Surgical Pathology Criteria

Mantle Cell Lymphoma

Differential Diagnosis

Small B Cell Lymphomas
  SLL/CLL Mantle Marginal Zone Lymphoplasmacytic Follicular
CD23 85% 2% 8% 0-30% on immunohistology but up to 60% weak positive on flow 0-25%
CD5 80% 80% 0% 5% 0%
bcl1 2% 85% 0% 0% 0%
CD10 0% 2% 2% 3% 85%
CD43 80% 85% 35% 10-30% 7%
bcl2 95% 95% 65-90% >50% 90%

 

Mantle Cell Lymphoma SLL/CLL
Irregular nuclear membranes Round nuclei
Residual germinal centers may be prominent Proliferation centers present
Expanded mantle zone around germinal centers variably present No mantle zone pattern
Scattered histiocytes Histiocytes not prominent
bcl1 85% bcl1 2%
CD23 2% CD23 85%
Blastic transformation Large cell transformation
Some mantle cell lymphomas have been reported to have proliferation centers; these are better considered as SLL/CLL

 

Lymphoplasmacytic Lymphoma / Immunocytoma Mantle Cell Lymphoma
Round nuclear membranes Variably irregular nuclear membranes
bcl1 negative bcl1 85%
CD5 5% CD5 80%
Large cell transformation Blastic transformation
Plasmacytoid diffrentiation may be prominent in mantle cell lymphoma

 

Nodal, Extranodal and Splenic Marginal Zone Lymphoma Mantle Cell Lymphoma
Enlarged marginal and mantle zones Enlarged mantle zone frequent
Polymorphous population Uniform small lymphocytes
bcl1 negative bcl1 85%
CD25 negative CD25 30%
CD5 negative CD5 80%
CD43 35% (Splenic 2%) CD43 85%

 

Follicular Lymphoma Mantle Cell Lymphoma
Distinct nodules composed of cleaved cells Residual germinal centers may simulate nodules
Mantle pattern surrounding germinal center rare Mantle pattern frequent
bcl1 negative bcl1 85%
CD5 negative CD5 80%
CD43 7% CD43 85%
CD10 85% CD10 2%
Follicular dendritic network intact FDC network disrupted or confined to germinal centers
bcl2 92% bcl2 95%
Floral variant of follicular lymphoma surrounds and invades follicles resulting in a lobulated follicle rather than the more even obliteration by mantle cell lymphoma

 

Lymphoblastic Lymphoma, T or B Blastic Mantle Cell Lymphoma
Median age 17-20 years Rare under 30 years
Histiocytes infrequent (tingible body macrophages frequent) Scattered histiocytes frequent
No prior diagnosis of mantle zone lymphoma Frequent diagnosis of mantle zone lymphoma
T lineage 90%, B lineage 10% B lineage markers positive
bcl1 negative bcl1 85%
CD5 negative if B lineage CD5 80%

 

Burkitt Lymphoma Blastic Mantle Cell Lymphoma
Median age 30 years Rare under 30 years
Histiocytes infrequent (tingible body macrophages frequent) Scattered histiocytes in most cases
No prior diagnosis of mantle zone lymphoma May have prior diagnosis of mantle zone lymphoma
bcl1 negative bcl1 100%
CD5 negative CD5 80%
CD10 99% CD10 negative
Translocation involving myc gene No myc translocation

Mantle Cell Lymphoma Reactive Hyperplasia
Uniform moderately atypical population Mixed population, small round cells
Light chain monotypia variably demonstrable No monotypia
Clonal Ig gene rearrangement No clonal rearrangement
Coexpression of CD43 by B cells 84% No CD43 coexpression
Coexpression of CD5 by B cells 80% No CD5 coexpression

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