LEUKEMIC PHASE OF MANTLE CELL LYMPHOMA PRESENTING AS ANEMIA - DIAGNOSIS BY COMBINING FLOW-CYTOMETRY AND CYTOMORPHOLOGY

We report a case of mantle cell lymphoma in leukemic phase, which was diagnosed by a bone marrow biopsy performed as part of a workup fbr ch ronic anemia in a patient without lymphadenopathy. The patient, a 79-y ear-old man with diabetes mellitus, hypertension, chronic renal failur e, congestive heart failure, and atherosclerosis, presented with claud ication. On admission, he also had an 8-month history of anemia, durin g which time he experienced a 18-kg weight loss, On presentation, the patient had normal vital signs, anemia, leukocytosis (as well as an ab solute lymphocytosis), and splenomegaly; as mentioned, lymphadenopathy was absent, A bone marrow biopsy showed an increase in small to inter mediate-sized, slightly irregular lymphocytes in interstitial nodules. Flow cytometric immunophenotyping of the bone marrow identified a mon oclonal population of cells, representing 25% of cells within the bone marrow, with expression of CD19, CD20, immunoglobulin M/D, lambda lig ht chain, HLA-DR, and CDS; reactions for CD10 and CD23 were absent. Ba sed on morphologic and immunophenotypic analysis of the bone marrow, a s well as morphologic review of the peripheral blood smear, a diagnosi s of mantle cell lymphoma involving the bone marrow and in leukemic ph ase was made. Subsequent polymerase chain reaction analysis of DNA fro m peripheral blood identified a population of cells with the bcl-1 rea rrangement. This case is unique in that the diagnosis of mantle cell l ymphoma was made without lymph node or spleen analysis and the patient , although exhibiting bone marrow and peripheral blood involvement by mantle cell lymphoma at presentation, did not have lymphadenopathy.