Follicular Lymphoma
Grading / Staging / Report
Grading
- Grading based on percent of large cells
- Grade 1, under 25%
- Grade 2, 25-50%
- Grade 3, over 50%
- Based on highest grade area present
- If two discrete patterns present, lymphoma may be considered composite
- WHO recommendation (Mann-Berard) entails counting 20 hpf using 40x objective
- Record mean number of large noncleaved cells
- Using the table below
- Grade 1 is at the low cutoff or below
- Grade 2 is above the low cutoff to the high cutoff
- Grade 3 is above the high cutoff
Microscope Type |
Eyepiece |
Low Cutoff |
High Cutoff |
American Optical |
10x |
5 |
15 |
American Optical |
15x |
4 |
12 |
Olympus |
10x |
7 |
20 |
Olympus |
15x |
4 |
12 |
Nikon |
10x |
7 |
20 |
Nikon |
15x |
4 |
12 |
- Modifications for other microscopes from Warnke et al. AFIP Fascicle
- Reproducibility of the Mann-Berard method is subject to:
- Interobserver consistency in recognition of large noncleaved cells
- Variations in slide thickness and staining
- We prefer the simpler percentage based scheme given above
While staging is linked to prognosis, it does not usually determine therapy
- Therapy is usually determined by clinical signs and symptoms
- Most staging is radiographic
- Pathologic staging is usually limited to bone marrow and biopsy of other sites to confirm clinical evidence of involvement
- Staging laparotomy is not generally indicated
- 40-70% present as stage III or IV
Ann Arbor Staging System
- Stage I
- I if involvement of a single lymph node region
- IE if involvement of a single extralymphatic organ or site
- Stage II
- II if two or more lymph node regions on same side of diaphragm
- IIE if localized involvement of an extralymphatic organ or site and one or more lymph node regions on the same side of the diaphragm
- Stage III
- III if Involvement of lymph node regions on both sides of the diphragm
- IIIS if spleen involved
- IIIE if extralymphatic site involved
- Stage IV
- Diffuse or disseminated involvement of one or more extralymphatic organs or tissues, with or without associated lymph node involvement
- Systemic Symptoms in 6 months preceding admission
- Fever, night sweats, 10% weight loss
- A = absent
- B = present
- Extranodal sites are also designated
- M+ = marrow
- L+ = lung
- H+ = liver
- P+ = pleura
- O+ = bone
- D+ = skin and subcutaneous tissue
- Although originally designed for Hodgkin lymphoma, the Ann Arbor System is also used for non-Hodgkin lymphomas.
The pathology report should contain the following information:
- Diagnosis in the World Health Organization (WHO) classification
- Equivalent diagnosis in other classifications used by relevant clinicians
- Results of supplementary studies if performed
- Relationship to other specimens from the same patient
- Information relevant to staging if available
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