Transcription
Hey guys, this is Medical Perfection Alice. Welcome to my channel. Today's topic is follicular lymphoma. The malignant B-cells that organize in a follicular pattern is the topic of today's video. So let's get started.
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The hematological malignancies are leukemias, lymphomas, and myeloma. Lymphoma is a solid tumor of the immune system. Not only the lymph node, but also spleen, MALT, associated lymphatic tissue, thymus, etc. Lymphoma could be Hodgkin's or non-Hodgkin's. Which is more common? Follicular lymphoma is a non-Hodgkin's lymphoma, specifically an indolent B-cell non-Hodgkin's lymphoma. Non-Hodgkin's could be indolent or aggressive. Follicular is the most common indolent non-Hodgkin's lymphoma, while diffuse large B-cell lymphoma is the most common aggressive non-Hodgkin's lymphoma. Between the diffuse large B-cell and follicular, which one is more common? Diffuse large B-cell lymphoma. Again, non-Hodgkin's lymphoma could be aggressive or high-grade, or indolent, also known as low-grade. So low-grade or indolent, such as follicular. The patients are older, fewer B symptoms, higher stage at presentation. You're sensitive to chemo, but not curable using chemo. Median survival rate is relatively long. They can change or transform into an aggressive lymphoma. For instance, follicular lymphoma can transform into diffuse large B-cell lymphoma, which is an aggressive non-Hodgkin's lymphoma. This transformation is usually fatal. It carries a very bad prognosis.
Follicular lymphoma is a B-cell non-Hodgkin's lymphoma, indolent. In fact, it's the most common indolent non-Hodgkin's there is. Painless lymphadenopathy in late adulthood. Translocation between 14 and 18 chromosomes will lead to over-expression of BCL-2, an anti-apoptotic protein. The protein that cancels apoptosis. Apoptosis is cool. Why? Because during somatic hypermutation, we'd like to get rid of these B-cells. But now, since we have no BCL-2, we cannot let these B-cells die. So they will grow and grow and replicate and replicate and replicate. Therefore, cancer.
Follicular lymphoma can transform into diffuse large B-cell lymphoma, which is aggressive. And it presents as an enlarging lymph node. So the patient presents with a lymph node that was already large, but now is even increasing in size. Be very suspicious. Same thing with like a nevus. When you have a nevus on your skin and suddenly it started to grow and change its color, think of melanoma. Same concept.
A very important comparison is that between follicular lymphoma and reactive hyperplasia. Follicular lymphoma is cancer. Reactive hyperplasia is not. So follicular lymphoma is monoclonal, of course, because this cancer. Reactive hyperplasia is polyclonal. Follicular lymphoma, the lymph node architecture is completely erased or disrupted. In reactive hyperplasia, it's maintained. Follicular lymphoma has no tangible body macrophages. Reactive hyperplasia does have them. Follicular lymphoma has BCL-2 over-expression due to the translocation between chromosomes 14 and 18. Reactive hyperplasia does not.
Clinically speaking, patients with follicular hyperplasia could be asymptomatic, or they could present with palpable, painless lymphadenopathy. Early stages, lymphadenopathy is localized. Late stages, the lymphoma is diffuse. Enlargement can occur, leading to fatigue, infection, and bleeding. Infections are the most common cause of death in follicular lymphoma patients. Follicular lymphoma can involve the bone marrow. It's called a leukemic phase. Of course, because it's a non-Hodgkin's lymphoma.
How to diagnose any lymphoma? You need a core needle biopsy or an excisional biopsy of that lymph node. You'll find malignant B-cells organized in a follicular pattern. That's why we call it follicular lymphoma. Even histological stain, you'll find CD20 positive because it's a B-cell lymphoma. BCL-2 over-expression, absolutely, the anti-apoptotic protein. Staging by physical exam and CT scan. PET scan can help to diagnose a lymphoma. You need an excisional or a core needle biopsy. Never do a fine needle aspiration.
Prognosis of follicular lymphoma. Please refer to Ann Arbor classification. Treatment: asymptomatic, no treatment. Localized radiation. Diffuse depends on the age. Young, combination chemotherapy. Old patients, rituximab, which is a monoclonal antibody against CD20. If there is transformation to diffuse large B-cell lymphoma, go ahead and add the R-CHOP.
Now, a quick mnemonic for you. Rituximab. To X, which is in Roman numerals, 10. Two times 10 is 20. That's why I wrote. Rituximab is a monoclonal antibody against CD20. Brilliant. Pay close attention. BCL-1 over-expression due to translocation between chromosomes 11:14. This is mantle cell lymphoma. BCL-2, however, this translocation between chromosomes 14 and 18 is in follicular lymphoma. Do not confuse both of them. Very important.
That's it for today. Thank you so much for watching. If you're good, subscribe and hit the bell. Would like to see on Facebook. I have 101 questions or cases until the end of this year. And also Twitter, Instagram, SoundCloud. And please consider supporting my channel on Patreon. Thank you so much for watching. This is Medicos Perfection Alice. Be safe, stay happy, and study hard.