In Situ Follicular Lymphoma Associated With Progressive Transformation of Germinal Centers

The authors report here a case of in situ follicular lymphoma (FL) associated with progressive transformation of the germinal center (PTGC). A 39-year-old Japanese male developed a mass in the right cervical region. Biopsy of the enlarged lymph node led to a diagnosis of PTGC. Then, 5 years later, the lymphadenopathy recurred. The second biopsy specimens contained numerous germinal centers, including PTGC. Although most follicles were cytologically reactive, a few GCs appeared to be somewhat monotonous, composed predominantly of centrocytes and lacking mitotic figures and tangible body macrophages. Immunohistochemical studies demonstrated that these atypical GCs were CD10+, CD20+, and bcl-2+, with lambda-light-chain restriction. A previous report emphasized the differential diagnostic problem between PTGC and the floral variant of FL. However, the present case indicated that in situ FL should be added to the list of differential diagnoses for PTGC.