{"paper_id":"032e3baa-bc87-40df-abd2-9c193861a66e","body_text":"Diagnostic challenges in a t(14;18)-negative and t(3;14)-negative follicular lymphoma with transformation to diffuse large B-cell lymphoma, along with negative BCR-IG clonal rearrangement, a pathological perspective | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Diagnostic challenges in a t(14;18)-negative and t(3;14)-negative follicular lymphoma with transformation to diffuse large B-cell lymphoma, along with negative BCR-IG clonal rearrangement, a pathological perspective Baoqin bai, Haijing zhang, Chunhui peng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8972484/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Follicular Lymphoma (FL) is an indolent B-cell non-Hodgkin's lymphoma that originates in the germinal centers(GC) of lymphoid follicles. The tumor cells are primarily made up of follicular centrocytic (CC) and centroblast cells(CB), and presented witn at least a focal follicular pattern identifiable by morphology. In approximately 85% to 90% of cases, BCL2 rearrangement involving t(14;18)(q32;q21) can be identified. However, the transformation of follicular lymphoma (FL) into diffuse large B-cell lymphoma(DLBCL)-particularly negative for t(14;18), t(3;14), and lacking a clonal BCR-IG rearrangement—was considered rare but noteworthy. Case Presentation A 50-year-old female patient who underwent resection of the thyroid and surrounding lymph nodes due to clinical suspicion of thyroid cancer with regional lymph node involvement. Postoperative pathological examination revealed DLBCL in the thyroid, arising from transformation of high-grade FL, while the lymph nodes also showed evidence of high-grade FL(BCL2 negative). Immunohistochemical analysis demonstrated that both the thyroid and lymph node lesions were negative for germinal center(GC) markers CD10 and BCL6, as well as for BCL2. FISH testing did not identify any break-apart rearrangements in the BCL2 or BCL6 genes, and PCR analysis failed to detect clonal BCR-IG rearrangement. Conclusions Here, We presented a rare case of nodal FL with BCL2-negative expression, accompanied by transformation into DLBL involving the thyroid. While the histomorphology of this case appeared relatively classic, its immunophenotypic and molecular profile presented unique features, making it a particularly interesting example of FL transforming into DLBL. FL t(14 18)-negative t(3 14)-negative DLBCL Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Follicular Lymphoma (FL) is an indolent B-cell non-Hodgkin's lymphoma that originates in the germinal centers(GC) of lymphoid follicles. The tumor cells are primarily made up of follicular centrocytic (CC) and centroblast cells(CB), and presented witn at least a focal follicular pattern identifiable by morphology[ 1 ]. FLs are typically associated with characteristic immunological markers such as CD20, BCL6, and CD10. In approximately 85% to 90% of cases, BCL2 rearrangement involving t(14;18)(q32;q21) can be identified. However, 10–15% of FLs lack the characteristic BCL2 rearrangement, revealing alternative oncogenic pathways. BCL6 rearrangements involving t(3;14)(q27;q32) can be found in any type of FL. Their frequency is 15–20% in FL with BCL2 rearrangement (BCL2-R) and is higher(~ 35%) in FLs lacking BCL2 rearrangement. In follicular large B-cell lymphoma(FLBCL), BCL6 rearrangements can be found in about 40% of cases, reflecting their closer biological relationship to DLBCL[ 2 ]. Histological transformation(HT) of FL to more aggressive forms of lymphoma is approximately 2%-3% per year. DLBCL is the most common HT from FL, representing 93%[ 3 ] of cases, indicating a more challenging prognosis. HT is often associated with a rapid increase in serum LDH, unexpected progression of localized lymphadenopathy, new development of extranodal disease, new development of B symptoms, hypercalcaemia, and high uptake values on FDG PET Imaging. Here, we presented a case of DLBCL transformation in a t(14;18)-negative and t(3;14)-negative FL, along with negative BCR-IG gene clonal rearrangement, aiming to help physicians better understand these rare diseases, thereby providing patients with personalized treatment. Clinical history A 50-year-old female presented with a neck mass detected five months ago, accompanied by recent episodes of occasional water aspiration and dysphagia. Color Doppler ultrasonography revealed diffuse parenchymal alterations in the thyroid gland, suggestive of Hashimoto's thyroiditis. Multiple nodules were identified in the left lobe, the largest measuring 6.4 x 4.9 x 3.7 cm, with solid composition, low echo, well-circumscribed margins, absence of an echogenic halo, morphological features consistent with C-TIRADS-4B. Additionally, multiple enlarged cervical lymph nodes were observed. The clinical impression was thyroid carcinoma with cervical lymph node metastasis. Subsequently, the patient underwent left hemithyroidectomy with isthmusectomy and neck central lymph node dissection. Meterials and Methods Gross examination:The thyroid specimen exhibited multiple nodular lesions. The largest nodule measured 6.5 x 5.2 x 4 cm, with a grayish-white to grayish-yellow section, solid, and relatively soft texture(Fig. 1 ). Multiple nodules are present in the perithyroidal region. Microscopic examination revealed a diffuse proliferation of lymphoid cells within the thyroid parenchyma. The cells were relatively large, exhibiting vacuolated nuclei and one or more prominent nucleoli, which were consistent with the centroblast-like cells(CB-like)(Fig. 2 a). However, in contrast to the thyroid, lymphoid cells within the lymph nodes displayed nodular proliferation, with morphological features consistent with centroblastic-like cells (CB-like) and centrocytic cells(CC-like)(Fig. 2 b). Immunohistochemical analysis demonstrated that tumor cells in both the thyroid and lymph nodes expressed B-cell markers. Germinal center(GC) markers CD10 and BCL6 were negative, whereas LMO2 was positive and BCL2 was negative in both the thyroid(Fig. 2 c) and lymph nodes(Fig. 2 d). No follicular dendritic cell (FDC) network was identified in the thyroid tissue by CD23 and CD21 immunostaining. On the contrary, an FDC network was present in the lymph nodes. The Ki-67 proliferation index was higher in the thyroid (approximately 70%) than in the lymph nodes (approximately 40%),the latter being lower than that typically observed in normal GCs, indicating that the lesion is consistent with neoplastic follicular proliferation rather than reactive follicular hyperplasia. Fluorescence in situ hybridization(FISH) analysis revealed no evidence of BCL2 or BCL6 gene rearrangements in either the thyroid(Fig. 3 a) or lymph node tissues(Fig. 3 b). Moreover, PCR analysis did not detect clonal rearrangement of B-cell receptor(BCR-IG) genes in the both the thyroid and lymph node tissues(Fig. 4 ) . Results Pathological diagnosis: High-grade follicular lymphoma with negative BCL2 expression in the lymph nodes, and diffuse large B-cell lymphoma of the thyroid arising from transformation of follicular lymphoma. Follow-up : The patient underwent 8 cycles chemotherapy (R-CHOP). After 13 months of follow-up, she was currently in clinical complete remission. Discussion Follicular lymphoma (FL) is the most common type of indolent B cell lymphoma, which is composed of centrocytes and centroblasts cells in varying proportions derived from GC-B cells, at least partially exhibiting a follicular growth pattern. FL expresses B-cell antigens (CD19,CD20,CD22,CD79a,PAX5). They also express the GC-associated markers (CD10, BCL6, GCET1, HGAL, LMO2, MEF2B and Stathmin), with variable sensitivity and specificity of each of the markers. Expression of CD10 and BCL6 may vary between neoplastic follicles and is usually stronger in the neoplastic follicles than in intertollicular FL cells. It may be absent in FL cells located in areas of marginal zone differentiation, peripheral blood, or bone marrow[ 4 ]. In our case, expression of the common GC markers CD10 and BCL6 was not detected in either the thyroid or lymph nodes, However, A weak expression of LMO2, a less commonly observed GC marker, was presented, suggesting us to consider other GC-associated markers in the rare CD10/BCL6-negative cases. In our case, the pathological diagnosis of thyroid was DLBCL, CD10 and BCL6 expressions are both negative, indicating a non-GC origin according to the Hans model, which seemed to be inconsistent with the typical characteristic of FL, a GC origin. However, in rare cases of t(14;18)-negative FL, an overexpression of non-GC signatures had been observed, suggesting a possible activated B-cell (ABC) and post-GC origin[5], which may explain why the negtive expression of CD10/BCL6 in both thyroid and lymph nodes. In most cases, the neoplastic follicles express BCL2, excluding follicular reactive hyperplasia. The frequency of BCL2-negative cases is low in FL(10 ~ 15%)[ 6 ]. The lack of BCL2 expression may be due to mutations in BCL2 that affect the BCL2 epitope recognized by the antibody used. If BCL2 is negative, it is recommended to use additional anti-BCL2 antibodies directed against different epitopes. Rare FL cases remain negative to multiple antibodies used, which usually corresponds to a lack of BCL2 rearrangement. IRF4(MUM1) is mostly negative in FL, except in occasional cases, which may be centroblast-rich and also lack CD10 and BCL2 expression[ 7 ]. In our case, neither BCL2 protein expression was detected, nor the t(14;18) translocation was identified. However, we detected the positive expression of MUM1-a marker associated with ABC, suggesting that t(14;18)-negative FL cells may be at a late stage of GCB-cell differentiation. A subset of t(14;18)-negative FLs showed a rearrangement whih chromosomal band 3q27, which results in the deregulation of BCL6 expression. BCL6 rearrangement had been reported in grade 3B FLs (44%)[ 8 ], which are more closely biologically related to DLBCL than to other FLs. Nevertheless, the frequency of t(3;14)(q27;q32) is also high (22%)[ 8 ] in t(14;18)-negative FL Grades 1and 2, suggesting an important role for BCL6 in a subgroup of t(14;18)-negative FL. Heike Horn's[ 8 ] research indicated that rearrangement involving both the BCL2 and BCL6 genes are rare in grade 3B FL, which was 9% and 17% respectively. FLs lacking BCL2 and BCL6 rearrangements showed evidence of somatic hypermutation, suggesting a distinct oncogenic pathways. In our case, we did not detect any rearrangement of the BCL2 or BCL6 genes in both the thyroid and lymph nodes. The pathology showed a transformation from high-grade FL to DLBCL, indicating a poor prognosis. In FL, the immunoglobulin heavy chain (IGH) and light chain (IGK, IGL) genes undergo monoclonal rearrangement-a key feature that helps to distinguish FL from reactive follicular hyperplasia. By using multiplex PCR with BIOMED-2 primer sets, clonal rearrangements can be successfully detected in over 90% of FL cases when both IGH and IGK targets are included, offering a reliable and sensitive diagnostic approach[ 9 ]. However, in our case, no clonal rearrangement of B cell receptors(IGH,IGK, IGL) was detected in either the thyroid tissue or the lymph node tissue. In conclusion, we presented a rare case of FL featuring DLBCL transformation, along with the absence of t(14;18), t(3;14), and BCR-IG clonal rearrangements. This distinct profile may point to an alternative pathogenic mechanism. We suggested clinicians to closely pay attention to the clinical characteristics and outcomes of such uncommon FL variants, and to develop personalized treatment strategie. Declarations Conflict of Interest The authors declare that they have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Tnformed consent to participate in the study had be obtained from the pationt Consent for publication For this type of study consent for publication is not required. Funding This study was not supported by any funding Author Contribution Baoqin Bai wrote the main manuscript text. Haijing Zhang provided professional pathological technical support for this research.Chunhui Peng revised this manuscript and provided valuable suggestions. All authors reviewed the manuscript. Acknowledgement The authors thank Dr. Chunhui peng, who revised this manuscript and provided valuable suggestions. References WHO Classification of Tumours Editorial Board. Haematolymphoid tumours.Lyon(France):International Agency for Research on Cancer; 2024.(WHO classification of tumours series, 5th ed; vol. 11). Nann D, Ramis-Zaldivar JE, Müller I, et al. Follicular lymphoma t(14;18)-negative is genetically a heterogeneous disease. Blood Adv. 2020;4(22):5652–65. 10.1182/bloodadvances.2020002944 . Maeshima AM. Histologic transformation of follicular lymphoma: pathologists' viewpoint. J Clin Exp Hematop. 2023;63(1):12–8. 10.3960/jslrt.22046 . Laurent C, Cook JR, Diagnosis, Classification of Follicular Lymphoma and Related Entities. Adv Anat Pathol, Kukita Y, Kitamura Y. M Bcl-2-negative IGH-BCL2 translocation-negative follicular lymphoma of the thyroid differs genetically and epigenetically from Bcl-2-positive IGH-BCL2 translocation-positive follicular lymphoma. Histopathology. 2021;79(4):521–532. 10.1111/his.14378 Kurz KS, Kalmbach S, Ott M, Staiger AM, et al. Follicular Lymphoma in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Biological Data. Cancers (Basel). 2023;15(3):785. 10.3390/cancers15030785 . Maeshima AM, Taniguchi H, Furukawa H, et al. Diagnostic clues of BCL2-negative, faint, or controversial follicular lymphomas: a study of 103 cases. Hum Pathol. 2023;135:84–92. 10.1016/j.humpath.2023.01.006 . Horn H, Schmelter C, Leich E, et al. Follicular lymphoma grade 3B is a distinct neoplasm according to cytogenetic and immunohistochemical profiles. Haematologica. 2011;96(9):1327–34. 10.3324/haematol.2011.042531 . Boone E, Groenen PJTA, Langerak AW. PCR GeneScan Analysis of Rearranged Immunoglobulin or T-Cell Receptor Genes for Clonality Diagnostics in Suspect Lymphoproliferations. Methods Mol Biol. 2025;2865:77–102. 10.1007/978-1-0716-4188-0_4 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8972484\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":615248644,\"identity\":\"474a4ca5-3155-48e6-bc4a-355fd673ba9d\",\"order_by\":0,\"name\":\"Baoqin bai\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Third People's Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Baoqin\",\"middleName\":\"\",\"lastName\":\"bai\",\"suffix\":\"\"},{\"id\":615248645,\"identity\":\"81456199-c496-4aa6-8e40-5f97a04d0844\",\"order_by\":1,\"name\":\"Haijing zhang\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Third People's Hospital\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Haijing\",\"middleName\":\"\",\"lastName\":\"zhang\",\"suffix\":\"\"},{\"id\":615248646,\"identity\":\"7978d918-1216-47b4-ab6e-fa8fd9b5ea15\",\"order_by\":2,\"name\":\"Chunhui peng\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYDACCQYGZjAJBAcSDGx4+PkbiNfC+OBDRZqM5IwDRGkBA2bDGWcO2xg0JODXwT+7x+xxYZtFHr90+zVp3rbzPAYMBxg/fMzBY8mdM+bGM9skiiXnnCkDarnNY87cwCw5cxtuLQYSOWZAlRKJG27kpIG1WDYcYGPmJUbLfoiWczwGBxKI1LJBIv0w0PsHCGuRuJFWJs1zTqJY4kYOKJCTeSRnHGzG6xf+GcnbpHnK6vL4Z6Q/AEalnT0/f/PBDx/xaIGBBAYGYPBCAGMDYfUQLewPiFI5CkbBKBgFIw8AALWIT1tRCopbAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Third People's Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Chunhui\",\"middleName\":\"\",\"lastName\":\"peng\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-02-26 02:39:09\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8972484/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8972484/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":106068601,\"identity\":\"b2f677c1-61be-4b96-9a25-bb7c3d7bbeb2\",\"added_by\":\"auto\",\"created_at\":\"2026-04-03 06:11:03\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":46915,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe thyroid gland exhibited a multinodular appearance on cross-sectional examination.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8972484/v1/4a821692b983a2430e1b38d4.jpg\"},{\"id\":106068585,\"identity\":\"a093613d-9af7-4d6c-a549-89af7995a3d1\",\"added_by\":\"auto\",\"created_at\":\"2026-04-03 06:10:57\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":1152300,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ea The thyroid gland demonstrated diffuse hyperplasia, with cellular morphology predominantly consistent with centroblast-like cells(CB-like).b The lymph nodes demonstrated nodular hyperplasia, with cellular morphology predominantly consistent withcentroblast-like cells(CB-like) and centrocytic cells(CC-like). BCL2 was negative in both thyroid tissue(c) and lymph nodes(d).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8972484/v1/d04d18692896da9c9058e3f8.png\"},{\"id\":106068581,\"identity\":\"a91c9fe1-f1a2-4da9-87fc-0a9be825d4ab\",\"added_by\":\"auto\",\"created_at\":\"2026-04-03 06:10:57\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":434525,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFISH showed that no breakage or rearrangement of the BCL2 was detected in either thyroid tissue(a) or lymph nodes(b).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8972484/v1/9d98ec2cccb1562b14a889f8.png\"},{\"id\":106068584,\"identity\":\"eb1818a2-b3f5-4d23-b8c5-7e240326a102\",\"added_by\":\"auto\",\"created_at\":\"2026-04-03 06:10:57\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":122645,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePolymerase chain reaction(PCR) analysis did not detect clonal rearrangement of B-cell receptor(BCR-IG) genes in both the thyroid and lymph node tissues.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8972484/v1/8be55c07ef7b76670b12cfba.png\"},{\"id\":107054155,\"identity\":\"7fbdf713-425a-4ef0-bded-78b83ddcd7d0\",\"added_by\":\"auto\",\"created_at\":\"2026-04-16 08:58:36\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2266986,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8972484/v1/1a123e91-1616-4137-afe4-ede4c3c6726e.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Diagnostic challenges in a t(14;18)-negative and t(3;14)-negative follicular lymphoma with transformation to diffuse large B-cell lymphoma, along with negative BCR-IG clonal rearrangement, a pathological perspective\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eFollicular Lymphoma (FL) is an indolent B-cell non-Hodgkin's lymphoma that originates in the germinal centers(GC) of lymphoid follicles. The tumor cells are primarily made up of follicular centrocytic (CC) and centroblast cells(CB), and presented witn at least a focal follicular pattern identifiable by morphology[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. FLs are typically associated with characteristic immunological markers such as CD20, BCL6, and CD10. In approximately 85% to 90% of cases, BCL2 rearrangement involving t(14;18)(q32;q21) can be identified. However, 10\\u0026ndash;15% of FLs lack the characteristic BCL2 rearrangement, revealing alternative oncogenic pathways. BCL6 rearrangements involving t(3;14)(q27;q32) can be found in any type of FL. Their frequency is 15\\u0026ndash;20% in FL with BCL2 rearrangement (BCL2-R) and is higher(~\\u0026thinsp;35%) in FLs lacking BCL2 rearrangement. In follicular large B-cell lymphoma(FLBCL), BCL6 rearrangements can be found in about 40% of cases, reflecting their closer biological relationship to DLBCL[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eHistological transformation(HT) of FL to more aggressive forms of lymphoma is approximately 2%-3% per year. DLBCL is the most common HT from FL, representing 93%[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e] of cases, indicating a more challenging prognosis. HT is often associated with a rapid increase in serum LDH, unexpected progression of localized lymphadenopathy, new development of extranodal disease, new development of B symptoms, hypercalcaemia, and high uptake values on FDG PET Imaging.\\u003c/p\\u003e \\u003cp\\u003eHere, we presented a case of DLBCL transformation in a t(14;18)-negative and t(3;14)-negative FL, along with negative BCR-IG gene clonal rearrangement, aiming to help physicians better understand these rare diseases, thereby providing patients with personalized treatment.\\u003c/p\\u003e\\n\\u003ch3\\u003eClinical history\\u003c/h3\\u003e\\n\\u003cp\\u003eA 50-year-old female presented with a neck mass detected five months ago, accompanied by recent episodes of occasional water aspiration and dysphagia. Color Doppler ultrasonography revealed diffuse parenchymal alterations in the thyroid gland, suggestive of Hashimoto's thyroiditis. Multiple nodules were identified in the left lobe, the largest measuring 6.4 x 4.9 x 3.7 cm, with solid composition, low echo, well-circumscribed margins, absence of an echogenic halo, morphological features consistent with C-TIRADS-4B. Additionally, multiple enlarged cervical lymph nodes were observed. The clinical impression was thyroid carcinoma with cervical lymph node metastasis. Subsequently, the patient underwent left hemithyroidectomy with isthmusectomy and neck central lymph node dissection.\\u003c/p\\u003e\"},{\"header\":\"Meterials and Methods\",\"content\":\"\\u003cp\\u003eGross examination:The thyroid specimen exhibited multiple nodular lesions. The largest nodule measured 6.5 x 5.2 x 4 cm, with a grayish-white to grayish-yellow section, solid, and relatively soft texture(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). Multiple nodules are present in the perithyroidal region.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eMicroscopic examination revealed a diffuse proliferation of lymphoid cells within the thyroid parenchyma. The cells were relatively large, exhibiting vacuolated nuclei and one or more prominent nucleoli, which were consistent with the centroblast-like cells(CB-like)(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003ea). However, in contrast to the thyroid, lymphoid cells within the lymph nodes displayed nodular proliferation, with morphological features consistent with centroblastic-like cells (CB-like) and centrocytic cells(CC-like)(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003eb).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003eImmunohistochemical analysis demonstrated that tumor cells in both the thyroid and lymph nodes expressed B-cell markers. Germinal center(GC) markers CD10 and BCL6 were negative, whereas LMO2 was positive and BCL2 was negative in both the thyroid(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003ec) and lymph nodes(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003ed). No follicular dendritic cell (FDC) network was identified in the thyroid tissue by CD23 and CD21 immunostaining. On the contrary, an FDC network was present in the lymph nodes. The Ki-67 proliferation index was higher in the thyroid (approximately 70%) than in the lymph nodes (approximately 40%),the latter being lower than that typically observed in normal GCs, indicating that the lesion is consistent with neoplastic follicular proliferation rather than reactive follicular hyperplasia.\\u003c/p\\u003e \\u003cp\\u003eFluorescence in situ hybridization(FISH) analysis revealed no evidence of BCL2 or BCL6 gene rearrangements in either the thyroid(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003ea) or lymph node tissues(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003eb). Moreover, PCR analysis did not detect clonal rearrangement of B-cell receptor(BCR-IG) genes in the both the thyroid and lymph node tissues(Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e) .\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003ePathological diagnosis: High-grade follicular lymphoma with negative BCL2 expression in the lymph nodes, and diffuse large B-cell lymphoma of the thyroid arising from transformation of follicular lymphoma. Follow-up : The patient underwent 8 cycles chemotherapy (R-CHOP). After 13 months of follow-up, she was currently in clinical complete remission.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eFollicular lymphoma (FL) is the most common type of indolent B cell lymphoma, which is composed of centrocytes and centroblasts cells in varying proportions derived from GC-B cells, at least partially exhibiting a follicular growth pattern. FL expresses B-cell antigens (CD19,CD20,CD22,CD79a,PAX5). They also express the GC-associated markers (CD10, BCL6, GCET1, HGAL, LMO2, MEF2B and Stathmin), with variable sensitivity and specificity of each of the markers. Expression of CD10 and BCL6 may vary between neoplastic follicles and is usually stronger in the neoplastic follicles than in intertollicular FL cells. It may be absent in FL cells located in areas of marginal zone differentiation, peripheral blood, or bone marrow[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. In our case, expression of the common GC markers CD10 and BCL6 was not detected in either the thyroid or lymph nodes, However, A weak expression of LMO2, a less commonly observed GC marker, was presented, suggesting us to consider other GC-associated markers in the rare CD10/BCL6-negative cases. In our case, the pathological diagnosis of thyroid was DLBCL, CD10 and BCL6 expressions are both negative, indicating a non-GC origin according to the Hans model, which seemed to be inconsistent with the typical characteristic of FL, a GC origin. However, in rare cases of t(14;18)-negative FL, an overexpression of non-GC signatures had been observed, suggesting a possible activated B-cell (ABC) and post-GC origin[5], which may explain why the negtive expression of CD10/BCL6 in both thyroid and lymph nodes.\\u003c/p\\u003e \\u003cp\\u003eIn most cases, the neoplastic follicles express BCL2, excluding follicular reactive hyperplasia. The frequency of BCL2-negative cases is low in FL(10\\u0026thinsp;~\\u0026thinsp;15%)[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. The lack of BCL2 expression may be due to mutations in BCL2 that affect the BCL2 epitope recognized by the antibody used. If BCL2 is negative, it is recommended to use additional anti-BCL2 antibodies directed against different epitopes. Rare FL cases remain negative to multiple antibodies used, which usually corresponds to a lack of BCL2 rearrangement. IRF4(MUM1) is mostly negative in FL, except in occasional cases, which may be centroblast-rich and also lack CD10 and BCL2 expression[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. In our case, neither BCL2 protein expression was detected, nor the t(14;18) translocation was identified. However, we detected the positive expression of MUM1-a marker associated with ABC, suggesting that t(14;18)-negative FL cells may be at a late stage of GCB-cell differentiation.\\u003c/p\\u003e \\u003cp\\u003eA subset of t(14;18)-negative FLs showed a rearrangement whih chromosomal band 3q27, which results in the deregulation of BCL6 expression. BCL6 rearrangement had been reported in grade 3B FLs (44%)[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e], which are more closely biologically related to DLBCL than to other FLs. Nevertheless, the frequency of t(3;14)(q27;q32) is also high (22%)[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] in t(14;18)-negative FL Grades 1and 2, suggesting an important role for BCL6 in a subgroup of t(14;18)-negative FL. Heike Horn's[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e] research indicated that rearrangement involving both the BCL2 and BCL6 genes are rare in grade 3B FL, which was 9% and 17% respectively. FLs lacking BCL2 and BCL6 rearrangements showed evidence of somatic hypermutation, suggesting a distinct oncogenic pathways. In our case, we did not detect any rearrangement of the BCL2 or BCL6 genes in both the thyroid and lymph nodes. The pathology showed a transformation from high-grade FL to DLBCL, indicating a poor prognosis.\\u003c/p\\u003e \\u003cp\\u003eIn FL, the immunoglobulin heavy chain (IGH) and light chain (IGK, IGL) genes undergo monoclonal rearrangement-a key feature that helps to distinguish FL from reactive follicular hyperplasia. By using multiplex PCR with BIOMED-2 primer sets, clonal rearrangements can be successfully detected in over 90% of FL cases when both IGH and IGK targets are included, offering a reliable and sensitive diagnostic approach[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. However, in our case, no clonal rearrangement of B cell receptors(IGH,IGK, IGL) was detected in either the thyroid tissue or the lymph node tissue.\\u003c/p\\u003e \\u003cp\\u003eIn conclusion, we presented a rare case of FL featuring DLBCL transformation, along with the absence of t(14;18), t(3;14), and BCR-IG clonal rearrangements. This distinct profile may point to an alternative pathogenic mechanism. We suggested clinicians to closely pay attention to the clinical characteristics and outcomes of such uncommon FL variants, and to develop personalized treatment strategie.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eConflict of Interest\\u003c/h2\\u003e \\u003cp\\u003eThe authors declare that they have no conflict of interest.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eEthical approval\\u003c/strong\\u003e \\u003cp\\u003eAll procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eInformed consent\\u003c/strong\\u003e \\u003cp\\u003eTnformed consent to participate in the study had be obtained from the pationt\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003eFor this type of study consent for publication is not required.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003eThis study was not supported by any funding\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eBaoqin Bai wrote the main manuscript text. Haijing Zhang provided professional pathological technical support for this research.Chunhui Peng revised this manuscript and provided valuable suggestions. All authors reviewed the manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgement\\u003c/h2\\u003e\\u003cp\\u003eThe authors thank Dr. Chunhui peng, who revised this manuscript and provided valuable suggestions.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWHO Classification of Tumours Editorial Board. Haematolymphoid tumours.Lyon(France):International Agency for Research on Cancer; 2024.(WHO classification of tumours series, 5th ed; vol. 11).\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNann D, Ramis-Zaldivar JE, M\\u0026uuml;ller I, et al. Follicular lymphoma t(14;18)-negative is genetically a heterogeneous disease. Blood Adv. 2020;4(22):5652\\u0026ndash;65. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1182/bloodadvances.2020002944\\u003c/span\\u003e\\u003cspan address=\\\"10.1182/bloodadvances.2020002944\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMaeshima AM. Histologic transformation of follicular lymphoma: pathologists' viewpoint. J Clin Exp Hematop. 2023;63(1):12\\u0026ndash;8. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3960/jslrt.22046\\u003c/span\\u003e\\u003cspan address=\\\"10.3960/jslrt.22046\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLaurent C, Cook JR, Diagnosis, Classification of Follicular Lymphoma and Related Entities. Adv Anat Pathol, Kukita Y, Kitamura Y. M Bcl-2-negative IGH-BCL2 translocation-negative follicular lymphoma of the thyroid differs genetically and epigenetically from Bcl-2-positive IGH-BCL2 translocation-positive follicular lymphoma. Histopathology. 2021;79(4):521\\u0026ndash;532. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/his.14378\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/his.14378\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKurz KS, Kalmbach S, Ott M, Staiger AM, et al. Follicular Lymphoma in the 5th Edition of the WHO-Classification of Haematolymphoid Neoplasms-Updated Classification and New Biological Data. Cancers (Basel). 2023;15(3):785. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/cancers15030785\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/cancers15030785\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMaeshima AM, Taniguchi H, Furukawa H, et al. Diagnostic clues of BCL2-negative, faint, or controversial follicular lymphomas: a study of 103 cases. Hum Pathol. 2023;135:84\\u0026ndash;92. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.humpath.2023.01.006\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.humpath.2023.01.006\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHorn H, Schmelter C, Leich E, et al. Follicular lymphoma grade 3B is a distinct neoplasm according to cytogenetic and immunohistochemical profiles. Haematologica. 2011;96(9):1327\\u0026ndash;34. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3324/haematol.2011.042531\\u003c/span\\u003e\\u003cspan address=\\\"10.3324/haematol.2011.042531\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBoone E, Groenen PJTA, Langerak AW. PCR GeneScan Analysis of Rearranged Immunoglobulin or T-Cell Receptor Genes for Clonality Diagnostics in Suspect Lymphoproliferations. Methods Mol Biol. 2025;2865:77\\u0026ndash;102. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/978-1-0716-4188-0_4\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/978-1-0716-4188-0_4\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"FL, t(14;18)-negative, t(3;14)-negative, DLBCL\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8972484/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8972484/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFollicular Lymphoma (FL) is an indolent B-cell non-Hodgkin's lymphoma that originates in the germinal centers(GC) of lymphoid follicles. The tumor cells are primarily made up of follicular centrocytic (CC) and centroblast cells(CB), and presented witn at least a focal follicular pattern identifiable by morphology. In approximately 85% to 90% of cases, BCL2 rearrangement involving t(14;18)(q32;q21) can be identified. However, the transformation of follicular lymphoma (FL) into diffuse large B-cell lymphoma(DLBCL)-particularly negative for t(14;18), t(3;14), and lacking a clonal BCR-IG rearrangement—was considered rare but noteworthy.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCase Presentation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eA 50-year-old female patient who underwent resection of the thyroid and surrounding lymph nodes due to clinical suspicion of thyroid cancer with regional lymph node involvement. Postoperative pathological examination revealed DLBCL in the thyroid, arising from transformation of high-grade FL, while the lymph nodes also showed evidence of high-grade FL(BCL2 negative). Immunohistochemical analysis demonstrated that both the thyroid and lymph node lesions were negative for germinal center(GC) markers CD10 and BCL6, as well as for BCL2. FISH testing did not identify any break-apart rearrangements in the BCL2 or BCL6 genes, and PCR analysis failed to detect clonal BCR-IG rearrangement.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHere, We presented a rare case of nodal FL with BCL2-negative expression, accompanied by transformation into DLBL involving the thyroid. While the histomorphology of this case appeared relatively classic, its immunophenotypic and molecular profile presented unique features, making it a particularly interesting example of FL transforming into DLBL.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Diagnostic challenges in a t(14;18)-negative and t(3;14)-negative follicular lymphoma with transformation to diffuse large B-cell lymphoma, along with negative BCR-IG clonal rearrangement, a pathological perspective\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-04-03 06:10:01\",\"doi\":\"10.21203/rs.3.rs-8972484/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"fb8348db-218b-4449-a1a2-054425b66008\",\"owner\":[],\"postedDate\":\"April 3rd, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-16T08:57:37+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-04-03 06:10:01\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8972484\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8972484\",\"identity\":\"rs-8972484\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}