Flow cytometry: Mantle cell Lymphoma

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Typical MCL morphology

Background

Typical MCL expresses CD5, but can be distinguished from CLL by the absence of CD23 and CD200.

However, individual markers may not be expressed in all cases - this can cause diagnostic difficulty particularly with atypical forms of MZL or occasionally other B-cell lymphoproliferative disorders. Generally it is correct to advise cytogenetic or genetic testing to confirm.

CD45 Expression

File:FCLCD45.jpg

Side scatter

Immunophenotype of MCL
Major markers useful in CLL diagnosis
Marker	Freq	Level	Comment
κ/λ			Expect moderate or strong restricted κ or λ expression
CD19		-	Expression is expected, typically more strongly than in CLL
CD5		-	Expression of CD5 is characteristic of MCL
FMC7		-	FMC7 is frequently expressed by typical MCL
Other relevant markers
CD5		-	Expression of CD5 is characteristic of MCL
CD10		-	Infrequently expressed, expression may suggest FL
CD11C			Expressed in some cases of MCL but not typical
CD19		-	Expression is expected, typically more strongly than in CLL
CD20		-	Expression is expected, typically stronger than CLL
CD23		-	Typically not expressed by MCL, may rarely be expressed
CD25			Not typical of MCL, not generally strong as HCL
CD38		-	Expression is expected in MCL but CD138 should be absent
CD43		-	Lower expression than in CLL, may be helpful in some cases
CD79b			Expression is expected and should be stronger than CLL
CD103		-	Not expressed by MCL, consider HCL if found
CD138		-	Predominantly expressed at plasma cell differentiation
CD200		-	Characteristically (though not always) negative in MCL

Key to table:

Markers most useful in initial diagnosis are underlined in blue text

Key to colour code for expression frequency Click for link

Key to expression strength code and use Click for link

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