Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 6, 2021; 9(31): 9542-9548
Published online Nov 6, 2021. doi: 10.12998/wjcc.v9.i31.9542
Clinical observation of pediatric-type follicular lymphomas in adult: Two case reports
Yao Liu, Hui Xing, Yue-Ping Liu
Yao Liu, Department of Pathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Hui Xing, Yue-Ping Liu, Department ofPathology, The Fourth Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Author contributions: Liu Y analyzed and interpreted the patient data and drafted the article; Xing H collected the data and contributed to manuscript writing; Liu YP performed the histological examination; Liu YP was in charge of the imaging data analysis; Liu YP reviewed the paper and put forward constructive suggestions; All authors read and approved the final version of the manuscript.
Supported by the Special Fund of Hebei Provincial Finance Department, No. 2016034942.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no competing interests to report.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yue-Ping Liu, MD, PhD, Director, Doctor, Professor, Senior Scientist, Department of Pathology, The Fourth Hospital of Hebei Medical University, No. 12 Jiankang Road, Shijiazhuang 050000, Hebei Province, China. annama@163.com
Received: January 27, 2021
Peer-review started: January 27, 2021
First decision: July 16, 2021
Revised: July 22, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 6, 2021
Abstract
BACKGROUND

Pediatric-type follicular lymphoma (PTFL) is a unique pathological type in the 4th edition of hematopoiesis and lymphoid tissue tumor classification revised by World Health Organization. It is unique in clinical practice and seldom seen in adult. PTFL mainly occurs in the head and neck lymph nodes. Most of the cases are short of fever, night sweat, weight loss, and other B symptoms which substitute for lymphadenopathy as the main symptom. PTFL can be disposed of surgical resection and it can achieve long-term tumor-free survival, and it has an excellent outcome.

CASE SUMMARY

Two cases of PTFL were reported and their clinicopathological features, differential diagnosis, therapy and prognosis were discussed. PTFL showed gray-brown tough texture in general performance. The histological manifestations of PTFL were similar to that of adult-follicular lymphoma (FL). Under low power microscope, the structure of lymph nodes was destroyed in different degree, the follicles were closely arranged, expanded and irregular, and the mantle zone became thin or disappeared. In addition, the “starry sky phenomenon” could be seen. At high magnification, the follicles were mainly composed of single medium-sized central cells, and some of them mainly consisted of centroblastic cells to characterize scattered chromatin and inconspicuous nucleoli. Immunohistochemical showed the tumor cells expressed CD20, PAX5, CD79a and CD10, BCL6, FOXP-1, which were limited in germinal center; Ki-67 was highly expressed in germinal center. CD21 and CD23 showed nodular and expanded follicular dendritic cells. Immunoglobulin gene rearrangement was positive for IGH and IGK. The two patients underwent surgical resection with no complications. After discharge, the two patients with a close review for 18 mo and 5 mo respectively and showed no evidence of recurrence.

CONCLUSION

PTFL in adult is generally supposed to be extremely rare. PTFL displayed characteristic morphological, immunophenotypic, and molecular biological changes which are a kind of neoplasm with satisfactory prognosis after surgical excision.

Keywords: Pediatric-type follicular lymphoma, Adult, Clinical pathology, Diagnosis, Immunophenotype, Case report

Core Tip: Pediatric-type follicular lymphoma (PTFL) is a unique type of follicular lymphoma, which occurs in childhood and adolescents frequently. PTFL is unique in clinical practice and seldom seen in adult. It has unique clinical and pathological characteristics, which is different from the pathological type of FL in adult. Through the discussion of the cases, we can deepen our understanding of the disease.