Lymphoma and plasma cell neoplasms
Follicular lymphoma

Topic Completed: 1 January 2011

Revised: 7 November 2019

Copyright: 2001-2019,, Inc.

PubMed Search: follicular lymphoma gastrointestinal

Nikhil Sangle, M.D.
Page views in 2018: 598
Page views in 2019 to date: 1,150
Cite this page: Sangle N. Gastrointestinal follicular lymphoma. website. Accessed December 16th, 2019.
Definition / general
  • Uncommon
  • For primary disease, median age is 54 years
  • May be slight female predominance
  • Origin of duodenal tumors appears distinct from nodal follicular lymphomas, but more similar to MALT lymphoma (Mod Pathol 2009;22:940)
Clinical features

Primary follicular lymphoma of small bowel:
  • Median age 54 years, 2/3 female
  • Small bowel is most common site in GI tract; duodenum > ileum > colon; often transmural involvement
  • Disease localized to bowel and regional lymph nodes in most cases (Am J Surg Pathol 2011;35:1255)
  • Indolent with occasional relapses but no / rare deaths, median disease free survival of 69 months (Am J Surg Pathol 2002;26:216)
  • Duodenal cases may be more common in women, are usually periampullary (Am J Surg Pathol 2000;24:688)
  • Distal small bowel involvement is more likely to present as bowel obstruction requiring resection
  • Treatment somewhat controversial since disease is rare and usually presents as low stage, but often multifocal (World J Gastroenterol 2010;16:5543)
  • Rituximab with chemotherapy (cyclophosphamide, vincristine and prednisone, possibly doxorubicin)
  • Also surgery, watchful waiting
  • Possibly antibiotics (Ann Oncol 2008;19:254)
  • Follow up with endoscopy (standard, capsule or double balloon)
Clinical images

Images hosted on other servers:

Endoscopic images

Gross description
  • Bowel wall thickening with multiple elevated nodules or plaques, possible bowel obstruction
Microscopic (histologic) description
  • Associated with lymphomatous polyposis
  • Usually low grade and low stage; often transmural involvement
  • Composed of neoplastic follicles with small cleaved cells
  • Predominantly follicular growth pattern, occasionally mixed with diffuse, rarely entirely diffuse
Microscopic (histologic) images

Images hosted on other servers:

Various images

Positive stains
Negative stains
Molecular / cytogenetics description
  • t(14;18) - the standard translocation for follicular lymphoma; associated with poorer clinical course
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