A 63-year old man presented with massive splenomegaly, lymphadenopathy and a total leucocyte count of 17000 per mm3. The flow cytometery showed CD 19 +, CD5 +, CD23 -, monoclonal B-cells with bright kappa positively comprising 80% of the peripheral blood lymphoid cells. Which of the following is the most likely diagnosis?
Mantle cell lymphoma
Follicular lymphoma
Hairy cell leukemia
Splenic lymphoma with villous lymphocytes
Patient in the question is showing features of mantle cell lymphoma. Mantle cell lymphoma is a subtype of non Hodgkins lymphoma. Patients often presents with lymphadenopathy at several sites along with fever, night sweats or weight loss. On examination hepatomegaly and spleenomegaly is evident. Investigations: Translocation of chromosome t(11:14) result in over expression of cyclin D1. Biopsy of lymph node mostly shows a diffuse enlargement of lymph node, rarely a mantle zone pattern. The flow cytometery shows CD 19 +, CD5 +, CD23 -ve monoclonal B-cells with bright kappa positivity. Ref: Williams Hematology, 8th Edition, Chapter 95, Pages 101 - 2