Follicular lymphomas are one of the most frequently
encountered lymphomas. In the new WHO Classification
of Hematopoetic and Lymphoid Tumors, published in
2008, some modifications in the diagnosis of follicular
lymphomas have been introduced.
One of these changes is in the grading of follicular
lymphomas which has been traditionally problematic. The
grading scheme was based on the number of blasts per
high power field in the 2001 WHO Classification. It was
realized that counting the number of blasts is subjective
and irreproducible. Therefore, in the new classification
separating the follicular lymphomas into two broad
categories in terms of grade, namely ‘low grade’ and
‘high grade’ is proposed. Grades 1 and 2 in the 2001
classification are lumped together under the low grade
category and grade 3 is referred to as high grade.
Another change is, if a diffuse large B cell component
is present in the sections it should be reported as the
primary diagnosis, with an estimated proportion of the
diffuse large B cell lymphoma and follicular lymphoma
In the new WHO classification, pediatric, primary
intestinal and other extranodal follicular lymphomas
are recognized as variants of the follicular lymphoma while primary cutaneous follicle center lymphomas are
classified as a separate entity by itself.
The case presented here did not have any diffuse
areas although all of follicles contained predominantly
centroblasts/immunoblasts without any intervening
centrocytes. This is relatively rare and may be a reflection
of sampling of the lymph nodes.