Leg Edema Unveiled: The Uncommon Culprit of Follicular Lymphoma

Abstract

Follicular Lymphoma is a type of Non-Hodgkin's Lymphoma. It is defined as a lymphoma of germinal center B cells and a complex disease involving genetic and epigenetic mutations of Follicular B cell. Some of the commonly known alterations are cell in BCL-2 oncogene and somatically mutated genes. Follicular Lymphoma is the second most prevalent malignancy in the west accounting for about 10-20% of all lymphomas although an alarming rise has been seen in Pakistan as well. A lot of diagnostic challenges are being faced as this disease is indolent and presents atypical features. An effective treatment regime for follicular lymphoma fluctuates depending on the extent of disease and the medical history of the patient. Various methods are available for the risk assessment of the disease. Radiotherapy, rituximab monotherapy or combination therapy are the first line of treatment for restricted spread for follicular lymphoma. For aggressive stage of disease is managed with disease surveillance with imaging and rituximab is given in low grade tumors while chemotherapy and along with immunotherapy is the choice of treatment in high grade tumors. We report a patient here who presented with gross and progressing edema of the right lower limb that started in the foot and progressed proximally up to the thigh. Literature shows that unilateral lymphoedema could be an initial symptom of malignancy and is more common in woman than in males so must be sought as a potential diagnosis.