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Case Reports in Hematology
Volume 2014, Article ID 145129, 7 pages
http://dx.doi.org/10.1155/2014/145129
Case Report

A Rare Presentation of In Situ Mantle Cell Lymphoma and Follicular Lymphoma: A Case Report and Review of the Literature

1Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, University of Arizona, USA
2Department of Medicine, University of Arizona, USA
3Department of Pathology, University of Arizona, USA

Received 7 September 2014; Revised 17 October 2014; Accepted 17 October 2014; Published 16 November 2014

Academic Editor: Sotirios G. Papageorgiou

Copyright © 2014 Josephine Taverna et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 65-year-old gentleman presented with left groin swelling over the course of two months. Physical exam revealed nontender left inguinal adenopathy, and computed tomography scans detected multiple lymph nodes in the mesenteric, aortocaval, and right common iliac regions. An excisional lymph node biopsy was performed. Pathologic evaluation demonstrated follicular center site which stained positive for PAX5, CD20, CD10, Bcl-2, Bcl-6, and mantle zone cells. These findings demonstrated CCND1 and CD5 positivity, suggesting composite lymphoma comprising follicular lymphoma (FL) with in situ mantle cell lymphoma (MCLIS). FL is known as indolent non-Hodgkin lymphoma; however, the clinical significance of a coexisting MCLIS continues to be elusive, and optimal management of these patients remains largely unknown. This case illustrates the diagnostic and therapeutic challenges of composite lymphomas. This paper also discusses advances in molecular pathogenesis and lymphoma genomics which offer novel insights into these rare diseases.