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Published on: September 12, 2025
"In situ-like" mantle cell lymphoma: a report of two cases
P Richard1, J Vassallo, S Valmary
1Department of Pathology, Purpan Hospital, INSERM U563 (CPTP), Centre Hospitalier Universitaire Purpan, Toulouse, France.
Insights
Mantle cell lymphoma (MCL) can mimic lymphoid hyperplasia. This report details two cases of in situ-like MCL, a rare pattern important for accurate diagnosis to avoid misclassification.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Mantle cell lymphoma (MCL) is a B cell neoplasm typically presenting with a diffuse growth pattern.
- Accurate diagnosis of MCL is crucial for appropriate patient management and treatment strategies.
Observation:
- Two cases of MCL with a prior diagnosis of lymphoid hyperplasia are presented.
- Morphological examination revealed hyperplastic germinal centers and small, irregularly shaped lymphocytes in the mantle zone, positive for CD20, CD5, and cyclin D1.
- This pattern, termed 'in situ-like MCL,' is characterized by a thin neoplastic mantle zone with minimal tumor cell spread into interfollicular areas.
Findings:
- The identified 'in situ-like MCL' pattern is distinct from the classic mantle zone lymphoma.
- Immunohistochemical markers (CD20, CD5, cyclin D1) are essential for confirming the diagnosis.
- This specific MCL presentation can be mistaken for benign lymphoid hyperplasia.
Implications:
- Recognition of this in situ-like MCL pattern is critical for pathologists to avoid misdiagnosis.
- Distinguishing this entity from lymphoid hyperplasia ensures timely and correct treatment for MCL patients.
- This report highlights a novel presentation of MCL, expanding the understanding of its morphological spectrum.
Abstract:
Mantle cell lymphoma (MCL) is a B cell neoplasm that most often shows a diffuse growth pattern. Two cases of MCL are reported here, both with a previous diagnosis of lymphoid hyperplasia. Morphologically, germinal centres are hyperplasic with a normal or discretely enlarged mantle zone, where foci of irregularly shaped small lymphocytes are seen. These are positive for CD20, CD5 and cyclin D1, confirming a diagnosis of in situ-like MCL. This type differs from the mantle zone pattern in that the neoplastic mantle zone is very thin and there is very little or no spread of tumour cells into interfollicular areas. To the best of our knowledge, this is the first report on such a pattern of MCL, which is important to recognise, as it can be confused with lymphoid hyperplasia.
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