Follicular lymphoma

Indolent B‑cell NHL with t(14;18) causing BCL2 overexpression and inhibited apoptosis.

• Classic cause of painless, waxing and waning lymphadenopathy; can transform to DLBCL.

• Middle‑aged adult with months of painless cervical/axillary nodes
• Nodes enlarge with stress or infections, then shrink (wax/wane)

1. Indolent course → often observe if asymptomatic
2. Confirm with flow/IHC (CD10+, BCL2+ in follicles)

1. Observation if low tumor burden; rituximab‑based therapy if symptomatic

• t(14;18) → BCL2 next to IgH enhancer = anti‑apoptosis
• Transformation to DLBCL = sudden rapid node growth, systemic symptoms

• Small cleaved cells in follicular pattern; BCL2+ in germinal centers