PakMediNet Discussion Forum : Medicine : What is your diagnosis
What is your diagnosis
67 year old patient with hoarseness of voice is worked up for a cartilage invading laryngeal tumor. Pathology reveals squamous cell carcinoma. During routine tests he is found to have leukocytosis. White cell count is 24,000 with 80% lymphocytes. A peripheral blood and bone marrow examination reveals presence of increased numbers of mature looking lymphocytes. A peripheral blood flow cytometry is ordered and reveals the following:
CD 5 +
CD 20 +
CD 3 -
CD 23 -
What is the diagnosis of this gentleman's otherwise asymptomatic blood condition?
Posted by: oncomanPosts: 23 :: 25-07-2004 :: | Reply to this Message
Re: What is your diagnosiswhat about CLL ?
Posted by: docosamaPosts: 333 :: 26-07-2004 :: | Reply to this Message
Re: What is your diagnosisGood differential with CD 5+ and CD 20+ but CLL is CD23+ as well. This is not CLL. The phenotype is that of a mantle cell lymphoma. Mantle cell though usually presents in lymph node but all lymphomas and specially Manlte cell has a leukemic phase which may herald the terminal stage of the illness.
Posted by: oncomanPosts: 23 :: 26-07-2004 :: | Reply to this Message
Re: What is your diagnosis
Just for conpletion sake other markers to look for would be
Surface immunoglobulin light chain restriction which is typically weak in expression and also a marker of monoclonality
CD 79b
FMC-7
Posted by: oncomanPosts: 23 :: 26-07-2004 :: | Reply to this Message
Re: What is your diagnosisthanks!
Posted by: docosamaPosts: 333 :: 26-07-2004 :: | Reply to this Message
Re: What is your diagnosisSo What is the treatment of choice and prognosis?
Posted by: memonPosts: 28 :: 29-08-2004 :: | Reply to this Message
Re: What is your diagnosis
Mantle cell lymphomas are incurable. There are two histologic types-nodular and diffuse. Median survival for nodular is about 5 year and diffuse approx 2 years. Leukemic phase would represent a more advanced stage and probably fall in 2 year category.
Chemotherapy with CVP or CHOP is therapy of choice. More data is now available to add Rituximab (monoclonal antibody against CD-20) may improve response rate but not induce cure. Again emerging data supports autologous stem transplant after high dose chemotherapy in selected patients.
Posted by: oncomanPosts: 23 :: 01-09-2004 :: | Reply to this Message