Since the letter I posted has elicited many kind and knowledgeable reponses as well as something of a small tempest, I want to clarify why I posted the letter in the first place. I did not intend to try to force a tissue diagnosis from immunophenotyping, but rather I was looking for - perhaps - someone's experiences with CD10 negative, small cleaved cell lymphomas that behave more aggressively. The use of the word follicular was really inappropriate. The story is, that a 63 year old medical service case presented with profound pancytopenia - there was no lymphadenopathy nor splenomegaly, Outside of low counts, there were no abnormal cells in the peripheral blood. Bone marrow aspiration was unproductive. Bone marrow biopsy showed complete diffuse replacement of marrow with small cleaved lymphocytes. Gallium scans were all negative. This marrow was not submitted for flow cytometric analysis. Based on the morphologic diagnosis of " atypical lymphoid infiltrate consistent with NHL, small cleaved cell" and in the absence of any extramedullary involvement that would have provided a piece of tissue -- the hematologists began a course of treatment with cytoxan, vincristine and prednisone with no objective response. Then they turned to fludarabine also with little effect ( except to induce profound megakaryocytic aplasia). It was at this point that we (flow cytometry) first became aware of the case. The hematologists produced a marrow biopsy and wanted to know if the immunophenotype could add any additional information. That phenotype ( CD5-, CD19+, CD22+, CD10-, CD20+, CD25-, CD23-, CD103-, CD11c-, kappa bright positive, lambda negative) seemed fairly consistent with small cleaved cell follicular lymphoma except for the lack of CD10. My question was really meant to test whether anyone had experienced similar immunophenotypes with refractory / aggressive behavior. My thanks to all who answered, Brent Dorsett
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