Follicular Lymphoma

Question 1

Bcl 2

Answer 1

Present at dx and transformation
Poor prognosis - increased risk of transformation
Anti apoptosis protein
Useful in distinguishing reactive from neoplastic follicles. Expressed by many lymphomas. Negative in the majority of BL. Also positive in many carcinomas.

Question 2

2 hallmark mutations

Answer 2

MLL gene re arrangement

T(14:18)

Question 3

T14:18- how does this cause dx

Answer 3

Confers survival adv as b cells expressing this Q

Question 4

MLL

Answer 4

Tumour suppressor gene - inactivating mutation found in 89% fl

Question 5

Histology pathogenesis

Answer 5

FL evolves in a nodal growth pattern after
malignant transformation of germinal center B cells. It is charac-
terized by the t(14;18)(q32;q21) translocation resulting in consti-
tutive overexpression of the antiapoptotic BCL2 gene

Question 6

MRD

Answer 6

PCR amplification of t14:18 translocation after first line Tx is good to further prognosticate os
Whether depth of MRD is informative about relapse currently being studied

Question 7

Grading of FL

Answer 7

Number of Centro lasts per hpf
Grade 1/2- 15 per hpf
3a- still some centocyte
3b- no Centrocytes only centroblasts

Question 8

Behaviour of FL based on grade

Answer 8

Grade 1-3a behave as indolent

3b like dlbcl

Question 9

What does t 14:18 do

Answer 9

Puts bcr gene under igh control