Introduction Discordant lymphomas are uncommon entities seen as a the simultaneous existence of two distinctive types of lymphomas in various anatomic sites. the bone tissue marrow and in the spleen, the hypothesis of the common origin, accompanied by a different clonal collection of the neoplastic lymphocytes may be taken into account. Bottom line Our case stresses the effectiveness of looking into simultaneous specimens from different anatomic sites in the same patient as well as the relevant diagnostic function of splenectomy. Launch The association of two distinctive B-cell non-Hodgkin lymphomas in the same individual and regarding different anatomical places is a uncommon sensation. This peculiar display, known as ‘discordant lymphoma’, must be differentiated in the so-called ‘amalgamated lymphoma’, which may be the incident of several and immunophenotypically distinctive lymphoma clones within a anatomical site morphologically, that’s within an individual body organ or tissue . We describe a patient with mantle cell lymphoma (MCL) concomitant with a marginal zone lymphoma (MZL). The former was responsible for massive splenomegaly, while the latter was responsible for bone marrow infiltration and peripheral blood spread. A multidisciplinary approach was necessary for diagnosis, but splenectomy proved to be of particular relevance both for detecting the localization of MCL in our patient and for choosing the most appropriate therapy. Case presentation A 60-year-old Caucasian woman who had a silent clinical history with the exception of obesity and mild diabetes had routine blood count and chemistry tests at the recommendation of her family doctor. A slight lymphocytosis (range: 4.0 to 4.5 109/L) was observed. All the other blood parameters, Rabbit Polyclonal to AML1. including white blood cells, hemoglobin, hematocrit, platelet count, lactate dehydrogenase, plasma proteins, protein electrophoresis, and immunoglobulin levels, were within the normal range. Serum immunofixation was negative. Immunophenotyping of peripheral blood samples was carried out by flow cytometry using a FacsCanto II cytometer (Becton Dickinson) equipped with two lasers (488 and 633 nm). Samples (50 L) were stained with fluorochrome-conjugated monoclonal antibodies (MoAbs) specific for the following antigens: CD3, CD4, CD8, Riociguat CD5, CD16, CD56, CD19, CD20, CD22, CD23, FMC7, CD103, CD11c, CD25, CD10, CD38, CD45 (purchased from Becton Dickinson), and K and immunoglobulin light chains (purchased from Dako). A six-color panel was used for each tube, associating MoAbs conjugated with FITC, PE, PerCP-Cy5.5, PE-Cy.7, APC and APC-Cy.7. At least 200,000 events were acquired and data were processed using FacsDiva software (Becton Dickinson). Lymphocytes were gated using CD45 expression and right angle scatter. A second gate included CD19+ events and was used to analyze the expression of the other markers. Immunophenotyping showed an excess of B-lymphocytes (1.5 109/L) with bright expression of CD20 and CD22, restriction for the K light chain of surface immunoglobulins, and absence of CD5 Riociguat and CD10 (Figure ?(Figure1).1). At light microscopy, lymphocytes were not villous (not shown). Figure 1 Flow cytometry of peripheral blood lymphocytes. CD19-positive lymphocytes are CD5- (A), and CD20+ and CD22+ (B, C), B-lymphocytes show restriction for surface K light chain (D) and are CD10-negative (E). Negativity for CD5 is confirmed by the use of another … A whole body computed tomography showed splenomegaly (20 cm longitudinal axis), but no lymphoadenomegaly or signs of other organ involvement were found. The patient was referred to the Division of Hematology for further observation and underwent bone marrow evaluation (morphology by myeloaspirate specimens, trephine biopsy, flow cytometry, molecular biology assays and karyotype). Bone marrow trephines were fixed in Myelodec? reagent A (Bio-Optica) for two hours, decalcified in EDTA for two days, embedded in paraffin, and cut into 3 to 5 5 m sections. Morphological evaluations were performed on hematoxylin-eosin, Giemsa and Gordon-Sweet for reticulin-stained sections. Immunohistochemical stainings were performed using a peroxidase-based system including antibodies specific for: CD20, CD3, CD5, CD23, DBA44, bcl2, bcl6, and cyclin-D1 (DSC-6). The spleen was sectioned and fixed in buffered formalin. The bone marrow biopsy specimens showed a global cellularity of 50% with nodular-interstitial infiltration by Riociguat CD20+ and bcl2+ lymphocytes, which accounted for 15% of cellularity and was negative for CD5, CD23, bcl-6, cyclin-D1 and DBA44 (Figure ?(Figure22). Figure 2 Bone marrow histology. A hematoxilin and eosin-stained section showing a discrete lymphocytic infiltrate, composed of small B cells as highlighted by anti-CD20 immunostaining (B). Only a small percentage (fewer that 10%) of these cells are CD5-positive … Flow cytometry of bone marrow blood showed 16% lymphocytes which were positive for CD19, CD20, CD22, CD103 and surface K light chain, and negative for CD5, CD23, CD10, CD11c, CD25, and surface .