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Case 88 - Discussion

Hematopathology Case

 

Flow Cytometry Analysis of the Lymph node

 

          Total events analyzed =          A gate Bright CD45 positive

               22029                       events = 16572 (94% of total

                                           events analyzed)

          CD45+/CD14-                           98%

          CD19+/CD3-                            66%

          CD3+/CD19-                            34%

          Total CD20+                           55% (Dim) 

          CD19+/CD20+                           55%     

          CD19+/CD38+                           41%

          CD19+/CD10+                           <2%

          CD5+/CD19+                            66% 

          CD5+/CD19-                            31%

          CD19+/CD23+                           31%    

          CD19+/FMC7+                            3%

          CD2+/CD7+                             21%

          CD3+/CD5+                             33%

          CD3+/CD4+                             14%

          CD3+/CD8+                             15%

          CD3-/CD56+                            <2%

                     Gated on CD19+ cells

          CD19+/sIg/Kappa+                      97%(Dim)

          CD19+/sIg/Lambda+                      2%

       

Interpretation: A monotypic B-cell population is detected with dim kappa chain restriction. They express: CD5, CD19, dim CD20, and partial CD23.. There is no expression of FMC-7 or CD10 in the neoplastic lymphoid population.

 

Diagnosis: small lymphocytic lymphoma

 

Discussion: the case may mimic mantle cell lymphoma based on the morphology: on the touch imprints, the tumor cells are small to medium in size with some degree of nuclear irregularity, and on the lower magnification, there is no obvious proliferation center. However, frequent paraimmunoblasts are present at high power, which is not a feature of mantle cell lymphoma. Flow cytometric findings support the diagnosis of small lymphocytic lymphoma.