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Potential New Paradigm in the Diagnosis of Pediatric-Type Follicular Lymphoma

By: Julia Fiederlein
Posted: Monday, July 25, 2022

Liliana Fonseca, MD, of Centro Hospitalar Tondela-Viseu, Portugal, and colleagues presented two clinical cases of pediatric-type follicular lymphoma during the European Hematology Association (EHA) 2022 Congress (Abstract PB2076). The results of their analysis may prompt further investigation into the role of the cytologic, immunophenotypic, and molecular methodologies in diagnosing this type of hematologic malignancy.

The first case featured a previously healthy 18-year-old man with an isolated, nonpainful cervical lymphadenopathy of approximately 20 mm. The second case focused on a 13-year-old boy without a relevant personal history who, after the second dose of vaccination against COVID-19, developed multiple adenomegalies that spontaneously regressed; however, a “suspicious” right submandibular adenomegaly appeared about 1 month later. In both cases, fine-needle aspiration of the lymph nodes was performed for cytologic diagnosis; the samples underwent immunophenotyping and molecular cytogenetic analysis by flow cytometry and fluorescent in situ hybridization (FISH), respectively.

Immunophenotyping suggested a diagnosis of large-cell B-lymphoma (DLBCL) with a phenotype compatible with Burkitt lymphoma. Based on the cytology of both cases, the population seemed to be more consistent with DLBCL or high-grade follicular lymphoma. No rearrangements in the MYC, BCL2, BCL6, or IRF4 gene were detected in a FISH study of the two cases. The lymphadenopathies were excised, and a probable diagnosis of pediatric-type follicular lymphoma or DLBCL was suggested. A histologic examination confirmed the diagnosis as pediatric-type follicular lymphoma.

“We did not find in the literature any reference to a clear causal relationship between vaccination against COVID-19 and the onset of lymphoproliferative diseases,” the investigators concluded. “The cytologic/immunophenotypic/molecular approach of this entity in both cases seems to define a characteristic pattern, which may eventually allow, in a first approach, to suspect this diagnosis.”

Disclosure: For full disclosures of the study authors, visit library.ehaweb.org.


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