Classical type and blastoid variant mantle cell lymphoma in the same lymph node: Histology and cytological findings from a touch imprint specimen

Abstract

Blastoid variant (BV) is one of the aggressive variants of mantle cell lymphoma (MCL). BV-MCL is defined by its blastic cytomorphology. Previous studies using sequential biopsies in cases with MCL have demonstrated that classical type MCL (C-MCL) often transforms or relapses as an aggressive variant, but a histopathological transition from C-MCL to an aggressive MCL variant in the same pathological specimen has been shown in only a limited number of the cases. We present a case of MCL in which a histological transition between C-MCL and BV-MCL was observed in the same lymph node. A 53-year-old man presented with a submandibular tumor. Touch imprint cytology revealed a monotonous proliferation of large blastic lymphoid cells. Histology revealed a transition between a large lymphoid cell component and small foci of small- to medium-sized cell component within the tumor. Both components were CD5(+), CD10(-), CD20(+), cyclin D1(+), and SOX11(+) on immunohistochemistry. Fluorescent in situ hybridization revealed the translocation of IgH/BCL1 locus. These findings led to a final diagnosis of BV-MCL with coexistent C-MCL. The present case suggests the existence of a pathogenetic pathway of MCL from C-MCL to BV-MCL. Because it is important to accurately identify BV-MCL for prognostication, appropriate ancillary diagnostic tools should be used in suspected cases. Diagn. Cytopathol. 2017;45:364-370. © 2016 Wiley Periodicals, Inc.

Blastic Transformation of a Mantle Cell Lymphoma Presenting as an Enlarging Unilateral Orbital Mass

“…Only two reports have identified the blastoid form of MCL in the orbital and ocular adnexal region [20]. While the blastoid variant of MCL may occur de novo or following transformation of MCL [11, 13], reports of MCL exhibiting transformation to the blastoid variant of MCL are rare [21, 22]. …”

“…The blastoid variant has been described morphologically as medium-sized cells with scant and indistinct cytoplasm and finely dispersed chromatin with barely distinguished nucleoli although some cases may also include large cells with centroblastic morphology, round nuclei, fine chromatin, prominent nucleoli, and a moderate amount of basophilic cytoplasm [12]. The blastoid variant of MCL is aggressive [13] and is typically associated with poor outcomes [11, 14]. …”

Imprint cytology: Invaluable technique to evaluate fresh specimens received in the pathology department for lymphoma workup

“…23 The descriptions of the cytomorphology of the small cell, generally low-grade lymphomas emanate mainly from smears. 6,13,23,[31][32][33] The principal entities in this group are chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), follicular lymphoma, marginal zone lymphoma, classic mantle cell lymphoma (discussed below), and rarely lymphoplasmacytic lymphoma. The cells in these entities are generally less than twice the size of a small lymphocyte.…”

“…The cells of mantle cell lymphoma are small to intermediate (the classic variant) or intermediate (the blastoid variant), monotonous with variably irregular nuclei resembling centrocytes, clumped chromatin often with mitotic figures. 6,23,[31][32][33] Burkitt lymphoma cells are medium-sized, monotonous with round or squared-off nuclei, several basophilic nuclei, in a background of necrosis or apoptosis. 6 B-or T-lymphoblastic leukemia/lymphoma cells are small to medium or medium with a high nucleocytoplasmic ratio, irregular often convoluted nuclei exhibiting fine chromatin, and inconspicuous nucleoli.…”

“…The principal entities that fall under the umbrella of medium‐size lymphoid cells (approximately 2‐2.5 times the size of a small lymphocyte) include the blastoid variant of mantle cell lymphoma, Burkitt lymphoma, and lymphoblastic lymphoma. The cells of mantle cell lymphoma are small to intermediate (the classic variant) or intermediate (the blastoid variant), monotonous with variably irregular nuclei resembling centrocytes, clumped chromatin often with mitotic figures 6,23,31‐33 . Burkitt lymphoma cells are medium‐sized, monotonous with round or squared‐off nuclei, several basophilic nuclei, in a background of necrosis or apoptosis 6 .…”