Missed incidental finding of non-Hodgkin’s B cell follicular lymphoma: A Case Report

Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin’s lymphoma (NHL) and the most common low-grade lymphoma in adults. The typical patient presentation is with painless peripheral adenopathy with waxing and waning lymph node enlargement. Patients are usually asymptomatic aside from lymphadenopathy.5 Initial screening is conducted via general physical examination, laboratory examination, and imaging examination with enhanced computed tomography (CT).4 Diagnosis of FL is best made by excisional lymph node biopsy. The pathogenesis of FL is incompletely understood, but thought to be associated with a t(14,18) translocation resulting in over-expression of the BCL2 oncogene and dysregulation of programmed cell death.2,6 This tumor has a distinct nodular growth pattern (Figure 1) consisting of a mixture of centrocytes and centroblasts, making it one of the few forms of NHL that can be diagnosed accurately based on morphology alone.5 In this report, we discuss how a routine endocrinology workup and a history of ineffective transitions of care led to the delayed diagnosis of non-Hodgkin’s B cell follicular lymphoma.