Leukemic mantle cell lymphoma and chronic lymphocytic leukemia: a rare composite lymphoma and literature review
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Composite lymphomas are rare entities that either represent a collision of two separate lymphomas, or one lymphoma that expresses two distinct phenotypes. Mantle cell lymphoma has been reported in some composite lymphomas, but when combined with chronic lymphocytic leukemia, it can be difficult to recognize because of the phenotypic overlap of these two entities. We report a case of a 75-year-old male with a slowly progressing lymphocytosis, but who was otherwise asymptomatic. Flow cytometry revealed two different populations, one showing bright Lambda positivity and CD5(+), while the other was positive for both lambda and kappa and was CD5(+). Subsequently, cytogenetics revealed two different populations, one with a trisomy 12 and the other with a t(11;14). Additionally, immunohistochemistry on a bone marrow biopsy showed SOX-11 to be negative and cyclin D1 to be positive on scattered lymphocytes. This was consistent with a composite lymphoma of leukemic mantle cell lymphoma and chronic lymphocytic lymphoma.
KeywordsComposite lymphoma Mantle cell lymphoma Chronic lymphocytic leukemia Sox-11 Leukemic mantle cell lymphoma
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- 1.Custer R (1954) Pitfalls in the diagnosis of lymphoma and leukemia from the pathologist’s point of view. Second National Cancer Conference; New York:554–557Google Scholar
- 3.Sun Y, Wang SA, Sun T (2017) Composite mantle cell lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma. Cytometry B Clin Cytom. https://doi.org/10.1002/cyto.b.21512. [Epub ahead of print]
- 5.Ondrejka SL, Lai R, Smith SD, Hsi ED (2011) Indolent mantle cell leukemia: a clinicopathological variant characterized by isolated lymphocytosis, interstitial bone marrow involvement, kappa light chain restriction, and good prognosis. Haematologica 96(8):1121–1127CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Kern W, Bacher U, Schnittger S, Dicker F, Alpermann T, Haferlach T, Haferlach C (2014) Flow cytometric identification of 76 patients with biclonal disease among 5523 patients with chronic lymphocytic leukaemia (B-CLL) and its genetic characterization. Br J Haematol 164(4):565–569CrossRefPubMedGoogle Scholar
- 9.Hu Z, Sun Y, Schlette EJ, Tang G, Li S, Xu J, Yin CC, Young KH, Patel KP, Miranda RN, Goswami M, Wang M, Jorgensen JL, Medeiros LJ, Wang SA (2017) CD200 expression in mantle cell lymphoma identifies a unique subgroup of patients with frequent IGHV mutations, absence of SOX11 expression, and an indolent clinical course. Mod Pathol. https://doi.org/10.1038/modpathol.2017.135. [Epub ahead of print]
- 10.Hoeller S, Zhou Y, Kanagal-Shamanna R, Xu-Monette ZY, Hoehn D, Bihl M, Swerdlow SH, Rosenwald A, Ott G, Said J, Dunphy CH, Bueso-Ramos CE, Lin P, Wang M, Miranda RN, Tzankov A, Medeiros LJ, Young KH (2013) Composite mantle cell lymphoma and chronic lymphocytic leukemia/small lymphocytic lymphoma: a clinicopathologic and molecular study. Hum Pathol 44(1):110–121CrossRefPubMedGoogle Scholar
- 11.Fend F, Quintanilla-Martinez L, Kumar S, Beaty MW, Blum L, Sorbara L, Jaffe ES, Raffeld M (1999) Composite low grade B-cell lymphomas with two immunophenotypically distinct cell populations are true biclonal lymphomas. A molecular analysis using laser capture microdissection. Am J Pathol 154:1857–1866CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Wang M, Rule S, Zinzani PL, Goy A, Casasnovas O, Smith SD, Damaj G, Doorduijn J, Lamy T, Morschhauser F, Panizo C, Shah B, Davies A, Eek R, Dupuis J, Jacobsen E, Kater AP, Le Gouill S, Oberic L, Robak T, Covey T, Dua R, Hamdy A, Huang X, Izumi R, Patel P, Rothbaum W, Slatter JG, Jurczak W (2017) Acalabrutinib in relapsed or refractory mantle cell lymphoma (ACE-LY-004): a single-arm, multicentre, phase 2 trial. Lancet. pii: S0140-6736(17)33108-2. https://doi.org/10.1016/S0140-6736(17)33108-2. [Epub ahead of print]
- 15.Wang ML, Rule S, Martin P, Goy A, Auer R, Kahl BS, Jurczak W, Advani RH, Romaguera JE, Williams ME, Barrientos JC, Chmielowska E, Radford J, Stilgenbauer S, Dreyling M, Jedrzejczak WW, Johnson P, Spurgeon SE, Li L, Zhang L, Newberry K, Ou Z, Cheng N, Fang B, McGreivy J, Clow F, Buggy JJ, Chang BY, Beaupre DM, Kunkel LA, Blum KA (2013) Targeting BTK with ibrutinib in relapsed or refractory mantle-cell lymphoma. N Engl J Med 369(6):507–516CrossRefPubMedPubMedCentralGoogle Scholar