Introduction: The natural history of follicular lymphoma (FL) is frequently characterized by transformation to a more aggressive diffuse large B cell lymphoma (DLBC). Outcomes of patients with histologic transformation (HT) of follicular lymphoma (FL) have been believed to be poor. However, a leucocytosis at presentation is infrequently described. In this report, we present a case of simultaneous presentation of follicular lymphoma and DLBCL

Case Presentation: A 50-year-old male patient presented to a head and neck specialist with complaints of slowly progressing swelling in the nose on the left side for a duration of 1 year, diagnosed with nasopharynx carcinoma. After excicion surgery patient refered to internist for follow up the leukocytosis. Biopsy and immunohistochemistry from the nose and tonsil was suggestive of DLBCL, however bone marrow aspiration was suggestive of follicular lymphoma. After a complete work-up, he was diagnosed with DLBCL and was treated with 6 cycles of standard (CHOP) regimen. Past history of the patient revealed a leukocytosis since 4 years prior, when patient therapy catheterisation of cardiac.

Conclusion: These findings suggest a clonal relationship between the two types of lymphoma cells. Furthermore, they support the transformation of an acute follicular lymphoma into a composite lymphoma combining a high-grade B-cell lymphoma. Understanding the natural history of follicular lymphoma can aid diagnosis and implies a worse prognosis in patients compared to de novo DLBCL.

Keywords: Follicular lymphoma, DLBCL, histological transformation

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