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The story is, that a 63 year old medical service case presented with
profound pancytopenia - there was no lymphadenopathy nor splenomegaly,
Outside of low counts, there were no abnormal cells in the peripheral blood.
Bone marrow aspiration was unproductive. Bone marrow biopsy showed complete
diffuse replacement of marrow with small cleaved lymphocytes. Gallium scans
were all negative. This marrow was not submitted for flow cytometric
analysis. Based on the morphologic diagnosis of " atypical lymphoid
infiltrate consistent with NHL, small cleaved cell" and in the absence of
any extramedullary involvement that would have provided a piece of tissue --
the hematologists began a course of treatment with cytoxan, vincristine and
prednisone with no objective response.
Then they turned to fludarabine also with little effect ( except to induce
profound megakaryocytic aplasia). It was at this point that we (flow
cytometry) first became aware of the case. The hematologists produced a
marrow biopsy and wanted to know if the immunophenotype could add any
additional information. That phenotype ( CD5-, CD19+, CD22+, CD10-, CD20+,
CD25-, CD23-, CD103-, CD11c-, kappa bright positive, lambda negative) seemed
fairly consistent with small cleaved cell follicular lymphoma except for the
lack of CD10. My question was really meant to test whether anyone had
experienced similar immunophenotypes with refractory / aggressive behavior.
My thanks to all who answered,
Brent Dorsett
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CD-ROM Vol 3 was produced by Monica M. Shively and other staff at the
Purdue University Cytometry Laboratories and distributed free of charge
as an educational service to the cytometry community.
If you have any comments please direct them to
Dr. J. Paul Robinson, Professor & Director,
PUCL, Purdue University, West Lafayette, IN 47907.
Phone: (765)-494-0757;
FAX(765) 494-0517;
Web