Diagnosis of MCL is established by the histologic examination in combination with an IHC profile. A surgical biopsy is preferred, where possible. Although fine-needle biopsy alone is generally not appropriate, accuracy improves when used in combination with IHC and flow cytometry. In cases where lymph nodes are not accessible, core needle biopsy in conjunction with other assessments may be an acceptable alternative.
As bone marrow involvement is common in MCL, a bone marrow biopsy is typically performed but may not always be needed if there is circulating disease in the peripheral blood. PET/CT is included in the workup for staging.
In terms of histologic examination, MCL is characterized by expansion of the mantle zone that surrounds the lymph node germinal centers by small-to-medium atypical lymphocytes. Irregular and indented nuclei and moderately coarse chromatin may also be seen, as well as scant cytoplasm that resembles the smaller cells seen in follicular lymphoma; however, mitoses are more numerous and large cells are infrequent in MCL.
MCL is further characterized by the presence of chromosomal translocation t(11;14) and overexpression of cyclin D1. In particular, overexpression of cyclin D1 is a hallmark of MCL; cyclin D1- MCL is uncommon (<5% of cases). An IHC profile consisting of CD5+, CD10 -/+, CD 23-/+, CD43+ and cyclin D1+ is indicative of a diagnosis of MCL. FISH testing for t(11;14) can also be helpful to establish the diagnosis.
Learn more about MCL.
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Cite this: Elwyn C Cabebe, Winston W. Tan, Ann S. LaCasce. Fast Five Quiz: Test Your Knowledge of Mantle Cell Lymphoma - Medscape - Jan 09, 2023.