濾胞性リンパ腫(FL)の細胞と亜分類

WHO 分類でのcentrocytes/centroblastの定義:
Centroblasts (濾胞中心芽細胞): 大型で,類円形核,水疱状クロマチン,核膜寄りに存在する1〜3個の核小体,狭い細胞質を持つ。典型的には小型リンパ球の3倍の大きさであるがより小さい 場合もある。
 Large cells with usually round or oval, but occasionally indented or multilobated nuclei, vesicular chromatin, one to three peripheral nucleoli and a narrow rim of cytoplasm. Typically, they are at least 3 times the size of lymphocytes, but they may be smaller in some cases.

Centrocytes (濾胞中心細胞): 小型から中型の細胞でくびれがある核,目立たない核小体,狭い淡明な細胞質を持つ。
Small to medium sized cells with angulated, elongated, twisted or cleaved nuclei, inconspicuous nucleoli and scant pale cytoplasm.

Follicular dendritic cells (濾胞樹上細胞): 繊細な核膜,均一なクロマチン,中心性の赤い核小体,ときに二核を持つ。
delicate nuclear membrane, dispersed chromatin, violet-coloured centrally located nucleoli, often binucleate

Tolksdorf G, Stein H, and Lennert Kの定義 (Br. J. Cancer 1980, 41; 168-82)
Centroblasts: Medium-sized or large cels with a round or oval, pale nucleus containing 2-3 nucleoli, usually located at the nuclear membrane; cytoplasm is sparse and intensely basophilic (Lennert, 1957, 1961).
Centrocytes: Small or medium-sized cells with a cleaved or irregularly shaped nucleus; cytoplasm is usually sparse and very weakly basophilic and thus difficult to recognize in sections (Lennert,1964).
Except in newly formed germinal centres, centrocytes are the predominant cells.

Follicular lymphomaの Grading 7視野中のcentroblastの数 (/hpf)の平均で決める
視 野数22の場合,7視野を数え,10で割った数で判定(WHO 分類)
Grade 1-2 (low grade): 0〜15 centroblasts/hpf G1, 0-5; G2, 6-15
Grade 3A > 15 centroblasts/hpf, centrocytes present
Grade 3B Solid sheets of centroblasts

Grade 1-2の部分がdiffuseにある場合
    意義は明らかではないが,下記の報告が推奨されている。
Reporting pattern
Follicular lymphoma,
    Follicular (>75% follicular)
    Follicular and diffuse (25〜75% follicular)
    Focally follicular (<25% follicular)
    Diffuse 0% follicular

ただし
Grade3に相当する部分がびまん性に広がっていたら,診断は DLBCL with follicular lymphomaとなる

Diffuseの定義: CD21/CD23 /FDC+の完全消失として定義される,ただし濾胞間に広がることはよくあるので,そこはびまん性と捉えない。
 Diffuse areas may be present, often with sclerosis, particularly in mesenteric and retroperitoneal infiltrates

CYTOGENETICS
t(14;18) 80% (= BCL2 rearranged) 80-90%
3q27-28 (= BCL6) 5-15%, grade 3Bに多い


kappa/lambda thresholds
Iancuらの検討によると,FCMでkappa/lambda比が
4以上ないし0.3以下がモノクロー ナリティの証拠として最適
 (Iancu D, et al. Arch Pathol Lab Med. 2007 ;131:282-287)