Case Studies: Treatment of Follicular Lymphoma
In this case-based interview, Loretta Nastoupil, MD, provides an overview on the diagnosis and therapeutic management of follicular lymphoma. The case of a newly-diagnosed patient and the case of a patient with high-risk progressive disease are discussed.
Treatment of Follicular Lymphoma: Case 1
Treatment of Follicular Lymphoma: Case 1
Treatment of Follicular Lymphoma: Case 2
January 2014
- A 71-year-old female reports having symptoms of bilateral axillary swelling of 1.5 years’ duration and presents with diffuse inguinal and cervical adenopathy.
- Past medical History: 15-year history of treatment for rheumatoid arthritis with methotrexate
- Physical examination:
- The patient is generally well-appearing; temperature, pulse, blood pressure, and HEENT are all WNL; extremities show no edema.
- Cardiac exam is normal; chest is clear
- Abdomen shows no abnormal hepatosplenomegaly
- Lymph nodes: left axillary 1.5 cm, right axillary 2 cm; cervical and inguinal nodes <1 cm bilaterally; non-tender
- Notable laboratory findings:
- CBC with diff, WNL
- LDH, 148
- Right groin excisional node biopsy shows small lymphocytes with nuclear indentations (centrocytes) and large lymphocytes without indentations (centroblasts).
- Pathology: t(14;18); co-expression of Bcl2, CD10, CD20.
- CT shows scattered adenopathy in the cervical, axillary, mesenteric, and pelvic regions. The largest lymph node measures 4.5 cm. The remaining lymph nodes are smaller than 3 cm.
