Epstein-Barr Virus Is Exceptionally Rare in Nodular Lymphocyte-Predominant Hodgkin Lymphoma Cases From North America (Poster No.
Marginal zone variant of mantle cell lymphoma is a challenging diagnosis that needs to be recognized because of its aggressive clinical behavior. Because of the aggressive clinical behavior, the patient received multiagent lymphoma chemotherapy. Moreover, cytogenetic analysis on the marrow showed a clone with the following karyotype: −3,−6,−11,t(11 14)(q13 q32) consistent with mantle cell lymphoma. Bone marrow examination revealed extensive involvement by cells with similar morphologic and immunophenotypic characteristics. Cyclin D1 unequivocally stained the nuclei of 40% to 50% of cells. Morphologic reassessment showed the small lymphocytes to have monocytoid appearance and prominent cell borders surrounding naked germinal centers. Flow cytometry on the lymph node showed the B lymphocytes to be negative for CD5 and CD10. A morphologic diagnosis of follicular lymphoma, grade 2 of 3, was rendered. However, the cells were positive for CD20 and CD45 and negative for CD3, neuron-specific enolase, and chromogranin. On initial frozen sections, small cell lung carcinoma was considered. No epithelial invasion was seen in the lung biopsy. A right upper lobe lung biopsy and a right axillary lymph node showed involvement by predominantly small cleaved lymphocytes with a small proportion of large cells. Computed tomography scan showed extensive necrotic mediastinal, celiac, and retroperitoneal lymphadenopathy a large right hilar mass encasing the right upper lobe bronchus bilateral pleural effusions and a soft tissue mass near the gastroesophageal junction. Blood count was significant for neutrophilia and mild anemia. An 83-year-old white man presented with pneumonia, persistent cough, and 30-lb weight loss for the past 15 months.
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