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 Table of Contents  
Year : 2021  |  Volume : 12  |  Issue : 1  |  Page : 55-56

Signet ring follicular lymphoma - A rare entity

Department of Hematopathology, AmPath, Hyderabad, Telangana, India

Date of Submission13-May-2020
Date of Decision01-Aug-2020
Date of Acceptance15-Aug-2020
Date of Web Publication15-Mar-2021

Correspondence Address:
Manu Goyal
Department of Hematopathology, AmPath, Nallagandla, Serlingampally, Hyderabad - 500 019, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joah.joah_66_20

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How to cite this article:
Goyal M, Begum AS. Signet ring follicular lymphoma - A rare entity. J Appl Hematol 2021;12:55-6

How to cite this URL:
Goyal M, Begum AS. Signet ring follicular lymphoma - A rare entity. J Appl Hematol [serial online] 2021 [cited 2021 Aug 5];12:55-6. Available from: https://www.jahjournal.org/text.asp?2021/12/1/55/311336

  Case Top

A 69-year-old female presented with generalized lymphadenopathy and weakness. Microscopic examination of the lymph node biopsy showed complete effacement of the architecture diffusely by follicles of varying sizes [Figure 1]a. These follicles were composed predominantly of medium-sized cells with eccentrically placed round-to-oval nuclei and cytoplasmic vacuoles, giving them a ”signet ring cell” appearance [Figure 1]b, and centroblasts, averaging 8–10/hpf. The cytoplasmic vacuoles were Alcian blue negative and the cells were pan-cytokeratin negative. Immunohistochemistry revealed the expression of CD20, CD10, BCL2, and BCL6 in the lesional cells with a low Ki-67 proliferation index, averaging 5%–8% [Figure 1]c and [Figure 1]d. Staging workup showed bone marrow involvement. The final diagnosis was follicular lymphoma, signet ring cell variant, WHO Grade 2/3, predominantly follicular pattern, Stage 4. Since the first description by Kim in 1978, around 50 cases of signet ring lymphoma have been reported in the literature. The majority of these are follicular lymphoma, fewer being other B-cell and T-cell lymphomas. The prognosis of these cases depends on the grade and stage, rather than the morphology.[1] The significance of awareness of this entity should prevent one to misdiagnose as adenocarcinoma, especially when the material is limited, i.e., fine-needle aspiration or core biopsy. Confirmatory tests should be performed to make a correct diagnosis.
Figure 1: Photomicrograph of the lymph node showing (a) follicles of varying sizes, arranged back to back (H and E stain, ×40); (b) follicular lymphoid cells with signet ring morphology with vacuolated cytoplasm and eccentrically placed nucleus (H and E stain, ×400); (c) signet ring cells diffusely positive for CD20 (hematoxylin counterstain, ×400); (d) signet ring cells diffusely positive for BCL6 (hematoxylin counterstain, ×400)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Krause JR. Signet ring lymphoma: A potential diagnostic mishap. Proc (Bayl Univ Med Cent) 2013;26:293-4.  Back to cited text no. 1


  [Figure 1]


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