Case number: 00008
A 60 year-old male is referred to you for a neck mass. He has some numbness around his jaw. There is no history of weight loss, night sweats or fever. An MRI scan showed a sub-mandibular mass extending into the mandible.
Biopsy of the neck mass showed a diffuse small lymphoid infiltrate. On immunohistochemistry, the cells were CD79A+, PAX5+, CD5+, CD10- and CD23+.
Answer the following questions before proceeding.
- What are your top two differentials?
- Which stain would you request to distinguish between them?
Further analysis shows that the atypical cells are cyclin D1 negative. LEF1 is positive. Ki67 is 20%.
A full blood count reveals a lymphocytosis (absolute count 15×10^9). The haemoglobin and platelet count are normal. Flow cytometric analysis shows that the lymphoid cells are CD45 positive, SSC-low, CD 19+, CD 20 dim, CD 5+, CD23+, CD200+, CD38-, kappa-restricted and sIgM dim.
- What are the components of the Marsden score?
- What is the diagnosis?
- What are the indications for treatment of an indolent lymphoma?
- Before starting treatment, what is the most important investigation to perform?