Follicular lymphoma: A survey of 75 cases with special reference to the syndrome resembling chronic lymphocytic leukaemia.

In a series of 75 cases of follicular lymphoma collected between 1950 and 1971 the following features were singled out as characteristic of, or specially frequent in, follicular lymphoma: (1) the high incidence in females; (2) the long history of symptomless lymph node enlargement; (3) the frequent presence of extensive symptomless disease at presentation, especially in patients below 40 years of age; (4) the syndrome resembling and often confused with chronic lymphocytic leukaemia, in which the notched nucleus cell, when present, is diagnostic; (5) the responsiveness of extensive disease to radiotherapy and alkylating agents at low dosage; (6) the long overall survival and the long survival after relapse; (7) the occurrence of abrupt change in the character of the disease in which, during a period of apparent quiescence, malignant transformation supervenes proving rapidly fatal. In the transformed stage the disease behaves as an invasive metastasizing sarcoma or as a blast cell leukaemia; in both cases the transformation is associated with the appearance of a new cell type, undifferentiated and distinct from that present before onset of transformation, which may however persist. The syndrome resembling chronic lymphocytic leukaemia occurs only in follicular lymphoma.