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Mantle Cell Lymphoma , Mantle Zone Pattern
Lessons From The Friday Unknowns
Histologic sections show fragments of an enlarged lymph node effaced by malignant lymphoma with a predominantly nodular pattern. The neoplastic cells mostly expand the mantle zones of the lymphoid follicles (mantle zone pattern).
The lymphoma is composed of monomorphic small lymphoid cells with mature clumped chromatin, inconspicuous nucleoli and scant cytoplasm admixed with scant pink histiocytes.
The neoplastic cells are positive for PAX 5, CD79a, CD5, cyclin D1 and SOX-11 (dim, subset) and negative for CD3 and CD43. CD3 highlight T cells in the background. The proliferation index measured by Ki-67 is approximately <20% of neoplastic cells, while the residual germinal centers show higher proliferation rate (up to 60%).
Flow cytometric analysis performed on the cell suspension of the lymph node shows an aberrant population of B-cells (~75% of the lymphoid population) that are positive for CD5, CD19, CD20, CD22, CD38, FMC 7, and lambda surface immunoglobulin light chain, consistent with a CD5 positive B cells lymphoma.
Cytogenetic analyses of the lymph node show a normal male karyotype. FISH study was positive for CCND1–IGH gene rearrangement t(11; 14), in 49% of interphases analyzed.
Overall these findings are those of Mantle cell lymphoma, classic type with a mantle zone growth pattern.
Link to digital slides: bit.ly/34bm9GQ | Case 1
Further read: https://pubmed.ncbi.nlm.nih.gov/9193367/
