PMC7533220_01
Flow cytometry of mantle cell lymphoma in the peripheral blood (2015) shows CD19/CD5 coexpression (depicted in dark blue) (A) and lambda light-chain restriction (B).
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Flow cytometry of the patient's blood revealed a small population of lymphocytes (0.42x109/L) with a CD19+, CD5+, CD23-, CD38+ phenotype and monotypic surface lambda light chain expression (Figure 1A and B).
Histologic and immunophenotypic findings in the spleen involved leukemic non-nodal mantle cell lymphoma and T-cell large granular lymphocytic leukemia. (A) Follicle with a germinal center and unexpanded mantle zone, a cluster of small lymphoid cells, and moderate expansion of splenic cords by small lymphoid cells (H&E, x100). (B) CD5 immunohistochemical staining shows a brightly positive signal in reactive T-lymphocytes and weakly colored mantle zone cells (CD5 stain, x200). (C) Cyclin D1 expression in the nuclei of cells, mostly in the inner mantle zone (cyclin D1 stain, x200). (D) Small cluster of cyclin D1-positive lymphocytes in the red pulp (cyclin D1 stain, x400). (E and F) Lymphocytes in the small cluster express BCL2 (E, BCL2 stain, x400) and weakly express CD5 (brightly colored cells are reactive T-lymphocytes) (F, CD5 stain, x400). (G and H) Neoplastic T cells in the splenic cords express CD3 (G, CD3 stain, x100) and granzyme B (H, granzyme B stain, x200).
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In the red pulp, small clusters of lymphoid cells and moderate expansion of the splenic cords by infiltration of medium-sized slightly pleomorphic lymphoid cells were observed (Figure 2A). In addition, the cells of the mantle zones strongly expressed BCL2, IgM, IgD and weakly expressed CD5 (Figure 2B). The expression of cyclin D1 was observed in cell nuclei in the inner layers of the mantle zones (Figure 2C). Namely, these cells expressed cyclin D1 (Figure 2D) and BCL2 (Figure 2E) and weakly expressed CD5 (Figure 2F).
Bone marrow aspirate smear (2018). (A) Giant hypersegmented hypergranular neutrophilic cells (arrows). (B) Nuclear fragmentation of an erythroid precursor (arrow). (C) Abnormal megakaryocytes displaying multiple separated nuclei. Romanowsky, x1000.
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The neutrophilic series showed approximately 22% giant hypersegmented hypergranular cells (Figure 3A). Approximately 10% of erythroid precursors had megaloblastoid features and nuclear fragmentation (Figure 3B). Megakaryocytes also exhibited abnormal morphology, such as multiple separated nuclei (Figure 3C).
(A) Biopsy of the bone marrow (2018) shows hypercellular, relative to the age norm, bone marrow. The bone marrow contains approximately 20% adipose tissue (H&E, x200). (B) CD3 staining shows infiltration by small T-cells with irregular nuclei (x400).
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Histological examination of trephine biopsy revealed an increase in bone marrow cellularity (Figure 4A). Based on immunohistochemical CD3 staining, both small clusters and interstitial infiltration by small T-cells were found (Figure 4B).
Flow cytometry of T-cell large granular lymphocytic leukemia in bone marrow (2018) shows CD3+/TCR gammadelta+ (depicted in green) (A), CD5-/TCR gammadelta+ (B), and CD7+/TCR gammadelta+ (C) expression.
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A population of TCR gammadelta+, CD3+, CD4-, CD5-, CD7+, CD8-, CD16-, CD56-, and CD57- lymphocytes was detected by flow cytometry (Figure 5A-C).