A 55-year-old woman has painless inguinal lymphadenopathy. Biopsy shows a predominantly follicular pattern of small cleaved centrocytes with fewer than 15 large centroblasts per high-power field. Immunophenotype: CD20+, CD10+, BCL6+, BCL2+. She is asymptomatic with no cytopenias or bulky disease. Most appropriate initial management?

• A R-CHOP chemotherapy immediately
• B Autologous stem cell transplant
• C Involved-field radiotherapy to all nodal sites
• D Watchful waiting with observation ✓

Explanation

Fewer than 15 centroblasts per high-power field confirms grade 1 or 2 follicular lymphoma, an indolent disease driven by BCL2 overexpression from t(14;18). Asymptomatic low-burden stage-appropriate disease follows a watch-and-wait approach because early treatment does not improve overall survival. R-CHOP is reserved for symptomatic or bulky disease, radiotherapy alone suits limited stage disease, and transplant is a relapse strategy, not front-line therapy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.