Follicular lymphoma, a long-term diagnosis

Abstract

Follicular lymphoma (FL) is the paradigm of all histological subtypes of Non-Hodgkin lymphomas, previously known as indolent lymphomas. This paper describes the extremely slow clinical course of a case FL until its diagnosis. Case: Man, 33 years old, healthy until six years when it arrives to the Emergency Department (ED) with complaints of pain in the right upper quadrant of the abdomen with 1 month of evolution. Abdominal ultrasound with giant splenomegaly and vesicular lithiasis. All body CT-scan revealed mediastinal and retroperitoneal lymphadenopathy. A splenectomy, a liver and a bone marrow biopsies were performed. As histological findings, necrotizing granulomatous disease in the spleen and inconclusive biopsies. Extended infectious serology study was performed with negative results. The patient was sent to outpatient follow-up. During the next six years, several of these studies were repeated with overlapping results except a slight progressive increase of lymphadenopathy. Six years later comes back to the ED with chest pain and chest pressure without cardiorespiratory complaints. Repeat CT-scan that reveals increased of conglomerate mediastinal lymphadenopathy (with 6 cm) and the patient was submitted to a mediastinoscopy for biopsy of lymphadenopathy and histological results were inconclusive but with some features of Castleman's disease. For a strong diagnosis it was decided a thoracotomy to removal of conglomerate mediastinal lymphadenopathy. Now the result of immunohistological staining was LF. With this case the authors pretend to highlight the difficulty of diagnosis and the need of long follow-up in these patients because of possible long and painless evolution of these cases.