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Year : 2023  |  Volume : 14  |  Issue : 1  |  Page : 68-69

A lymphoproliferative disorder playing hide and seek

Laboratory of Hematology, Agen-Nerac Hospital, Agen, France

Date of Submission14-Oct-2022
Date of Decision06-Nov-2022
Date of Acceptance06-Nov-2022
Date of Web Publication17-Feb-2023

Correspondence Address:
Dr. Nicolas Athanase
Laboratoire de Biologie Médicale, Centre Hospitalier Agen-Nérac, Route de Villeneuve Sur Lot, Saint-Esprit 47923 Agen
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/joah.joah_91_22

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How to cite this article:
Athanase N, Frébet E. A lymphoproliferative disorder playing hide and seek. J Appl Hematol 2023;14:68-9

How to cite this URL:
Athanase N, Frébet E. A lymphoproliferative disorder playing hide and seek. J Appl Hematol [serial online] 2023 [cited 2023 Mar 20];14:68-9. Available from: https://www.jahjournal.org/text.asp?2023/14/1/68/369849

An asymptomatic 71-year-old male presented with isolated lymphocytosis at 10g/L. Blood lymphocytes had regular nuclei and dense chromatin [Figure 1a, May–Grünwald–Giemsa staining, ×1000], and 85% of them showed the expression of CD19, CD5, CD23, and Kappa chains (bright), concluding an atypical chronic lymphoid leukemia. In few months, lymphocytosis raised above 100g/L. Karyotype was highly complex, with ATM and TP53 deletion. Rituximab–idelalisib therapy was initiated. After a brief response, a positron emission tomography scanner revealed axillary lymphadenopathy with standardized uptake value above 20, in favor of a Richter's transformation, leading to the use of rituximab–gemcitabine–oxaliplatin chemotherapy. The patient relapsed and was switched to venetoclax. After 3 months, lymphadenopathy regressed and blood count normalized. Unexpectedly, lymphadenopathy biopsy concluded a blastoid variant of mantle cell lymphoma (MCL) with an overexpression of cyclin D1 [Figure 1b, H and E-Safran staining and [Figure 1]c, ×40, respectively]. After review, the initial flow cytometry analysis revealed CD200 low expression, and fluorescent in situ hybridization demonstrated t(11;14) hidden in the complexity of the karyotype. All in favor of a misdiagnosed MCL.

When the diagnosis seems atypical, with a rapid evolution, or resistance to treatment, examinations should be repeated and reinterpreted, as the initial diagnosis is to be questioned.


  • Nicolas Athanase wrote the manuscript and collected the data
  • Elise Frébet collected the data and reviewed the manuscript.

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Conflicts of interest

There are no conflicts of interest.


  [Figure 1]


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