Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Case report
Year : 2017 | Month : July | Volume : 11 | Issue : 7 | Page : ED15 - ED17

Important Diagnostic Clues for Diagnosing Splenic Marginal Zone Lymphoma in Absence of Splenic Histology

Anisha Mohanpuria, Vijay Kumar, Pooja Suteri, Sadhna Marwah, Abhay Shankar Nigam

1. Senior Resident, Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India. 2. Associate Professor, Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India. 3. Junior Resident, Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India. 4. Professor, Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India. 5. Consultant Pathologist, Department of Pathology, PGIMER, Dr. RML Hospital, New Delhi, India.

Correspondence Address :
Dr. Anisha Mohanpuria,
Room 310, 3rd Floor, OPD Block, Dr. RML Hospital, New Delhi-110001, India.
E-mail: aneesha86.doc@gmail.com

Abstract

Splenic Marginal Zone Lymphoma (SMZL) is a rare B-cell neoplasm comprising less than 2% of non-Hodgkin lymphomas. We hereby report a case of SMZL in a 66-year-old female who presented with fever and massive splenomegaly. Peripheral blood smear examination showed atypical lymphoid cells showing variable cytoplasmic processes. Flowcytometric immunophenotyping of peripheral blood showed tumour cells which were found to be positive for CD19, CD79b and showing kappa light chain restriction along with lack of expression for CD5, CD10, CD23, CD103 and lambda. These findings were suggestive of B cell chronic lymphoproliferative disorder. Various differential diagnoses considered in this case were analysed by using different diagnostic clues to arrive at the diagnosis. Bone marrow examination and Immunohistochemical (IHC) analysis showed tumour cells in nodular, interstitial and intrasinusoidal pattern of infiltration which were positive for CD20 and CD79b with kappa light chain restriction and lack of expression of CD5, CD10, CD23 and CD103 which further corroborated the flowcytometric immunophenotyping. The diagnosis of SMZL is arrived at by a combination of diagnostic clues like clinical features, peripheral smear findings, flowcytometric immunophenotyping, morphological and IHC findings in bone marrow biopsy. This case highlights the significance of flowcytometric immunophenotyping and bone marrow biopsy with immunohistochemistry to arrive at a diagnosis of SMZL even in absence of splenic histopathology.

Keywords

CD20, Intrasinusoidal pattern, Massive splenomegaly

How to cite this article :

Anisha Mohanpuria, Vijay Kumar, Pooja Suteri, Sadhna Marwah, Abhay Shankar Nigam. IMPORTANT DIAGNOSTIC CLUES FOR DIAGNOSING SPLENIC MARGINAL ZONE LYMPHOMA IN ABSENCE OF SPLENIC HISTOLOGY. Journal of Clinical and Diagnostic Research [serial online] 2017 July [cited: 2017 Jul 20 ]; 11:ED15-ED17. Available from
http://jcdr.net/back_issues.asp?issn=0973-709x&year=2017&month=July&volume=11&issue=7&page=ED15-ED17&id=10190

DOI and Others

DOI: 10.7860/JCDR/2017/27149.10190


Date of Submission: Jan 31, 2017
Date of Peer Review: Feb 21, 2017
Date of Acceptance: Apr 17, 2017
Date of Publishing: Jul 01, 2017

Financial OR OTHER COMPETING INTERESTS: None

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