| Summary: | Follicular lymphoma (FL) of B cell type is a common mature B cell neoplasm of germinal center origin that effaces the nodal architecture usually by back to back follicles. These are usually composed of an admixed population of small centrocytes with cleaved and angulated nuclei and centroblasts which are larger cells with dispersed chromatin and variably prominent peripheral nucleoli. While the proliferation index using Ki-67 (MIB1) is not used to grade follicular lymphomas, studies have shown that FL with a higher proliferation index may behave differently and more aggressively than FL with lower proliferation index. In addition, it has been repeatedly recognized that additional chromosomal aberrations affect the biologic and clinical behavior of FL. In this manuscript, we report four different cases of FL diagnosed from small core needle biopsies and discuss the challenges faced interpreting limited biopsies, significance of incorporating the proliferation fraction, and additional chromosomal or gene aberrations from concurrent cytogenetic studies.
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