A 57-year-old woman is found to have painless bilateral inguinal lymphadenopathy. Excision biopsy shows effaced architecture replaced by closely packed follicles of centrocytes with rare centroblasts, consistent with grade 1 follicular lymphoma. Staging PET-CT shows infradiaphragmatic nodal disease only. She is completely asymptomatic. What is the most appropriate initial management?

• A Observation with periodic review ✓
• B Immediate R-CHOP chemotherapy
• C Involved-field radiotherapy to both groins
• D Autologous stem cell transplantation

Explanation

Advanced-stage, low-burden, indolent follicular lymphoma in an asymptomatic patient follows a watch-and-wait policy, since early initiation of chemoimmunotherapy does not improve overall survival. R-CHOP, radiotherapy, and transplantation are reserved for symptomatic, bulky, progressive, or transformed disease. Transplantation is a salvage option after relapse, never front-line therapy for untreated low-grade 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.