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Mantle Cell Lymphoma, Blastoid Variant

View larger version (173K): [in this window] [in a new window]   Figure 1. A 64-year-old male who was seen three years previously for an evaluation of lymphadenopathy. A diagnosis of mantle cell lymphoma was made. He did well until approximately one month ago when he was noted to have increasing adenopathy and hepatosplenomegaly. His WBC is now 26.4k/uL with 70% lymphocytes. An axillary node biopsy shows complete effacement of the normal nodal architecture. The tissue has a mottled appearance with pale areas scattered throughout.

View larger version (180K): [in this window] [in a new window]   Figure 2. At higher magnification, there appears to be a monomorphic lymphoid infiltrate interspersed by large pale-appearing cells that coalesce in areas suggesting a granulomatous infiltrate.

View larger version (160K): [in this window] [in a new window]   Figure 3. The pale appearing areas noted at low magnification can now be seen to be due to the presence of abundant epitheliod histiocytes giving the biopsy a "starry sky" appearance. In addition, blood vessels are also prominent. A few scattered small lymphocytes are noted, but the predominant cells type is represented by a pleomorphic lymphoid population. The cells are heterogeneous with large cleaved to oval nuclei and pale cytoplasm. Nucleoli are prominent and multiple in some of these cells. Increased mitotic activity is also evident.

View larger version (159K): [in this window] [in a new window]   Figure 4. This image further illustrates the pleomorphic nature of the infiltrate. Using the nucleus of macrophage as an internal marker, it is evident that the majority of these cells are small to intermediate in size. On immunophenotypic analysis the cells were CD19, CD20, CD5+, CD23, and CD10– and exhibited light chain restriction consistent with the diagnosis of mantle cell lymphoma, pleomorphic blastoid variant.

View larger version (181K): [in this window] [in a new window]   Figure 5. On immunohistochemical staining the cells are CD20+. The pale areas noted on the image are due to the marked increase in epitheliod histiocytes noted on the H and E image previously shown.

View larger version (164K): [in this window] [in a new window]   Figure 6. The nuclei of the lymphoid cells stain strongly positive for cyclin D1 (Bcl 1), consistent with the diagnosis of mantle cell lymphoma.

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This Article Figures Only Services Similar articles in this journal Alert me to new content in the Image Bank Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lazarchick, J. Search for Related Content PubMed Articles by Lazarchick, J. Related Collections B-Cell Neoplasms Related ASH-SAP Chapter Related Image Bank Image Sets Related ASH Education Book Article Social Bookmarking                   What's this?