A 62-year-old man presents with generalised lymphadenopathy and weight loss. Flow cytometry of a node shows CD19+, CD5+, surface Ig strong, FMC7 positive, and CD23 negative. Immunohistochemistry demonstrates strong nuclear cyclin D1 expression. Which diagnosis fits best?
- A Mantle cell lymphoma ✓
- B Chronic lymphocytic leukaemia/small lymphocytic lymphoma
- C Follicular lymphoma
- D Nodal marginal zone lymphoma
Correct answer: A. Mantle cell lymphoma
Explanation
CD5 positivity with CD23 negativity distinguishes mantle cell lymphoma from CLL, and strong nuclear cyclin D1 confirms it, driven by the t(11;14) placing CCND1 under the immunoglobulin heavy chain promoter. Mantle cell also shows bright surface Ig and FMC7 positivity, unlike CLL. Follicular lymphoma is CD5 negative and expresses BCL2 with a nodular growth pattern, so its profile cannot explain the cyclin D1 staining that decides this case.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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