Follicular lymphoma in situ in the spleen of a patient with autoimmune hemolytic anemia and carrying HCV was associated with more clonal B-cells than t(14;18) positive B-cells

Certain autoimmune conditions are associated with an increased risk of lymphoid malignancy. We report a 65-year old patient with autoimmune hemolytic anemia (AIHA) complicated by a follicular lymphoma (FL) in situ and other B-cell clones in the spleen. This diagnosis was made by immunohistochemistry, flow cytometry, and Southern blot analysis of the B-cell receptor. Chromosomal analysis revealed 46,XX,t(14;18)(q32;q21) 2/20, 46,XX,del(7)(q?),del(11)(q?) 2/20, and 46,XX 16/20. It has been speculated that these preneoplastic conditions do not progress to overt FL and other lymphomas without a second lymphomagenic insult. However, AIHA confers a 27.4-fold higher risk of such an insult leading to lymphoma compared with the normal healthy population. Without any therapy after splenectomy, our current study patient remained healthy with no lymphoma development for 28 months. Based on this case, we discuss the pathophysiology of lymphomagenesis in a spleen with AIHA and the roles of a splenectomy for preventing further lymphomagenesis in AIHA patients.

Recent Advances in Follicular Lymphoma: Pediatric, Extranodal, and Follicular Lymphoma in Situ

Follicular lymphoma is a relatively common B-cell lymphoma composed of follicle center B lymphocytes. Follicular lymphomas occurring in the pediatric population and in some extranodal sites exhibit particular clinicopathologic features and clinical behavior that are often distinct from adult nodal follicular lymphoma. A type of "in-situ" follicular lymphoma presents as intrafollicular neoplastic cells in a background of architecturally normal lymphoid tissue and may be difficult to recognize in routine sections. Accurate recognition of the morphologic variants and clinicopathologic subtypes of follicular lymphoma is important to avoid confusing them with other lymphomas and reactive processes; in addition, some of these subtypes of follicular lymphoma display unusually indolent clinical behavior that warrant their separation from "conventional" follicular lymphoma.