Leukemic phase of mantle cell lymphoma, blastoid variant

Six patients with mantle cell lymphoma, blastoid variant, involving the blo od are described. The circulating blast-like cells suggested the possibilit y of acute leukemias, chronic lymphoproliferative disorders or peripheraliz ed lymphomas. The WBC counts ranged from 3,700 to 249,000/mu L (3.7-249.0 x 10(9)/L) and the absolute Lymphocyte counts from 1,000 to more than 200,00 0/mu L (1.0 to >200.0 x 10(9)/L). The peripheral blood smears showed a spec trum of cells, from small mature lymphocytes with irregular nuclei to mediu m-sized lymphocytes with blast-like chromatin. However the morphologic feat ures in a lymph node biopsy specimen and the immunophenotype confirmed a di agnosis of mantle cell lymphoma, blastoid variant. By flow cytometry the ly mphoma cells expressed B-cell-associated antigens (CD19, CD20 and CD22), co expressed CD5, lacked CD23, and expressed moderate intensity monoclonal sur face immunoglobulin and CD20. Cytogenetic analysis showed the characteristi c t(11;14) in 2 of 4 analyzed specimens. Mantle cell lymphoma, blastoid var iant, is part of the differential diagnosis for blast-like cells.