be familiar with this unusual morphological variant to avoid diagnostic pitfalls.
Highlights
Reverse Variant of Follicular Lymphoma (RVFL) is one of the rare morphological variants of Follicular lymphoma (FL), characterized by dark staining small centrocytes in the center and pale staining large centroblasts at the periphery of the neoplastic follicles
The follicles are replaced by a proliferation of small centrocytes with angulated nuclei admixed with a variable number of large centroblasts which have more finely dispersed chromatin than the interfollicular
Materials and methods With approval of the Institutional Review Boards of Wuhan University, Zhongnan Hospital, China, four cases of follicular lymphoma with unusual morphologic features considered to be RVFL were retrieved from the archives of the Department of Pathology, Zhongnan Hospital of Wuhan University
Summary
Reverse Variant of Follicular Lymphoma (RVFL) is one of the rare morphological variants of FL, characterized by dark staining small centrocytes in the center and pale staining large centroblasts at the periphery of the neoplastic follicles. Follicular lymphoma (FL) is the second most common mature B-cell lymphoma diagnosed in adults in the USA and western Europe [1]. It is characterized by neoplastic follicles arranged in a back-to-back pattern throughout the lymph node with decreased interfollicular area. The follicles are replaced by a proliferation of small centrocytes (small cleaved cells) with angulated nuclei admixed with a variable number of large centroblasts which have more finely dispersed chromatin than the interfollicular.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
