Hello Maryalice,
we have these cases as well. Either atypical CLL, SLVL with bipolar
morphology or MCL/MZL with atypical morphology or we donīt know. Morphology
(jpg-file) would be nice.
Our preliminary data on Cyclin D1 and esp. surface CD79a (serotec clone)
including discussions with Estella Matutes and Ricardo Mordilla at Catovskis
lab at the Royal Marsden Hospital in London seem to show that these markers
donīt give definite answers for the diagnosis of MZL. No answers from van
Dongen who suggested cyclin D1. EQA from INSTAND in Germany just shipped
such a case and we have no answer yet (Stefan Serke, Berlin). No way around
a lymph node biopsy and histology. And Harald Stein (Berlin) from the REAL
club says only members of the group can give the real diagnosis.
Soul-destroying remarks from Germany. Esp. nice if there is no enlarged
lymph node.
Our NHL antibody panel (remeber our exchange of panels) is still too small
yet (including the REAL/WHO panel). With the existing panel we can confirm
or exclude (HCL in your case) and still have a sediment of cases like the
one you presented. Of course there is still the discrepancy in several
markers between immunohistology and flow.
>From the clinical point of view we can exclude HCL and treatment for other
low malignant NH lymphoma (according to the KIEL classification ;-) ) is
the same for MCL, SLVL or CLL with spleen involvement. Until now.
Our new MedNet on leukemia http://www.kompetenznetz-leukaemie.de/ puts a lot
of efforts into a consensus (whatever that is) panel for acute leukemia (not
yet published) but NHL is not well in the focus. Suggestions for a better
panel are still wellcome.
Regards
Thomas
Dr.med. C. Thomas Nebe
Universitaetsklinikum Mannheim
Zentrallabor
Theodor-Kutzer-Ufer 1-3
D-68167 Mannheim
Tel. +49 621 383-3485
FAX +49 621 383-73 3485
+49 621 383-3819
e-mail: thomas.nebe@ikc.ma.uni-heidelberg.de
http://www.ma.uni-heidelberg.de/inst/ikc/ (Internet)
http://pandora/inst/ikc/ (Intranet)
-----Original Message-----
From: Maryalice Stetler-Stevenson [SMTP:stetler@box-s.nih.gov]
Sent: Thursday, July 27, 2000 9:24 PM
To: Cytometry Mailing List
Subject: interesting case
We have a case of an 80 year old male, with bone marrow biopsy
showing lymphoproliferative process and enlarged spleen. The bone
marrow tumor cells are reported cyclin D1 negative. The case was
submitted with a diagnosis of hairy cell. WBC is 2.2 with anemia and
thrombocytopenia. The peripheral blood is minimally involved (7% of
lymphs). The tumor cells are CD19+, CD20 moderate (not dim), CD22
moderate, Immunoglobulin moderate- kappa/IgA IgM +, CD5 positive but
spectrum from dim to moderate, FMC7 + and negative for CD23, CD10,
CD103, CD25, CD38, IgD, IgG, and IgE. This doesn't look like CLL or
mantle cell. We will be following up on the marrow biopsy and further
clinical history and will let you know anything that pops up. Has
anyone had a case like this? What is your favorite diagnosis for this?
Maryalice Stetler-Stevenson and Doug Kingma
Maryalice Stetler-Stevenson
Director Flow Cytometry Unit
Laboratory of Pathology, NCI, NIH
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