> We have a clinical case that's interesting to the point of frustration. Any > comments? > > 53 y male, 3 years ago and now (recurrent) lymphoma, B-cell type. Phenotype is > similar in both flow cytometric studies: > > CD19+ CD20+ CD22 dim, CD5 dim before, partial now, CD25+, CD23 partial, CD11c > partial, with kappa light chain restriction. Negative for CD10. We do not stock > FMC7 (but will soon), CD21 or CD24. > > By morphology and flow (considering dim CD5 as negative), the diagnosis of > follicular center cell lymphoma (noting that 20-30% of these are known not to > express CD10) was made. None of us are entirely sure of that diagnosis now, and > there appears to be a tad more CD5 expression (recent specimen was FNA of > cervical node); it was suggested that this may be a mantle cell lymphoma. > > OK, simple enough - immunohistochemical stains bcl-2 and cyclin D1 should answer > that question. Those are difficult stains to optimize, however, and are affected > by variations in fixation. In other words, they didn't help much. CD20 nor kappa > light chain expression is remarkable for staining intensity, but I'd favor a CLL > based on the rest of the phenotype. The pathologists say small cell, low grade, > but not really CLL-like and definitely not PLL. > > ?? Thanks for any discussion. Sharon, Just make sure that you do the bcl2 and cyclin D1 immunohistochemistry after high pH anitigen retrieval. It makes a big difference. Brent Dorsett Lenox Hill Hospital --- NYC
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