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A 58-year-old man presen ts with fatigue and weigh t loss over the past 1 month. On physical exam. he has enlarged lymph nodes and splenomegaly. Hemoglobin is 9.3 g/dl. leukocyte count is 1 78.000/,LLL. and platelet count is 85.000/,LLL. Flow cytometry of the peripheral blood reveals expression of CDS . CD 1 9 . and CD 20. and lack of CD23. Cyclin D 1 is positive. The peripheral blood smear is shown below.
These findings are most consistent with a diagnosis of:
- Chronic lymphocytic leukemia
- Hairy cell leukemia
- Marginal zone lymphoma
- Mantle cell lymphoma
Medicine
D. The blood smear shows marked leukocytosis with pleomorphic cells with irregular, round, and clefted nuclei with condensed chromatin. This picture, in concert with the immunopheno-type, is diagnostic of mantle cell lymphoma (MCL). MCL is typically positive for CDS, CD19, and CD20, but negative for CD23. The typical immunophenotype of CLL is CDS, CD19, CD20, and CD23 positive. Marginal zone lymphoma expresses CD20, but CDS and CD23 are negative. The morphology is not characteristic of hairy cell leukemia. Mantle cell lymphoma may present in a leukemic phase and portends a poor prognosis with a poor response to chemotherapy (Cancer. 1999;86:8S0-8S7).
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