수고 많으십니다. lymphoma 조직학적 진단명 문의드립니다. 골수검사결과 아래로 확인되며, M9673/3Mantle cell lymphoma(includes all variants)이 맞는지 문의드립니다. CLINICAL INFORMATIONFever of unknown originPERIPHERAL BLOOD FINDINGSHb 9.3g/dL     WBC 18.85x10³/μL   PLT 370X10³/μL  Reticulocyte 2.64%RBC: Normocytic normochromic anemia     PolychromasiaWBC: Slightly increased in number     Atypical lymphoid cells 19%     Left-shifted maturationPLT: Normal in numberBONE MARROW FINDINGSDIFFERENTIAL COUNT (Total count: 500)     M : E ratio   1.8 : 1Myeloblasts                          0.4%  Monoblasts             0% Promyelocytes                          0%  Promonocytes           0% Myelocytes                             8%  Monocytes            0.4% Metamyelocytes                      12.4%  Immature monocytes     0% Band neutrophils                      10%  Eosinophils            1% Segmented neutrophils                  4%  Basophils              0% Pronormoblasts                       0.4%  Plasma cells         2.2% Basophilic normoblasts                 2%  Histiocytes            1% Polychromatophilic normoblasts      10.4%  Mast cells             0% Orthochromic normoblasts             7.6%  Metastatic cells       0% Lymphoblasts                           0%  Immature cells                         0%  Atypical lymphoid cells             34.2%  Lymphocytes                            6%  BM ASPIRATION (LEFT)The bone marrow aspirate shows good quality.The estimated M:E ratio is 1.8:1.Atypical lmyphoid cells are counted up to 34.2% of total nucleated cells.Erythropoietic cells are observed.Granulopoietic cells are obesrved.Megakaryocytes are frequently observed.Iron stain: normal storage iron (Grade 2+/6)BM BIOPSY (LEFT)The biopsy section is good quality.The cellularity is 20%-30% which is normocellular for age.Atypical lymphoid aggregates are scattered.Erythropoiesis is observed.Granulopoiesis is observed.Megakaryocytes are increased in number (8-12/HPF).Plasma cells and eosinophils are unremarkable.Fibrosis are not present.Immunohistochemical StainCD34: not increasedCD117: not increasedCD61: increased in numberCD3: normal distributionCD5: positive on increased atypical lymphoid cells (interstitial)CD10: normal distributionCD20: positive on increased atypical lymphoid cells (interstitial)CD23: normal distributionCyclin D1: weak positive on some atypical lymphoid cellsMPO: normal distributionRelated StudyLeukemia/Lymphoma immunophenotyping: Leukemic manifestation of CD5 positive lymphomaChromosome study: PendingIGH/CCND1 rearrangement FISH: Negative (0/500 : 0%)IGH/CCND1 atypical signal FISH: Positive (56/500 : 11.2%)Specimen Quality (1: Good, 2: Acceptable, 3: Poor)BM23-0058   Aspirate : 1   Biopsy : 1CONCLUSION ========================================Normocellular Marrow with Interstitial Infiltration of Lymphoid AggregatesBone Marrow Involvement of CD5-positive Mature B-cell Neoplasm (Suggestive of Leukemic Non-Nodal Mantle Cell Lymphoma)
''suggestive' 용어는 의사에 판단에 따라 다르게 사용되므로 최종적으로 Mantle zone lymphoma 진단이 맞다면 M9673/3로 암등록합니다.