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Published on: September 12, 2025
Indolent lymphoma: follicular lymphoma and the microenvironment-insights from the microscope
1Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Insights
Follicular lymphomas (FLs) are cancers of germinal center (GC) B cells. Their microenvironment, composed of non-neoplastic cells, influences tumor survival and is studied using microscopy and gene expression profiling.
Area of Science:
- Hematology
- Oncology
- Immunology
Background:
- Follicular lymphomas (FLs) originate from germinal center (GC) B cells, mirroring normal GC B cell characteristics.
- The tumor microenvironment, comprising non-neoplastic cells, significantly impacts FL biology and B cell survival.
- Understanding the GC/FL microenvironment is crucial for comprehending FL pathogenesis.
Purpose of the Study:
- To review insights into the follicular lymphoma microenvironment derived from morphological and immunophenotypic analyses.
- To discuss the role of gene expression profiling in understanding the GC/FL microenvironment.
- To highlight challenges in enumerating microenvironmental cells for clinical prognostication.
Main Methods:
- Morphological analysis of neoplastic follicles.
- Immunophenotypic characterization of cellular components.
- Gene expression profiling of GC/FL tissues.
Main Results:
- GC B cells and FL cells share numerous features with normal GC B cells.
- The microenvironment contains non-neoplastic cells that interact with FL B cells.
- Microscopic and gene expression studies have advanced understanding of the microenvironment.
Conclusions:
- The microenvironment plays a vital role in follicular lymphoma survival.
- Morphological and immunophenotypic analyses provide key insights into the GC/FL microenvironment.
- Clinical prognostication based on microenvironment cell enumeration faces significant challenges.
Abstract:
Follicular lymphomas (FLs) are neoplasms of germinal center (GC) B cells, which retain many of the morphologic, immunophenotypic, genetic, and functional features of normal GC B cells. Both normal GCs and neoplastic follicles of FL also contain non-neoplastic cells (microenvironment) that influence and are influenced by the GC and FL B cells and are likely important for tumor cell survival. Many insights into the nature of the GC/FL microenvironment have come from morphologic and immunophenotypic analysis, both before and after the discoveries from gene expression profiling. This chapter reviews what we have learned from the microscope and highlights the pitfalls involved in trying to enumerate cells in the microenvironment for clinical prognostication.
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