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Lymphoma - B cell neoplasms

B cell lymphoma subtypes

Mantle cell lymphoma - blastoid variant

Reviewer: Nikhil Sangle, M.D., University of Utah and ARUP Laboratories (see Reviewers page)
Revised: 27 February 2011, last major update February 2011
Copyright: (c) 2001-2011, PathologyOutlines.com, Inc.

Clinical features
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● Median age 63 years, range 40-79 years; 80% men
● Moderate to marked leukocytosis
● Aggressive behavior

Case Reports
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● Leukemic mantle cell lymphoma with classic and blastoid components with different immunophenotypes (Am J Clin Pathol 2004;122:122)

Micro description
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● Diffuse, nodular or mantle zone pattern
● Higher grade histologic features than classic mantle cell
● Either (a) lymphoblastic with intermediate size cells containing round nuclei and finely disbursed chromatin, marked mitotic activity and leukemic involvement, resembling CLL/SLL or AML; or (b) pleomorphic with heterogeneous larger cells with deeply indented, pleomorphic nuclei and variably prominent nucleoli, high proliferation rate, often with striking staining of chromatin due to tetraploid clones, resembling diffuse large B cell lymphoma

Micro images
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Cases with prominent nucleoli

Various images


A-starry sky pattern; B-immature chromatin and high mitotic rate

Cytology images
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Left: bone marrow aspirate smear; right: peripheral blood smear

Positive stains
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● CD19, CD20, CD5, surface immunoglobulin

Negative stains
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● CD34, TdT, CD23 (or weak)

Molecular
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● t(11;14)
● Blastoid variant is also associated with c-myc and 8q24 abnormalities (Mod Pathol 2002;15:1266)
● Usually complex karyotypes with 3+ additional chromosomal abnormalities, most commonly chromosome 13; also 18, 17, 8 and 3 (Hum Pathol 2003;34:1022)

Molecular images
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Left: bcl1 by PCR; right: cyclin D1 mRNA by RT-PCR

Differential diagnosis
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● Transformation of CLL: clinical history, CLL cases resemble ALL-L3, CD23+ (Mod Pathol 1997;10:818)
● Transformation of B-PLL: variable CD5+, background of CLL type cells, lower N/C ratio, prominent nucleoli (Am J Clin Path 2002;117:246)

End of Lymphoma - B cell neoplasms > B cell lymphoma subtypes > Mantle cell lymphoma - blastoid variant

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