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Mantle Cell Lymphoma : Peripheral Blood

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The involvement of peripheral blood at the time of presentation is frequently seen in mantle cell lymphoma (MCL). The atypical lymphoid cells are present in 20% to 70% of cases morphologically and in 100% of cases with flow cytometry. The absolute lymphocyte count may or may not be increased. Some patients have leukemic involvement and minimal or absent nodal disease. These patients generally have massive splenomegaly.

In a typical case of MCL with peripheral blood involvement, the circulating tumor cells are small to medium-sized with scant cytoplasm, indented or clefted nuclei, and reticular chromatin. The clumped chromatin of CLL is not seen.

In occasional cases, the peripheral blood picture resembles acute leukemia and the circulating tumor cells have blastoid morphology (as shown here). The cells are medium to large-sized with high nuclear-to-cytoplasmic ratio, finely dispersed chromatin, and occasional prominent nucleoli. Such cases progress very rapidly and the patients usually succumb to the disease within 3-4 months. Image courtesy of: George Paterakis, MD, PhD, Athens General Hospital, Athens, Greece; @gspaterakis

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