title: Follicular Lymphoma: A Clinicopathological Analysis from a Tertiary Care Institute in Southern India.
abstract: BACKGROUND
  Follicular lymphoma (FL) is an indolent lymphoproliferative disorder of B-cells with variable clinical behavior. It is the second most common subtype of Non-Hodgkin lymphoma in western countries but reported to have a lower incidence in Asia.
  
  
  METHODS
  Cases of FL diagnosed in the Department of Pathology of our Institute from January 2009 to June 2015 were included in the study. The clinicopathological parameters including staging, histological details, and immunohistochemical markers CD20, CD10 and BCL-2 were recorded in all the cases.
  
  
  RESULTS
  Of the 497 cases of Non-Hodgkin Lymphoma reported during the study period, 36 (7.2%) cases were follicular lymphoma. The mean age was 50 years with male to female ratio of 3.2:1. Grade 1/2 was seen in 70% cases. 22 % cases had low grade with high proliferation index (Ki67 > 40%). Granulomatous response was seen in two cases. Diffuse large cell lymphoma component was present in four cases. Bone marrow involvement and peripheral blood spill were seen in 12 (37.5%) and six cases (18.8%) respectively. 72% cases were in stage 3 or 4.
  
  
  CONCLUSIONS
  The incidence of FL was lower in our study than other Indian studies. FL presented in the elderly, with male predominance and disseminated stage. The study highlights features of low grade with high proliferation index, granulomatous response, leukemic involvement, and transformation to high grade lymphoma.
authors.affiliation: Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Mary Theresa
authors.initials: MT
authors.lastname: Sylvia
authors.affiliation: Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Biswajit
authors.initials: B
authors.lastname: Dey
authors.affiliation: Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Debdatta
authors.initials: D
authors.lastname: Basu
authors.affiliation: Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Sajini Elizabeth
authors.initials: SE
authors.lastname: Jacob
authors.affiliation: Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Kar
authors.affiliation: Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
authors.forename: Biswajit
authors.initials: B
authors.lastname: Dubashi