Follicular non-Hodgkin's lymphoma

Case contributed by Safwat Mohammad Almoghazy
Diagnosis almost certain

Presentation

A pathologically proven case of follicular lymphoma by biopsy, for staging.

Patient Data

Age: 40 years
Gender: Male

Lower brain cuts and orbits are unremarkable. Mucosal thickening with near total opacification of the left maxillary sinus. Multiple bilateral enlarged lymph nodes in the different cervical levels, submental,
submandibular and supraclavicular groups, the largest is noted in level IB on the
right side.

A large lymphomatous mass is seen encasing the trachea more to the right side, the
right main bronchus and the origin of the right brachiocephalic trunk, and showing faint areas of
breaking down inside. Enlarged lymph nodes are noted in the anterior mediastinum, the prevascular area and precarinal regions. Bilateral sub-centimetric axillary lymph nodes are noted. Mild right-sided pleural effusion with right sided pigtail catheter is seen within. Bilateral apical fibrosis, pleural tags, and atelectatic bands are noted. No evidence of pulmonary nodules.

The liver is average in size with no suspicious focal lesions, no IHBR dilatation. Unremarkable gall bladder, spleen (small splenule), pancreas, both adrenals and kidneys (right cortical renal cyst)  Multiple enlarged paraaortic and mesenteric lymph nodes, the largest is noted in the lower aortocaval area. Multiple enlarged left inguinal lymph nodes, no sizable right inguinal lymph nodes.

Bones are unremarkable

Case Discussion

Follicular non-Hodgkin's lymphoma (NHL) is a unique subtype of NHL, which is indolent, with a high prevalence of residual mass after treatment, and may transform to more aggressive NHL.

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