Texture analysis and multiple-instance learning for the classification of malignant lymphomas
Marco LippiStefania GianottiAngelo FamàMassimiliano CasaliElisa BarboliniAngela FerrariFederica FioroniMauro IoriStefano LuminariMassimo MengaFrancesco MerliValeria TrojaniAnnibale VersariMagda ZanelliMarco Bertolini
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Keywords:
Follicular lymphoma
Follicular lymphoma
B-cell lymphoma
Gene rearrangement
Large-cell lymphoma
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Follicular lymphoma
Follicular hyperplasia
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Composite lymphoma is very rare and a combination of Hodgkin lymphoma and non-Hodgkin lymphoma and even histiocytic tumors can occur. Because of the unfamiliarity, not only can this cause diagnostic problems, but can also affect treatment plan. We report a case of composite lymphoma in a 40-year-old male. Initial biopsy showed a composite lymphoma of follicular lymphoma grade 1 and classic Hodgkin lymphoma. After chemotherapy, another lymph node was taken because of disease progression, which revealed follicular lymphoma, grade 3a without Hodgkin lymphoma component.
Follicular lymphoma
Lymph node biopsy
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In situ follicular lymphoma, more recently known as follicular lymphoma-like B cells of uncertain/undetermined significance is well accepted. However, the morphological criteria have evolved since it was first described and data are limited and conflicting regarding its clinical implications and whether the extent of involvement predicts an association with overt lymphoma. It is also unknown how often it will be identified by flow cytometric studies and how often it precedes overt follicular lymphomas. A multiparameter study of 31 biopsies with follicular lymphoma-like B cells of uncertain significance and 4 'benign' lymph node biopsies that preceded an overt follicular lymphoma was, therefore, performed. Fifty-two percent of biopsies with follicular lymphoma-like B cells were associated with a prior or concurrent lymphoma but only 6% subsequently developed lymphoma (median follow up 26 months). Neither the number, proportion or density of BCL2+ germinal centers were associated with overt follicular lymphoma/diffuse large B-cell lymphoma. Flow cytometric studies identified follicular lymphoma-like B cells in 8 of 15 evaluable cases. The proportion but not the absolute number of BCL2+ germinal centers was associated with the likelihood of positive flow cytometric studies (P
Follicular lymphoma
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Introduction: Composite lymphoma is defined as coexistence of two or more morphologically and phenotypically distinct lymphomas in the same anatomical site. Composite lymphoma may include combinations of Hodgkin lymphoma (HL) and B- or T-cell non-Hodgkin lymphoma (NHL); B-cell NHL and T-cell NHL; or two distinct B-cell or T-cell NHLs. The exact pathogenesis of composite lymphoma is unknown. Most cases demonstrate poor outcomes with a median survival of 12 months. The treatment is usually directed toward the higher-grade component. Case Report: Here, we report an extraordinarily rare case of a composite lymphoma composed of peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) and follicular B-cell lymphoma (FBCL) coexisting in a single axillary lymph node in a 66-year-old female. Conclusion: The medical literature lacks significant information regarding this type of composite lymphoma, thus creating a challenge for management. Currently, only one other case of this type of composite lymphoma has been reported in the English medical literature, with this case reporting the first female patient.
Follicular lymphoma
T-Cell Lymphoma
B-cell lymphoma
Not Otherwise Specified
Peripheral T-cell lymphoma
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Follicular lymphoma is a low grade malignant lymphoma. However, some follicular lymphomas undergo histological transformation into higher grade malignant lymphomas. We recently encountered a diffuse large cell lymphoma which seemed to have progressed from a follicular lymphoma and which finally transformed into a small non-cleaved lymphoma. Each stage of the histological transformation was accompanied by increasing clinical grades of malignancy. It was suspected that in our patient a follicular lymphoma initially developed due to rearrangement of the BCL2 gene, and then underwent histological transformation into a diffuse large cell lymphoma, which was associated with p53 mutation. Subsequent rearrangement of C-MYC promoted the histological transformation of this diffuse large cell lymphoma into a small non-cleaved lymphoma. Our findings indicate that p53 mutation and rearrangement of C-MYC are involved in the histological transformation of follicular lymphomas into more advanced lymphomas.
Follicular lymphoma
Gene rearrangement
Malignant Transformation
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Follicular lymphoma
Interim
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The diagnosis of histological transformation of follicular lymphoma can be challenging and ambiguous. We investigated the distribution of the Ki-67 labeling index of histological transformation of follicular lymphoma and determined its cutoff value to predict poor outcomes. The diagnostic criteria for histological transformation were a diffuse pattern of proliferation and a proportion of large lymphoma cells ≥20%. Of the 1121 patients with follicular lymphoma, 171 (15%) showed histological transformation to diffuse large B-cell lymphoma. Of these, 76 patients, whose biopsies were obtained from the sites with the highest maximum standardized uptake values, according to the positron emission tomography findings, were included. The Ki-67 index ranged from 16.8% to 98.4% (median, 60.6%). In patients with histological transformation, the most significant differences were found in progression-free survival (p = 0.087, 58% vs. 87% at 2 years) and overall survival (p = 0.024, 53% vs. 85% at 5 years) when a 70% cutoff was used. Additionally, overall survival was significantly shorter in patients with histological transformation with maximum standardized uptake values of ≥20 (p < 0.0001) and absence of a follicular lymphoma component (p = 0.004). A Ki-67 index of ≥70% was a significant adverse factor for overall survival in patients with histological transformation of follicular lymphoma and may predict poor outcomes.
Follicular lymphoma
International Prognostic Index
Proliferation index
Proliferative index
Ki-67
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Composite lymphoma is defined as two or more lymphomas with distinct morphological and immunophenotypical characteristics synchronously diagnosed at the same anatomical site. Composite lymphoma is rare, and the most common combination is follicular lymphoma (FL) associated with diffuse large B cell lymphoma, followed by FL associated with classic Hodgkin’s lymphoma (HL). Histologically, composite lymphomas display a mixed pattern or distinct zonal distribution of each lymphoma component. Composite lymphoma poses a diagnostic challenge, especially when two lymphoma components are mixed in the same lymph node. Here, we report a case of composite HL and FL 11 years after initial and repeat biopsies consistent with FL in a man in his 70s emphasising the importance of repeat biopsy in lymphoma diagnosis.
Follicular lymphoma
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Follicular lymphoma grade 3 is recognized as a distinct entity in the World Health Organization classification of lymphomas. There is confusion regarding the natural history of these lymphomas, because some studies indicate an indolent behavior and others show more aggressive behavior. This review examines the biological and clinical characteristics of follicular lymphoma grade 3 and compares these characteristics with other lymphomas.Several reports suggest that follicular lymphoma grade 3 has molecular and genetic characteristics that distinguish these lymphomas from other grades of follicular lymphoma. These characteristics are often more common in patients with diffuse large B-cell lymphoma than follicular lymphoma. It is impossible to make firm recommendations on management because prospective trials are lacking. Nevertheless, recent studies have demonstrated that follicular lymphoma grade 3 patients treated with anthracycline-based therapy have similar outcomes to patients with diffuse large B-cell lymphoma.Patients with follicular lymphoma grade 3 should be treated with curative intent. They should receive aggressive anthracycline-based therapy combined with rituximab, which is identical to therapy used for patients with diffuse large B-cell lymphoma.
Follicular lymphoma
Confusion
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