We recently have observed a few clinical leukemia cases that have phenotypic patterns suggestive of mantle cell lymphoma, but with a number of larger transformed cells that morphologically appear to be prolymphocytes. From our experience, these two entities can have similar, if not identical phenotypes (CD5+, CD19+, CD20+ (mod-bright), FMC-7+, CD79b+, and mod-bright Ig light chains). With approx. 30% of PLL retaining CD5 and most cases of PLL are CD23 negative, my question is: How are people signing out these cases? As we continue to gain experience with FMC-7 and CD79b, we are finding them to be variably expressed in different lymphoid malignancies. Are people always signing out cases with a differential diagnosis, or is the diagnosis more specific and pointed? Being in a reference laboratory setting, getting adequate history or assessable morphology is exceedingly rare. Thank you in advance for your comments. Michael S. Brown, MD Dept. of Pathology University of Utah ARUP Laboratories, Inc.
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