Composite Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia and Follicular Lymphoma: A Clinicopathological Study of Six Cases. (April 2018)

• Record Type: Journal Article
• Authors: Jelloul, Fatima Zahra; Chen, Qiang Hua; Yang, Tianyu; Haghi, Nina; Brody, Judith; Zhang, Xinmin; Sheikh-Fayyaz, Silvat
• Is Part Of: International journal of surgical pathology. Volume 26:Number 2(2018)
• Page Start: 135
• Page End: 144
• Publication Date: 2018-04
• Subjects: composite lymphoma -- follicular lymphoma -- small lymphocytic lymphoma/chronic lymphocytic leukemia; Pathology, Surgical -- Periodicals; 617.07
• DOI: 10.1177/1066896917737161
• Languages: English
• ISSNs: 1066-8969

Abstract

Background: Composite small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) and follicular lymphoma (FL) is extremely rare, and only 13 cases have been reported previously.Methods: We identified 6 cases of composite SLL/CLL and FL in our database and studied their clinical, histologic, immunophenotypic, and cytogenetic features. A literature review of the existing cases was also conducted.Results: The patients included 4 males and 2 females, with a median age of 72 years. Four patients presented with lymphadenopathy and 2 with extranodal diseases. Lymphocytosis was seen in 2 cases. Serum lactate dehydrogenase levels were within normal range in all but one case. There were 2 histologic patterns: SLL/CLL predominant pattern (type I) and FL predominant or mixed pattern (type II). The type I pattern was exclusively associated with in situ follicular neoplasia (ISFN). The SLL/CLL showed typical morphology and immunophenotype in all the cases. The FL component included low grade (n = 3), ISFN (n = 2), and primary cutaneous FL (n = 1). Four cases had staging bone marrow biopsies including 3 cases with involvement by SLL/CLL and 1 case with involvement by SLL/CLL and FL. Four patients received treatments, one was under clinical surveillance, and one had no available information. All patients were alive after a median follow-up of 22 months.Conclusions: This is the largest case serial of composite SLL/CLL and FL. The CL affects elderly individuals, presents with advanced clinical stage, and appears to have a relatively indolent clinical course.