17-years girl with right inguinal lymphadenopathy.  
After a month of enlargement of lymph nodes (SONO: the biggest one 2 cm in diameter and few smaller, 1.3 cm) the cytology was performed and reactive hyperplasia was diagnosed. One month later the cytological finding was the same. Patient does not have any symptoms. Clinical and all laboratory exams are normal. Since lymph nodes did not regress the biopsy of the biggest lymph node was performed.  
Histologic and immunohistochemical analysis was suspicious for pediatric variant of follicular lymphoma. The study of clonality was also performed – IGH (BIOMED-2) and TCRB/TCRG; and the monoclonality of B cells (IgH regions FR1-JH; FR2-JH; FR3-JH; DH-JH) was cofirmed.  
I would be grateful for your opinion and support.  
 
 
 

diane.c.farhi 2009-01-20 18:29	It might be helpful to contact the lab that did the clonality studies and find out if the majority of cells were clonal, versus a small clonal population in a background of reactive cells.
Jonjic 2009-01-21 17:30	Unfortunately molecular lab that performed the analysis was not able to answer this particular question with certainty.
Mueller-Hermelink 2009-01-21 19:34	This can well be pediatric variant of follicular lymphoma. The arguments for me would be: Cytology rather uniform without starry sky pattern, no clear zonal organisation of dense and light zone, pathological distribution and increase of intrafollicular T cells. Negativity of follicles for CD 10 ( the strong reaction of TFH cells is seen).   If a monoclonal band is seen in all Primer-Pairs this would be another argument in favour.   I would do Kappa /Lambda light chain stain and also Ki67 to see the proliferation pattern.Higher magnification of Bcl 2.
Jonjic 2009-01-21 20:20	Thank you very much for your kind help. We will perform the suggested staining and I will add a higher magnification of the bcl-2 staining.
tzankov 2009-01-22 18:40	I also agree with the proposed diagnosis of FL; the hypoproliferative pattern of Ki-67 is also in support of this diagnosis. The interpretation of Bcl2 is more difficult, since there are a lot of CD5+ intrafollicular T-cells, which physiologically express Bcl2, I think that the FL is negative, another finding that will fit with the diagnosis of pediatric FL.   In summary, all findings are in support of the diagnosis of "pediatric FL".
diane.c.farhi 2009-01-22 18:55	I agree with the diagnosis of follicular lymphoma.
Jonjic 2009-01-22 21:14	Thank you very much for your opinions which are also compatible with ours. However, it is very helpful to have your support since it is a young patient considered for chemotherapy in spite of the fact that so far she did not have any symptoms or complains. We will include the staining for kappa /lambda light chain as suggested by Prof. Mueller-Hermelink. Once again I am grateful for your help.
hurwitz 2009-02-13 18:24	Final diagnosis: Follicular Lymphoma in a young patient (pediatric)
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