A Rare Case of Follicular Lymphoma with both Malignant Pleural Effusion and Ascites

Follicular lymphoma (FL), a type of non-Hodgkin's lymphoma (NHL) originating from follicular center B cells, is clinically highly heterogeneous. Its typical immunophenotype is CD5- CD10+ CD19+ with t(14;18) (q32;q21). Liquid-based preparation and smear microscopic examination are common laboratory methods in patients with tumor invasion in the serous cavity.

Pleural effusion and ascites were collected and sent to the laboratory for liquid-based preparation and smear microscopic examination.

"Ascites" liquid-based preparation and cell wax blocks: found scattered heteromorphic cells, IHC: Bcl-2 (+), Bcl-6 (-), CD20 (-), CD3 (slight+), CD79a (+), Ki 67 (40%+), c-myc (part+). Rivalta test of pleural effusion and ascites was positive, the nucleated cell counts were 1,105 x 106/L and 3,960 x 106/L, and lymphoma cells accounted for 20% and 10%, respectively.

FL, in which lymphoma cells infiltrate both thorax and abdomen, is rarely seen clinically and develops rapidly. Early FL patients are expected to get long-term disease control, but late FL cannot be cured, so we should adhere to annual physical examination for early detection and treatment.