This could very well be a CLL or small lymphocytic lymphoma- SLL (a not yet leukemic neoplasm with same features as CLL). The CD22 dim, CD5+ (at least partial), CD10 negativity and CD23 +(at least partial)are consistent with CLL.The partial CD11c (as long as it is dim) and CD25 + is common in CLL. Mantle cell is almost always CD22 moderate or better. This would also go with the morphology. Lymph nodes in CLL/SLL show an inflitrate of small lymphoid cells with larger lymphoid cells forming pseudofollicles, which are proliferation centers. Thus CLL/small lymphocytic lymphoma can be confused with follicular lymphoma based upon morphology. The small lymphocytes can be irregular resulting in confusion with mantle cell lymphoma. On the other hand, if the CD5 is really negative, one can see CD10- and CD23+ follicular lymphoma. It all depends upon the CD5 to distinguish between the 2. Have you tried blocking stainin with CD5 with non-labeled CD5? If you have true CD5+ I don't like follicular lymphoma and I don't like mantle cell with CD23+ and CD22 dim. Your cyclin D1 and bcl-2 may be difficult to interpret because they are both negative. It is impossible to come to a strong final diagnosis based upon the data reported, but I would favor CLL/SLL. This is not a typical anything, and its biological behavior is likely to reflect that. Maryalice >Hi all, > >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 > >Sharon F. Vogt >svogt@bellsouth.net >Dekalb Medical Center >Atlanta, GA 30033 Maryalice Stetler-Stevenson Director Flow Cytometry Unit Laboratory of Pathology, NCI, NIH
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