would you be kind to include a Ki-67 stained slide?  
 
why is the patient thrombopenic?

we are preparing to appload Ki-67 slide. Regarding trombocytopenia - in the myelogram there are 33,3 of megacariocytes (N 53-73). also increasing of prolymphocytes number -1,2 (N 0-0,2). Others are in normal ranges.

Ki-67 image1

Well, what I see is a follicular lymphoproliferation with a rather (as far observabel on the poorly processed slides) monotonous composition and a pathologic distribution of the Ki-67 stainable cells. Bcl-2 seems not to be overexpressed in the follicles. The tissue is poorly rpcessed, there are obvious problems with the dehydration, thus some of the phenotypic pecularities, such as the hagativity for bcl-2 might be attributed to technical issues. On the submitted, slightly outfocussed slides, it is hard to count for centroblasts, though it is important, considering tha young age of the patient and the negativity (?) for bcl-2 since follicular lymphoma grade 3 is a differential. I do not see obviously progressively transformed germinal centers neither large cells. From all said I regard this case consistent with follicluar lymphoma, grading is not possible on the submitted slides, I do not see obvious grade components.  
 
I think that you should reconsider your fixation and dehydration proceedusres in order to obtain optimal results. The nodes should be cut into 4 mm thick slides and fixed in 4% buffered formalin approximately 24 hours long, dehydration should start with 70% alc., and the steps with 90%, 95-96% and 100% as well as xylol should be adequately long to allow complete dehydration.

Dear Martynchyk,  
 
this is not an easy case. Considering the age of the patient, the low-grade fever and the histologic picture of a lymphoid proliferation with a lot of follicles you should be very sure before you diagnose a follicular lymphoma (especially with a bcl-2 negativity).  
Could you send us please pictures from interfollicular areas (CD20, CD10 and bcl-6) in order to see if the interfollicular areas are replaced by CD20, CD10 and bcl-6 positive B-cells (which seems not to be the case in the bcl-2 staining, here there are a lot of bcl-2 positive T-cells between the follicles). Till now a follicular hyperplasia is in my opinion not at all ruled out (this distiction between FL and follicular hyperplasia has a high clinical impact on the patient!).  
Do you know how long the lymphadenopathy is clinically evident?

Unfortunately the poor quality of the images is caused by not so much the quality of the slide but the possibilities of our photographic equipment, which we will try to correct. There are no signs of centroblasts in the follicles, cellular composition is remarkably monomorphic - presented by cells such as centrocytes.