Mantle cell lymphoma with flow cytometric evidence of clonal plasmacytic differentiation: A case report

Abstract

Background: Plasmacytic differentiation in mantle cell lymphoma (MCL) occurs rarely. However, no flow cytometric studies that demonstrate plasmacytic (PC) differentiation in MCL have been reported. Herein, we report a case of MCL with PC differentiation identified by flow cytometry.Methods: Morphologic review was performed by hematoxylin and eosin (H&E) stained sections from paraffin-embedded lymph node, colon and bone marrow specimens, and Wright-Geimsa stained bone marrow aspirate smears and touch imprints. Immunohistochemical stains using antibodies against CD3, CD5, CD20, and cyclin-D1, and in-situ hybridization for kappa and lambda light chains were reviewed. Multicolor flow cytometry analysis was performed on the bone marrow aspirate with monoclonal antibodies to CD3, CD4, CD5, CD8, CD14, CD19, CD20, CD23, CD38, CD45, CD56, CD138, and kappa and lambda light chains. FISH analysis for t(11;14)(q13;q32) was performed on interphase cells.

Plasma cell and terminal B-cell differentiation in mantle cell lymphoma mainly occur in the SOX11-negative subtype

“…However, in recent years, several studies have reported occasional tumors with clonally related monotypic plasma cells. [30][31][32]37 These cases are rare but have raised questions on the potential mechanisms Plasmacytic differentiation mantle cell lymphoma involved in their terminal B-cell. This process is normally regulated by the coordinated action of several transcription factors including PAX5, IRF4/ MUM1, BLIMP1, and XBP1.…”

“…[30][31][32]37 Most of these patients had nodal involvement but extranodal dissemination was also frequent. One previous case had a periorbital presentation as one of our patients.…”

“…29 However, occasional mantle cell lymphomas with focal areas of plasma cell differentiation have been reported. [30][31][32] These studies have emphasized the presence of mature clonally related plasma cells in otherwise classical mantle cell lymphoma but the potential relationship to SOX11 expression is not known. On the other hand, the expression of transcription factors regulating the switch from mature B-cell to plasma cells such BLIMP1, IRF4/MUM1 and XBP1 have not been well investigated in these tumors.…”

Bortezomib resistance in mantle cell lymphoma is associated with plasmacytic differentiation

“…In these reports, clonally related B cells and fully differentiated plasma cells showing t (11;14) have been found to coexist. [50][51][52] One case showed 3 discernible populations including a B-cell population in transition to plasma cells characterized by coexpression of CD19, CD38, and CD138. 51 These cases may be extremes, but illustrate the ability of MCL cells to differentiate into plasma cells.…”

“…[50][51][52] One case showed 3 discernible populations including a B-cell population in transition to plasma cells characterized by coexpression of CD19, CD38, and CD138. 51 These cases may be extremes, but illustrate the ability of MCL cells to differentiate into plasma cells. The plasmacytic phenotype we describe herein is more subtle but appears to be more common: 3 of 10 primary cases in our study showed CD38 expression of at least twice the median, and in a series of 127 MCL tumors, IRF4 expression has been reported in 35% of cases.…”