title: Isolated Follicles Enriched for Centroblasts and Lacking t(14;18)/BCL2 in Lymphoid Tissue: Diagnostic and Clinical Implications.
abstract: We sought to address the significance of isolated follicles that exhibit atypical morphologic features that may be mistaken for lymphoma in a background of reactive lymphoid tissue. Seven cases that demonstrated centroblast-predominant isolated follicles and absent BCL2 staining in otherwise-normal lymph nodes were studied. Four of seven cases showed clonal B-cell proliferations amid a polyclonal B cell background; all cases lacked the IGH-BCL2 translocation and BCL2 protein expression. Although three patients had invasive breast carcinoma at other sites, none were associated with systemic lymphoma up to 44 months after diagnosis. The immunoarchitectural features of these highly unusual cases raise the question of whether a predominance of centroblasts and/or absence of BCL2 expression could represent a precursor lesion or atypical reactive phenomenon. Differentiating such cases from follicular lymphoma or another mimic is critical, lest patients with indolent proliferations be exposed to unnecessarily aggressive treatment.
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Grant E
authors.initials: GE
authors.lastname: Nybakken
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Bala
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Dita
authors.initials: D
authors.lastname: Gratzinger
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Carol D
authors.initials: CD
authors.lastname: Jones
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: James L
authors.initials: JL
authors.lastname: Zehnder
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Charles D
authors.initials: CD
authors.lastname: Bangs
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Athena
authors.initials: A
authors.lastname: Cherry
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Warnke
authors.affiliation: Department of Pathology, Stanford University School of Medicine, Stanford, California, 94305, United States of America.
authors.forename: Yasodha
authors.initials: Y
authors.lastname: Natkunam
mesh_terms: D001402:B-Lymphocytes / Q000166:cytology*; D001943:Breast Neoplasms / Q000473:pathology; D049109:Cell Proliferation / Q000235:genetics; D002648:Child; D002883:Chromosomes, Human, Pair 14 / Q000235:genetics*; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics*; D005260:Female; D006801:Humans; D007145:Immunoglobulin kappa-Chains / Q000235:genetics; D007146:Immunoglobulin lambda-Chains / Q000235:genetics; D017404:In Situ Hybridization, Fluorescence; D008198:Lymph Nodes / Q000473:pathology*; D008224:Lymphoma, Follicular / Q000235:genetics / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000235:genetics*; D014178:Translocation, Genetic / Q000235:genetics
chemical_list: D007145:Immunoglobulin kappa-Chains; D007146:Immunoglobulin lambda-Chains; D019253:Proto-Oncogene Proteins c-bcl-2