Asian Journal of Case Reports in Surgery

Aims: This study aims to present a case of follicular lymphoma with an unusual extranodal presentation in the lower limb and discuss the diagnostic and therapeutic implications.

Presentation of Case: A 55-year-old woman presented with a painless, slowly growing mass in the right thigh. MRI showed a 63mm mass with well-defined boundaries. Excisional biopsy and histopathology confirmed grade 1 follicular lymphoma, but reviewed histopathology favor the diagnosis of follicular lymphoma, grade 3A, with areas of progression to diffuse large B-cell lymphoma. Bone marrow biopsy and PET scan were normal. The patient underwent six cycles of RCHOP chemotherapy. No significant abnormalities were detected post-treatment.

Discussion: Follicular lymphoma typically presents with nodal involvement, and extranodal presentation is uncommon. The MRI findings and excisional biopsy were crucial for diagnosis. The absence of B symptoms and normal bone marrow biopsy indicated a localized disease. The RCHOP regimen is standard for treating follicular lymphoma, and the patient responded well to this treatment. This case underscores the importance of considering follicular lymphoma in the differential diagnosis of extranodal masses and the role of comprehensive diagnostic workup in guiding treatment.

Conclusion: Extranodal follicular lymphoma is a rare clinical presentation. This case emphasizes the necessity of considering follicular lymphoma in the differential diagnosis of extranodal masses and highlights the importance of histological diagnosis for guiding treatment.