{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T18:10:06Z","timestamp":1767204606489,"version":"build-2238731810"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>\n                    Chronic lymphocytic leukemia (CLL) is a subtype of mature B-cell proliferative neoplasms characterized by abnormally increasing lymphocytes in circulation. The diagnosis of CLL is usually established on peripheral blood analysis and typical flow cytometric immunophenotype rather than biopsy. In particular, the high RMH (Royal Marsden Hospital Scoring System for CLL) score of immunophenotype has a highly sensitive weight for diagnostic value. However, immunophenotyping by flow cytometry may also be misleading in specific clinical situations. Here, we report a case on admission with lymphadenopathy and lymphocytosis, misdiagnosed as chronic lymphocytic leukemia by flow cytometry initially but finally confirmed as follicular lymphoma (FL) in the leukemic phase\n                    <jats:italic>via<\/jats:italic>\n                    lymph node biopsy. Since FL in the leukemic phase is uncommon at the time of diagnosis and indicates a poorer prognosis of FL, such misdiagnosis is worthy of attention. It is also thought-provoking that there had been conflicts between immunophenotype of bone marrow and immunohistochemistry of lymph node. Our case report aims to remind clinicians\u2019 awareness that the immunophenotyping by flow cytometric analysis needs to be interpreted with caution especially when the results cannot account for all of clinical features, and it is significant to make the right decision about when to conduct further examination including lymph node biopsy for avoiding misdiagnosis.\n                  <\/jats:p>","DOI":"10.3389\/fonc.2023.1170598","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T01:32:56Z","timestamp":1679880776000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Interpreting flow cytometry with caution: A case report of follicular lymphoma in leukemic phase misdiagnosed as chronic lymphocytic leukemia"],"prefix":"10.3389","volume":"13","author":[{"given":"Yuan","family":"Ren","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Congwei","family":"Jia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.annonc.2020.09.019","article-title":"Chronic lymphocytic leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"32","author":"Eichhorst","year":"2021","journal-title":"Ann Oncol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"185","DOI":"10.6004\/jnccn.2020.0006","article-title":"Chronic lymphocytic Leukemia\/Small lymphocytic lymphoma, version 4.2020, NCCN clinical practice guidelines in oncology","volume":"18","author":"Wierda","year":"2020","journal-title":"J Natl Compr Canc Netw"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30422-7","article-title":"Chronic lymphocytic leukaemia","volume":"391","author":"Hallek","year":"2018","journal-title":"Lancet"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/108.4.378","article-title":"Improvement of the chronic lymphocytic leukemia scoring system with the monoclonal antibody SN8 (CD79b)","volume":"108","author":"Moreau","year":"1997","journal-title":"Am J Clin Pathol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25696","article-title":"Follicular lymphoma: 2020 update on diagnosis and management","volume":"95","author":"Freedman","year":"2020","journal-title":"Am J Hematol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1997.15.3.1110","article-title":"Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: a randomized study from the groupe d'Etude des lymphomes folliculaires. groupe d'Etude des lymphomes de l'Adulte","volume":"15","author":"Brice","year":"1997","journal-title":"J Clin Oncol"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.21967","article-title":"Role of fluorine-18 fluoro-deoxyglucose positron emission tomography scan in the evaluation and follow-up of patients with low-grade lymphomas","volume":"107","author":"Karam","year":"2006","journal-title":"Cancer"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2014.963578","article-title":"Clinicopathological characteristics of follicular lymphoma with peripheral blood involvement","volume":"56","author":"Maeshima","year":"2015","journal-title":"Leuk Lymphoma"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V91.12.4708","article-title":"Follicular lymphomas contain a clonally linked but phenotypically distinct neoplastic b-cell population in the interfollicular zone","volume":"91","author":"Dogan","year":"1998","journal-title":"Blood"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.12675","article-title":"Peripheral blood involvement in patients with follicular lymphoma: a rare disease manifestation associated with poor prognosis","volume":"164","author":"Sarkozy","year":"2014","journal-title":"Br J Haematol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V120.21.1594.1594","article-title":"Detection of leukemic phase in patients with follicular lymphoma At diagnosis: A rare event associated with poor prognosis","volume":"120","author":"Sarkozy","year":"2012","journal-title":"Blood"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.leukres.2013.05.016","article-title":"Follicular lymphoma with leukemic phase at diagnosis: a series of seven cases and review of the literature","volume":"37","author":"Beltran","year":"2013","journal-title":"Leuk Res"}],"updated-by":[{"DOI":"10.3389\/fonc.2023.1229649","type":"corrigendum","label":"Corrigendum","source":"publisher","updated":{"date-parts":[[2023,6,6]],"date-time":"2023-06-06T00:00:00Z","timestamp":1686009600000}}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1170598\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,5]],"date-time":"2023-06-05T11:00:48Z","timestamp":1685962848000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2023.1170598\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,27]]},"references-count":12,"alternative-id":["10.3389\/fonc.2023.1170598"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2023.1170598","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,27]]},"article-number":"1170598"}}