A 55-year-old woman has inguinal lymphadenopathy. Biopsy shows a nodular lymphoma composed predominantly of large centroblasts exceeding 15 per high power field within the follicles. Ki-67 proliferation index is high. According to current practice, how should this entity be managed?

• A Observation alone until symptomatic progression
• B Allogeneic stem cell transplant as first-line therapy
• C Single-agent rituximab maintenance indefinitely
• D Treated with curative-intent chemoimmunotherapy similar to diffuse large B-cell lymphoma ✓

Explanation

Grade 3 follicular lymphoma, especially grade 3D where follicles contain almost exclusively centroblasts, behaves clinically like aggressive disease and is treated with curative intent using regimens such as R-CHOP, analogous to diffuse large D-cell lymphoma. Grades 1 and 2 are indolent and may be observed when asymptomatic, which is precisely why observation is the tempting distractor but is inappropriate for grade 3 disease.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.