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| IMAGE IN HEMATOLOGY |
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| Year : 2023 | Volume
: 14
| Issue : 1 | Page : 68-69 |
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A lymphoproliferative disorder playing hide and seek
Nicolas Athanase, Elise Frébet
Laboratory of Hematology, Agen-Nerac Hospital, Agen, France
| Date of Submission | 14-Oct-2022 |
| Date of Decision | 06-Nov-2022 |
| Date of Acceptance | 06-Nov-2022 |
| Date of Web Publication | 17-Feb-2023 |
Correspondence Address:
Dr. Nicolas Athanase
Laboratoire de Biologie Médicale, Centre Hospitalier Agen-Nérac, Route de Villeneuve Sur Lot, Saint-Esprit 47923 Agen
France
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/joah.joah_91_22
How to cite this article:
Athanase N, Frébet E. A lymphoproliferative disorder playing hide and seek. J Appl Hematol 2023;14:68-9 |
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.
Acknowledgments
- Nicolas Athanase wrote the manuscript and collected the data
- Elise Frébet collected the data and reviewed the manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
[Figure 1]
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